Ortho Oracle - orthopaedic operative atlas

Q waves: Discussion

* Normally found in leads: I, AVL, V6, (V5);  – Normal if < 1/2 mm wide or < 0.025 sec;  – Do to Septal depolarization;  – Ignore Q waves in AVR; * Pathologic Q waves:  – Abnormal in V2, V3;  – Greater than 0.03-0.04 sec and/or 1/4 R wave; * Transmural MI: Q waves seen … Read more

Function After TKR

See: Physical Therapy after TKR and Work Up of Painful TKR – Discussion:     – Quadriceps:            – references:                   – Dynamic electromyography after cruciate-retaining total knee arthroplasty revealed a threefold quadriceps demand compared with the contralateral normal knee                  – Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee … Read more

Pulmonary Artery Catheter: Swan Ganz Catheters

     Afterload      Cardiac Output      Catheter Description      Central Lines      Central Venous Pressure      Heart Rate      Indications      Interpretation      Internal Jugular Veins      Mixed Venous O2      Preload      Respiratory Failure      Subclavian Vein Approach      Systemic Vascular Resistance … Read more

Pull Thru Technique for FDP Reinsertion

– Discussion:     – in the case of FDP laceration, if cut is less than 1 cm from insertion, consider tendon advancement and reinsertion;     – raise osteo-periosteal flap in distal phalanx, which is just distal to volar plate;           – damage to the volar plate may lead to … Read more

Pubic Ramus Fracture

– Discussion:       – note potential for bleeding: (corona mortis)                – references:                        – Stable fracture of the pubic rami: a rare cause of life-threatening bleeding from the inferior epigastric artery managed with transcatheter embolization                        – Life-threatening bleeding from the pubic branch of the inferior epigastric artery after pubic ramus fracture                        – … Read more

Puncture of Shoulder Joint & Subacromial Bursa

– Puncture of Shoulder Joint:     – posterior approach gives easy access to glenohumeral joint & avoids risk of damaging brachial plexus or cephalic vein;     – pt should be seated & entire shoulder, both anterior & posterior, should be prepped and draped;     – palpate most lateral edge of the acromion … Read more

Pulmonary Contussion

– See: Cardiac Contussion:  – primary complication is comprimised oxygenation;  – due to intersitial hemorrhage with alveolar collapse and alveolar flooding  – shunting, results in hypoxia that is relatively refractory to enhanced inspiratory oxygen concentration;  – pulmonary contusions are usually quite localized;  – Management:  – PEEP and continuous positive airway pressure   – over-agressive diuresis or … Read more

Pulmonary capillary wedge pressure

– Normal = 6 – 12 mm Hg; (Swan Ganz)  – in absence of pulmonary HTN, > 10 cm PEEP, or mitral valve dz, it reflects left atrial Pressure (Preload), and is measured after inflation of the balloon, which allows the tip of the catheter to wedge in a capillary;  – in absence of obstruction … Read more

Psuedohyponatremia: Criteria

a) Demonstrating a normal serum osmolality in the presence of hyperlipidemia or hyperproteinemia;  b) Demonstrating a significant ( >10 mmol/kg) osmolar gap, indicating the presence of additional osmotically active solutes, which can falsely lower the serum sodium level;  This is done by having the lab measure serum osmolality