Medical Malpractice Insurance for orthopaedic surgeons

Diabetic Skeletal Muscle Necrosis

– Discussion: (tumoriform focal muscular degeneration);      – poorly defined process which occurs in long term diabetics;      – other names for this syndrome include: tumoriform focal muscular degeneration and idiopathic diabetic muscle infarction;      – may be confused w/ sarcoma, deep infection, or even a compartment syndrome (the mass may be … Read more

DVT (Deep Venous Thrombosis) – Diagnosis

Clinical signs Clinical signs are unreliable but should not be ignored Calf tenderness, swelling, fever, and increased pulse rate may be present Work up for DVT arterial blood gas/pulse oximetry coagulation labs (for HCT & platelet count) prothrombin time (PT)/partial thromboplastin time (PTT) fibrinogen CBC EKG and CXR (if PE is suspected) D-dimer level below … Read more

Dexamethasone/Decadron

– See: Steroids – Cerebral Edema:     – 10mg IV initially, followed by 4mg IV/IM q6hr;     – expect response in 12 to 24 hrs and dosage may be reduced after 2 to 4 days, and gradually discontinued after 5 to 7 days; – Acute Allergic Rxn: Decadron Phosphate injection: 4 mg/ml   … Read more

Dexter Stables

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Dextran 40

low mol. wt. dextran; – adjunct in peripheral vascular surgery; works by expanding plasma volume and decrease blood viscosity; prophylaxis of DVT and thromboembolism: 10 ml/kg IV on day of surgery followed by 500 ml IV daily for 2-3 days; then 500ml IV every 2-3 days based on patient risk factors for thromboembolism for up … Read more

DEXTROMETHORPHAN (MEDIQUELL, BENYLIN DM)

– for cough associatted with cold or other bronchial irriations;  – Adult: 10-20 mg PO q4hr prn;  – Peds: 1-2 mg/kg/24hr divided tid/qid;  – Supplied: Chewy squares 15mg; lozenges 5 mg; syrup 15 mg/5ml, 5mg/5ml, 10mg/5ml, 7.5 mg/5ml; liquid, sustained action 30 mg/5ml

Examination of the Diabetic Foot

– neurological exam for the neuropathic charcot foot:       – in exam of the diabetic foot note the neurologic findings are usually distal, symmetrical, and sensory;        – absent or diminished tendon reflexes are characteristic findings;        – ankle jerk is mainly affected and is absent 4 times > knee jerk;        – diminution or … Read more

Determination of RATE

300 150 100 75 60 50 250 136 94 71 214 125 88 68 187 115 83 65 Atrial: 60 – 100 167 107 79 62 Junct : 50 – 60 Vent : 30 – 40

Development of Atlas

– See: atlas: – Body:     – not ossified at birth     – center (occassionally 2 centers) appears during 1st year after birth;            – anterior ring of atlas remains unossified in infants (younger than 1 year) but progressively ossifies and enlarges through age 6-9 years;     – … Read more