Spinal Cord Injury

Common to highly educated person

Common in July

Cause: vehicular accident, violence, sports related injuries  eg diving

Areflexia- absence of reflexes after injury

stroke

-sudden neuro deficit

Diagnosis: Right CVA – left hemapheresis

                   Left CVA – Right hemapheresis

40% - thrombotic

30% -embolic

          Lacunar

           Hemorrhagic – devastating

*prone to depression

*prevent depression – family support

2 common cause in depression

1.       Acquired

2.       Side effects of drugs

Stages of Recovery:

1.       Flaccidity

2.       Spasticity begin

3.       Spasticity continues

4.       Peak spasticity 

5.       Spasticity declines

6.       Spasticity disappear – normal recovery

Risk Factors:

Lifestyle, obesity, diabetes mellitus, increase serum cholesterol, age, black people

Management:

1.       Drug – anti – coagulant (heparin)

2.       Carotid endarterectomy – surgical removal of plaques ; side effects – alzheimer’s disease

Bacillar artery affected = death

Pontine artery affected = doll’s eye phenomenon (oculo cephalic reflex)

Complication: immobility, contractures, sexual dysfunction

**prevent footdrop contractures – wear high tennis shoes

HERBAL MEDS

Chamomile

Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. C

Mnemonics 01

MI management: MONA
Morphine
O2
Nitroglycerine
Aspirin

HYPOGLYCEMIA: TIRED
T Tired
I Irritability
R Restless
E Excessive hunger
D Diaphoresis-Depression

HEART MURMURS: SPASM
S Stenosis
P Partial obstruction
A Aneurysms
S Septal defect
M Mitral regurgitation

Hyperthyroidism (s/s)
THYROIDISM
Tremor
Heart rate up
Yawning (fatigueability)
Restlessness
Oligomenorrhea & amenorrhea
Intolerance to heat
Diarrhea
Irritability
Sweating
Muscle wasting & weight loss

Miotic: Little word=Little pupil
Mydriatic: Big word=Big pupil

Anticholingergics Side Effects:
Can't see
Can't pee
Can't spit
Can't sh*t

5W's of common causes of post-op fever

Wind (think pneumonia, splinting, incentive spirometer exercises not done, DB+ coughing not done)
Water (dehydration...)
Wound (infection, dehiscence...)
Walking (PE...)
Wonder drug (approriate antibiotic...)

Cranial Nerves

Oh Olfactory Some
Oh Optic Say
Oh Oculomotor Marry
To Trochlear Money
Touch Trigeminal But
And Abducens My
Feel Facial Brother
Virgin Vestibulocochlear Says
Girl's Glossopharangeal Big
Violins Vagus Breasts
Ah Accessory Mean
Heaven Hypoglossal More

For the third column, S stands for sensory, M for motor, and B is both. Also, you have one nose, so Olfactory is CNI, two eyes, so optic is CNII. To remember which order the As come in, ABducens comes before ACcessory alphabetically.

Acute Pancreatitis: I GET SMASHED

I - idiopathic
G - gallstone
E - EtOH
T - trauma
S - steroids
M - mumps (paramyxovirus) and other viruses (EBV, CMV)
A - autoimmune
S - scorpion sting / snake bite
H - hypercalcemia, hyperlipidemia and hypothermia
E - ERCP
D - drugs, duodenal ulcers

To apply a telemetry monitor:
White over right (top right shoulder)
Black beside the white (Over lt shoulder)
Checkers (red below the black)
Christmas (Green beside the red)
Then ofcourse, the brown will be in the middle!

The HYPERKALEMIA "Machine" - Causes of Increased Serum K+
M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, hemolysis
I - Intake - Excesssive
N - Nephrons, renal failure
E - Excretion - Impaired


Signs and Symptoms of Increased Serum K+: MURDER
M - Muscle weakness
U - Urine, oliguria, anuria
R- Respiratory distress
D - Decreased cardiac contractility
E - ECG changes
R - Reflexes, hyperreflexia, or areflexia (flaccid)

HYPERNATREMIA
"You Are Fried"

F - Fever (low grade), flushed skin
R - Restless (irritable)
I - Increased fluid retention and increased BP
E - Edema (peripheral and pitting)
D - Decreased urinary output, dry mouth


"CATS" of "HYPOCALCEMIA"

C - Convulsions
A- Arrhythmias
T - Tetany
S - Spasms and stridor

CDC ISOLATION

SAFE WORK PRACTICES

• Keep hands away from face
• Work from clean to dirty
• Limit surfaces touched
• Change when torn or heavily contaminated
• Perform hand hygiene

DISEASES THAT NEED DROPLET ISOLATION:

"DROPLETISMM"

• Diptheria
• Rubella
• Oral (mumps, strep, paryngitis)
• Pertussis
• Legionnaire’s
• Erythema infectiousum, Epiglottitis (Hemaphilus influenza type B)
• Tonsillitis
• Influenza
• Scarlet fever
• Meningitis
• Mycoplasma pneumonia

DISEASES THAT NEED CONTACT PRECAUTION:

• Major drainages
• Bronchiolitis C. difficile (gastroenteritis)
• Congenital Rubella
• Cutaneous diphtheria
• Hepa A (diapered or incontinent patient)
• Herpes zoster (+ airborne)
• Herpes simplex
• Impetigo
• Pediculosis
• Multi-drug resistant organism infection ( MRSA, VRE, VISA, ESBL)
• Eczema
• Scabies
• Major pressure ulcer

DISEASES THAT NEED AIRBORNE PRECAUTION:

• Measles
• SARS
• Smallpox
• Tuberculosis
• Varicella zoster
• Pulmonary / laryngeal diseases