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Terms in this set (80)
What is the max dose of acetaminophen?
3.5 grams a day
What is the benefit of prescribing Celebrex?
it is an NSAID that cuases less GI upset
What is the prescription for Percocet?
Percocet 5/325mg (oxycodone/acetaminophen)
1 tab po q 4-6 hrs prn pain
What is the prescription for ibuprofen?
1 tab po q 8hrs with food prn pain
What is the prescription for Norco?
Norco 5/325mg (hydrocodone/acetaminophen)
1 tab po q 4-6 hrs prn pain
If a patient has an allergy to codeine, what is an alternative pain medication?
What is the prescription for Tramadol?
1 tab po q 4-6hrs prn pain
What can you prescribe for a patient with opioid induced constipation?
What is the prescription for docusate?
1 tab po qhs (qhs- before bed)
What can you prescribe for a patient who is experiencing post op nausea and vomiting?
1 tab po q 6 hrs prn nauzea/vomiting
What can you prescribe a patient for post op DVT prophylaxis?
1 injection q day
What can you do for a patient who has chronic plantar fasciitis, who is not responding to conservative treatment? Describe it.
Topaz procedure- radio frequency waves that gently cause microscopic trauma to scar tissue inducing acute healing to area (80% success rate)
What is the normal range for HIPA?
What is the normal range for DASA?
What is the normal range for PASA?
What is the normal range for HAA?
What is the normal MAA for a rectus foot?
What is the normal MAA for an Adductus foot?
>/= 15 degrees
What is the normal range IMA for a rectus foot?
What is the normal range IMA for an adductus foot?
What is the normal tibial sesamoid position?
How do you find the total adductus angle?
TAA= MAA + IMA
When choosing to do a bunion procedure, what angles do you go off of for a rectus and an adductus foot type?
What are the general rules for choosing locations of bunion procedures based on IMAs for a rectus foot?
<10 degrees = soft tissue procedure
10-15 degrees = head
15-20 degrees = head or base
>20 degrees = base
What are the general rules for choosing locations of bunion procedures based on TAAs for an adductus foot?
<20 degrees = soft tissue procedure
20-25 degrees = head
25-30 degrees = head or base
>30 degrees = base
What is a functional PASA?
When the PASA = IMA
What is a dysfunctional PASA? What does that mean for your bunion procedure?
When PASA > IMA
*need to subtract the PASA from the proposed IM angle
Describe the difference between a structural and a positional deformity using lateral deviation of the hallux as an example.
-Structural: PASA + DASA = HAA
-Positional: abnormal HAA & normal PASA and DASA
What are examples of structural deformities of the hallux?
What are examples of structural deformities of the metatarsals?
What is the normal IM angle between the 4th and 5th mets?
What information is included in a CBC?
-white blood cells
What is the normal dose for Vancomycin perioperatively?
1-1.5 grams IV
What is the rule of thumb for the use of a tourniquet for surgery that is going over 2 hours?
deflate for 5 min for every 30 minutes of surgery over 2 hours
What is the genetic marker for CMT?
What size screw would you use on a chevron bunionectomy?
What size screw would you use for a lapidus?
What size screw would you use for an Aiken?
What are the steps to lag by design?
-Drill- under drill or over
-Drill- over drill or under
What is found in a urine analysis in a UTI?
nitrites and leukocyte esterase
What is the Kalish modification?
long dorsal arm of an Austin bunionectomy
What are the steps of a PIPJ arthrodesis?
-incision from DIPJ to neck of metatarsal
-Dissect down to the long extensor tendon
-Extend plane of dissection between the superficial fascia and the deep fascia from the PIPJ to the MTPJ
-Transect tendon at the level of the PIPJ
-Dis-articulate the PIPJ by transecting the joint capsule dorsally and med. and lat. and get the collateral ligaments
-Reflect the extensor tendon and collateral ligaments to expose the head of the proximal phalanx
-remove the head of the proximal phalanx with saw or straight-edge bone cutting forceps
-Remove articular cartilage and subchondral bone from base of middle phalanx
-Check deformity correction with Kelikian pushup test
-If contracture of the extensor tendon exists then a Z-plasty may be done
-If residual deformity still exists a plantar plate release may need to be done
-tendons approximated in corrected position
-close in layers
-WB in post op shoe, pin out in 6 weeks
What are the steps to an Austin bunionectomy?
-Dissect down to identify EHL and capsularis
-Cut to bone between EHL and capsularis and into the MTPJ
-Dissect off periosteum from met head and neck
-Release the medial collateral ligaments
-Remove medial eminence
-Make cut (traditionally 60 degrees)
-Remove medial overhang
-Close in layers
What are the steps to a head Taylor's bunionectomy?
-Retract extensor tendons
-Dissect of periosteum from met head and neck
-Release lateral collateral ligaments
-Remove eminence/Perform osteotomy
-Remove lateral overhang
What are the steps to a Lapidus?
What are the steps for an Aiken?
What are the steps to a Weil osteotomy?
What are the steps to an Achilles repair?
Know how to do the Krackow stitch?
Know how to do a modified Kessler stitch?
How do you perform a Whip stitch?
How do you perform a modified Bunnell suture technique?
What are examples of joint sparing procedures for hallux limitus/rigidus?
-Youngswick modification of an Austin
Describe the Watermann osteotomy.
For hallux limitus/rigidus
Describe the Youngswick modification osteotomy.
Shortens 1st met and can plantarflex also
What are examples of joint destructive procedures for hallux limitus/rigidus?
-McKeever First metatarsal fusion
-Total or hemi implants
Describe a Keller arthroplasty.
What are the nerves targeted in a Mayo block?
-Medial dorsal cutaneous n.
-Medial plantar n.
-Deep peroneal n.
What are the nerves targeted in a Mini-mayo block?
-intermediate dorsal cutaneous n.
-lateral dorsal cutaneous n.
-lateral plantar n.
What are the nerves targeted in an ankle block?
-posterior tibial n.
-superficial peroneal n.
-deep peroneal n.
Know the dorsal innervation of the foot.
Know the plantar innervation of the foot.
What is the definition of delayed union?
a fracture or osteotomy that fails to heal clinically and radiographically in 3 months
What is the definition of nonunion?
9 months elapsed time with no healing progress for 3 months
What are the 4 AO principles?
What is an incisional biopsy?
What are the differential diagnosis for post op fever?
What are some soft tissue procedures for a bunion?
-McBride- lateral release
-Silver- shave off the medial eminence
-Adductor tendon transfer
What are some procedures you can do to shorten the hallux?
What are some bunion head/neck procedures?
What are some bunion shaft/base procedures?
-abductory base wedge
What is a juvara osteotomy?
What is a Mau osteotomy?
What are some procedures to elevate the 1st ray?
-dorsal closing wedge
What are some procedures to lower the 1st ray?
What are some procedures that shorten/decompress the metatarsal or joint?
Describe a Youngswick Austin osteotomy.
Describe a Green decompression osteotomy.
How do you take an ankle mortise xray?
internally rotated 15 degrees so malleoli are parallel to the cassette
What are examples of absorbable suture?
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