Nota Perubatan

Author: notaperubatan

  • Chorioamnionitis

    Features

    • Temperature ≥38 °C
    • Maternal tachycardia ≥120 bpm
    • Fetal tachycardia ≥160 bpm
    • Malodorous (foul-smelling liquor)
    • Uterine tenderness
    • Leucocytosis

  • Femoral Shaft Fracture

    Complications

    📒 Fat embolism syndrome
    📒 Hypovolaemic shock
    📒 Femoral nerve injury / pudendal nerve injury
    📒 Femoral artery injury
    📒 Delayed union / non-union

  • Nexus Criteria in Cervical Clearance

    Remember NSAID ❗️

    N: neurological deficit
    S: spine tenderness
    A: alertness & consciousness
    I: intoxication
    D: distracting injury

  • Wound

    Types of wound debridement

    • surgical
    • mechanical
    • enzymatic
    • autolytic
    • biological
    • Hydrosurgery debridement

  • Ortho Miscellaneous Notes

    Common injuries and associated nerve injuries

    1. Shoulder dislocation: axillary nerve
    2. Midshaft humerus: radial nerve
    3. Post K-wire supracondylar humerus: ulnar nerve
    4. Fracture of radial neck: posterior interosseous nerve, PIN
    5. Hip dislocation: Sciatic nerve
    6. Fibular neck fracture: common peroneal nerve

  • Tscherne Classification on Soft Tissue Injury for Closed Fracture

    Grade 0
    Minimal soft tissue damage, indirect violence, mild to moderate fracture

    Grade 1
    Superficial abrasion of contusion caused by pressure from within, mild to moderate fracture

    Grade 2
    Deep contamination abrasions associated with localised skin or muscle contusion, impending compartment syndrome, severe fracture

    Grade 3
    Extensive skin contusion or crushed, underlying severe muscle, decompensated compartment syndrome associated with major vascular injury, severe fracture

  • Tension Pneumothorax

    Miscellaneous

    Tracheal deviation is a late sign in tension pneumothorax. Don’t wait for tracheal deviation to diagnose tension pneumothorax.

  • Atrial Flutter

    ECG features

    • Saw-tooth baseline
    • Atrial rate 300 bpm
    • 2:1 AV conduction / 3 3:1 AV conduction
    • Variable / fixed conduction

    ECG example

  • Delirium

    Definition

    Clinical syndrome characterized by disturbed cognitive function, perception or consciousness, that has an acute onset and fluctuating course

    Types

    (i) Hyperactive: agitated, restless, distressed
    (ii) Hypoactive: drowsy, lethargy, unengaged, inattentive
    (iii) Mixed: alternates between hyperactive and hypoactive states

    Predisposing factors

    Remember ‘PINCH ME‘

    • Pain
    • Infection / cognitive impairment / intracranial problem
    • Nutrition
    • Constipation / urinary retention
    • Hydration / Hypoxia

    • Medication
    • Environment / Electrolyte imbalance / Extra device or restrain

    Symptoms

    • Confusion
    • Hallucination
    • Delusion
    • Changes in sleeping habits
    • Changes in personality
    • Changes in mood
    • Agitated
    • Quiet and withdrawn
    • Inattention

    Screening tool for delirium

    • CAM score
    • 4AT delirium assessment tool

    Management

    • Manage underlying medical illness
    • Treat the predisposing factors e.g. pain, constipation
    • Supportive care e.g. daily orientation, availability of caregiver / objects that are familiar to patient, help patient to mobilise
    • Prevent hospital acquired complications e.g. pressure sores, DVT

    The most important thing is to PREVENT delirium

    How to reduce risk of delirium?

    • Avoid pain
    • Avoid constipation
    • Bring glasses / hearing aids / dentures that patient usually used at home
    • Orient the patient throughout the day
    • Encourage patient to move / have physical activity
    • Bring familiar objects from home / familiar caregiver
    • Avoid sedatives

  • Low Back Pain

    History Taking

    Nature of patient

    • Age
      • Younger age e.g. ankylosing spondylitis
      • Older age e.g. lumbar stenosis, vertebral compression fracture
    • Social

    Low back pain description

    • Duration: acute <12 weeks; chronic >12 weeks
    • Radiation to:
      • Lower limbs (i.e. )
    • Triggering factor e.g. trauma, fall
    • Exacerbating factors
      • ]
    • Relieving factor
    • Timing

    Associated symptoms

    • Constitutional symptoms e.g. unexplained weight loss
    • (e.g. unable to pass urine for 1 – 2 days)
    • e.g. lower limb weakness

    Medical history

    • Comorbidities: ,
    • Recent / admission for

    Medication history

    • Corticosteroids

    Red Flags

    • Onset before 20 years or after 50 years
    • Pain >6 weeks
    • Worse at
    • Associated symptoms
      • Fever
      • Weight loss
      • New onset neurological symptoms e.g.
    • Associated with systemic illness
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