Surgery Flashcards
(52 cards)
Parkland formula
-kg x % of burn x 4 cc LRs
for babies used 4-6 ml/kg/% or can start with 20 ml/kg/hour
Topical tx for burns
default- silver sulfadiazine
deep penetrating burn- mafenide acetate
eyes- triple antibiotic formulation
snake bite tx
CROFAB if a crotalid, or specific antivenom if other
black widow spider bite sx and tx
sx: nausea, vomiting, and muscle cramps
tx: IV calcium gluconate
congenital dysplasia of the hip
dx:
tx:
dx: uneven gluteal folds, hips can be dislocated positeriorly, confirm with a sonogram
tx: splint with a pvlik harness or 6 months
SCFE
Sx:
Dx:
Tx:
Sx: chubby or lanky 13 years old boy, with groin pain, knee pain, or limp.
- when sitting the sole of the foot on the affected side points towards the other foot.
- as the hip is flexed the thigh goes into external rotation and cannot be internally rotated
Dx: X ray
Tx: pinning of the femoral head back in place
septic hip
Sx:
Dx:
Sx: toddlers have a febrile illness and won’t move their hip, hold it in flexion and external rotation
Dx: aspiration of the hip
Osgood-Schlatter disease
Sx: teenagers with pain right over the tibial tubercles, aggravated by contraction of their quads
Tx: RICE
-(if that doesn’t work immobilization with a cast can be used)
supracondylar fracture
Mechanism of injury:
Tx:
Mechanism of injury: hyperextension of the elbow in a child who falls on the hand with the arm extended
Tx: casting or traction, but also need to be closedly monitored due to the danger to the axillary artery and nerve
Anterior vs posterior dislocation of the shoulder
Mechanism:
Anterior- MC shoulder dislocation vs.
Posterior- Rare, occurs after a massive uncoordinated muscle contraction (like epileptic seizure or electrical burn)
Position at presentation:
Both: arm close to body
Anterior- arm externally rotated (like they are going to shake your hand)
Posterior- Arm internally rotated
XRays:
Anterior- AP and lateral
Posterior: Regular XRAYS can miss it, axillary views or scapular views are needed
Colle’s fracture
mechanism:
Sx:
Tx:
mechanism: fall on an outstretched hand (usually in an older woman with osteoporosis)
Sx: “Dinner fork” wrist
Tx: closed reduction
Fracture of the scaphoid
mechanism:
Dx:
Tx:
mechanism: fall on an outstretched hand
Dx: undisplaced fractures will not show up on Xray till 3 weeks later, dx on history and physical
-dysplaced fractures will show up and need internal fixation or risk avascular necrosis
Tx: thumb spica splint for undisplaced fractures
Metacarpal neck fracture
Mechanism:
Tx:
Mechanism: closed fist hits a hard surface
Tx: ulnar gutter splint
Position in a hip fracture vs posterior dislocation of the hip
Both: affected side looks shortened
Hip fracture- Leg externally rotated
Posterior dislocation- Leg internally rotated
Gas gangrene Tx
IV penicillin, surgical debridement, and possibly hyperbaric oxygen
trigger finger
Sx:
Tx:
Sx: acute finger flexion, unable to extend without using the other hand (results in a painful snap)
Tx: steroid injections
De Quervain tenosynovitis
Dx:
Tx:
think *new moms
dx: pain reproduced by holding thumb in a closed fist, and ulnar flexion of the wrist
tx: steroid injections are the most effective tx
Dupuytren contracture
contraction of palm of the hand
* think norwegians and alcoholics
morton’s neuroma
Sx:
Cause:
Sx: inflammation between third and forth toes
neuroma is palpable and tender to palpatation
cause: used of pointed high heels
Ulcer from arterial insufficiency vs venous statis
location:
appearance:
location:
arterial- as far from the heart as possible
venous- above the medial malleolus
appearance:
arterial- pale base, NO granulation tissue (new connective tissue and microvascular that forms on the surface of a wound during healing)
venous- edematous, hyperpigmented with granulating bed
osteogenic sarcoma
age:
location:
xray pattern:
age: 10-25
location: lower femur or upper tibia
xray: “sunburst”
Ewing sarcoma
age:
location:
xray pattern:
age:5-15
location: diaphyses of long bones
xray pattern: “onion skinning”
multiple myeloma
Sx:
Sx: fatigue, anemia, localized pain in specific places over many bones, bence jones protein in the urine
Hepatic risk factors for surgery
ABCDE
Ascitis Bilirubin Clotting (prothrombin time) Diet (low albumin) Encephalopathy (from ammonia)
