The Hip - book

Metacarpal Head Fractures

– See: MP joint injuries – Discussion:     – often badly comminuted;     – consider a short period of splinting followed by early active motion;     – this may mold the articular surface by using the soft tissue sleeve;     – early motion will also prevent joint stiffness, but loos of … Read more

Metacarpal Extra-articular Base Frx

– See: Extra-articular Thumb Metacarpal Fractures – Discussion:     – interosseous muscles & intrinsically strong carpometacarpal capsular and interosseous ligaments provide intrinsic stability to extra-articular fractures at the metacarpal bases;     – mechanism of frx of little CMC:           – stability of CMC joint derives from articulation w/ carpal … Read more

Metabolic Sequence: in Muscle Contraction and Relaxation

– Discussion:     – muscle contraction is initiated w/ release of ionic calcium, from terminal cisternae into the sarcoplasm;     – complexing of calcium by troponin shifts the protein conformations in thin filament & allows formation of crossbridges between actin &           myosin, which then moves the actin molecule up long axis of the myosin filament;     … Read more

Metabolic complications from TPN

* EFA deficiency: * Hyper Vitamin A & D; * Fluid Over Load: (See CHF) * Hypercholemic Metabolic Acidosis: from excessive Cl from IV or from amino acid solutions (as HCL salts – more common in children or patients w/ decrease renal f(x) ); * Hypercalcemia / Hypo Ca * Hypoglycemia:     May occassionally … Read more

Metabolic Bone Diseases

    Bone multicellular units     Calcium supplements     Calcitonin     Differential Dx     Estrogen:     HyperPTH / HypoPTH     HypoCa / HyperCa     Hypophosphatemic Vitamin D-resistant rickets     Hyperthyroidism     MSK Changes Associated w/ Steroids     Osteomalacia     Osteoporosis, Postmenopausal     Pagets Disease … Read more

Metabolic Alkalosis

See ABG  – Definition: primary increase HCO3.  – Must distinguish: Compensatory HCO3 incr vs. Primary Resp Acid  – the Resp response to Met. Alk may vary: pCO2 incr approx 0.6 : 1 HCO3. HCO3: 24 26 28 30 32 34 36 38 40 pCO2: 40.0 41.2 42.4 43.6 44.8 46.0 47.2 48.4 49.6  * if … Read more

Metabolic Acidosis: Diff Dx

– See ABG AG: Endogenous; AG: Exogenous Lactic Acid Aspirin Hypovolemia ketoacidosis Methanol DKA Starv. Uremia Renal Failure Rhabdomyolysis  – elevated CK, myoglobin ETOH Ethylene glycol Hyperaliment Dialysis Buffer TPN

Metabolic Acidosis

– See ABG  – See Diff Dx: Anion Gap / Non Anion Gap   – By definition: primary decrease HCO3 concentration.  – Simple Met acidosis, Stimulates Ventilation, Decreasing pCO2   – Base Deficit:          – indicator of blood loss, resuscitation, and mortality in trauma patients, and it is a more sensitive marker of hypovolemia than  vital signs;          … Read more

Merchant Technique

– Discussion:     – for evaluation of both the patella and trochlea surfaces of femur;     – disadvantages:           – this view does not necessarily predict which patients will show functional improvements w/ surgical realignment;           – as pointed out by O’Neil (1997) some patients … Read more

Meperidine/Demerol

– Adult: 50-150mg PO/IM/SQ q3-4hr prn Pain; (75mg IM Demerol =10mg Morphine) 1-2 mg/kg/dose PO/IM/IV (including Peds q 6 hr) – PO: peak effect at 2 hrs; – IM/IV: onset at 2-5 min; Peak at 1 hr; lasts 2-3 hrs. – IV administration must be slow in diluted solution; – Peds: 1 mg/kg/dose IV/IM q2-4hr;    1.0-1.5 mg/kg/dose … Read more