#Long_case
#pripheral vascular occlusive disease
Checklist for history
• Character of the pain, severity aggravating and
relieving factors
• Claudication distance
• History of sudden onset or gradual onset
• History of smoking
• History of diabetes mellitus
• History of cardiac illness
Ex في الشيت

History topics :
🏷️ Abdominal pain / abdominal distention / masses
🏷️ Bleeding ( upper GI / hematuria /epistaxis )
🏷️ Ulcers / LL oedema+ leg pain / varicose vein
🏷️ Swelling ( breast / groin / scrotum / goiter .. etc )
🏷️ Dysphagia / dysuria / kidney stone / infertility / urine retention / fistula
🏷️ Post operative history
🏷️ Ano-rectal pain
🏷️ Change in bowel habit
🏷️ Back pain / joint pain
#clinic

💫💎EXTERNAL FIXATORS💎💫

💎Examination💎
You may be shown a patient who is having an external fixator in situ and asked to comment. Be prepared to discuss the indications, advantages and complications of external fixators.
1. Identify the type of external fixator.
2. Comment on the bones involved and the probable fracture site.
3. Look for shortening of the affected limb, areas of bony loss,
wounds and skin grafted sites.
4. Look for pin site infection.
5. Offer to assess the joint stiffness.

💎Presentation💎

This patient is having a unilateral frame type external fixator on the left
lower limb probably due to underlying fracture shaft of the tibia. There is
an area of bony loss in the middle of the shaft of the left tibia but no
apparent shortening of the left leg. There is a superficial ulcer with
healthy granulation tissue over the fracture site which is ready for skin
grafting. No sign of pin site infection and he can move the affected lower
limb without any pain.

💎Flashcards💎
1. Type of EF.
2. Bones involved.
3. Fracture site.
4. Shortening of the affected limb? Bony loss? Skin grafts?
5. Pin site infection?
6. Joint stiffness?

💎FAQs💎

Q1. What are the main two types of external fixators (EF)?

1. Unilateral frame.
2. Cylindrical frame (Llizarov).

Q2. What is unilateral frame?

Screw threaded half pins are inserted from one side of the bone and they are
anchored to a rigid external bar.

Q3. What is Llizarov frame?

Thin transfixation wires are inserted through the bone and they are attached
to fixator rings which are interconnected by longitudinal metal rods.

Q4. What are the types of internal fixators (IF) you know of?

1. Plate& Screws.
2. Intramedullary nails (K nails).
3. Compression screw plates.

Q5. What are the indications for external fixators?

1. For severe open fractures in tibia (Gustilo 3b,3c).
2. For open fractures with bony loss.
3. For closed fractures with severe soft tissue injury.
4. For compartment syndrome after fasciotomy.
5. As an adjunct to internal fixation.
6. For unstable pelvic fractures (in damage control surgery).
7. For limb lengthening & bone transport.

Q6. What are the advantages of EF over POP?

1. More comfortable.
2. Early Mobilization possible.
3. Less joint stiffness & DVT risk.
4. Allow management of other injuries/ wounds.
5. Allow skin grafting.

Q7. What are the advantages of EF over IF?

1. Can use in open or infected fractures.
2. Less expensive.
3. Need less expertise.

Q8. What are the complications of EF?

1. Pin site infection.
2. Pin loosening.
3. Non union.
4. Neurovascular damage.
5. Chronic pain.
6. Joint stiffness.

💎Pictures 💎

M'd نقلا عن


لجنة جت في امتحانات سابقة
Dx / ex

#clinic

⚔🪚Amputation⚔ 🪚

💎Examination💎

You may be given a patient with peripheral vascular disease (PVD) who is having an amputated limb, with or without gangrenous toes. Remember to examine the both lower limbs, especially assess the peripheral pulses of the non-amputated limb which could be vital, but easily forgotten.

1. Examine the amputation stump first.
a. Describe the anatomical level of amputation.
b. Comment on the skin wound. Healed completely?
c. Ask the patient to flex and extend the knee in a below knee
amputation ( to exolude fixed flexion deformity).
d. Move the skin over the stump and check whether it is
freely movable.

2. Look for the scars of previous vascular bypass surgeries. Scars
may be in the abdomen!
3. Examine the peripheral pulses of the affected limb. Comment on
the presence or absence of pulse and the pulse volume.
4. Examine the contralateral limb.
a. Carefully examine toes (Toe amputations, Gangrenous
toes, Ischemic Ulcers).
b. Feel the skin temperature.
c. Check the capillary refilling time (CRFT).
d. Examine all peripheral pulses (femoral, popliteal, posterior
tibial & dorsalis pedis) and comment on pulse volume.
e. Perform Buerger's test. (Lift the straightened leg up while
patient is lying flat on the bed, and look for colour change
the leg to white as the perfusion drops. Then ask to
lower the leg over the side of the bed and look for reactive
hyperaemia).
f. Auscultate for a femoral bruit.
5. Look for nicotine stains in the right hand.
6. Examine/ offer to examine comorbidities associated with PVD.
a. Carotid bruit.
b. Deviated heaving apex.
c. Pulsatile epigastric lump (Abdominal Aortic Aneurism).

⚡️⚡️Presentation⚡️⚡️

The left lower limb of the patient is amputated at below knee level and the skin wound is completely healed. The skin over the amputation stump is
freely movable and there is no fixed flexion deformity.
There are no scars suggestive of previous vascular bypass surgeries.
Both femoral pulses are felt and good in volume, but distal pulses are weak in the contralateral limb. There are no partial amputations,
gangrenous toes or ischemic ulcerations of the right lower limb. The peripheries are warm and capillary refilling time is less than 2 seconds.
Beurger's test is negative. There are no femoral or carotid bruits, no
nicotine stains, pulsatile epigastric lumps and the apex beat in the normal position and it is normal in character.

💫Flashcards💫

1. Amputation stump.
a. Anatomical level of amputatio.
b. Skin wound healed?
c. Exclude fixed flexion deformity (in below knee).
d. Skin freely movable?
2. Scars of previous vascular bypass surgeries?
3. Pulses of the affected limb.
4. Contralateral limb.
a. Toes (lschemic Ulcers, Gangrenous toes, Toe
amputations).
b. Skin temperature.
c. CRFT
d. Examine all peripheral pulses & comment on pulse volume.
e. Perform Buerger's test.
f.Auscultate for a femoral bruit.
5. Nicotine stains?
6. Comorbidities associated with PVD.
a. Carotid bruit?
b. Deviated heaving apex?
c. Pulsatile epigastric lump (AAA)?

💦FAQS 💦
Q1. What are the Indications for amputation?

1. Dead- Dry gangrene.
2. Deadly- Wet gangrene, Spreading cellulitis, Osteomyelitis, Trauma.
3. Dead loss - Paralysis.

Q2. What are the levels of amputation of lower limb?

1. Partial toe amputation.
2. Toe disarticulation.
3. Partial foot (Ray) amputation.
4. Trans-metatarsal amputation.
5. Ankle disarticulation (Syme's).
6. Trans-tibial (Below knee) amputation.
7. Trans-femoral (Above knee) amputation.
8. Hip disarticulation.

Q3. What are the specific
complications of amputation?

1. Haematoma formation & wound dehiscence.
2. Phantom Limb Pain.
3. Osteomyelitis.
4. Stump ulceration.
5. Stump neuroma & osteophytes formation.
6. Psychological disturbances.

Q4. What is "Gangrene"?

It is the tissue death due to persistent ischemia.

Q5. What is "Dry gangrene"?

It is a hard, shrunken, non-infected patch of gangrene with a clear line of demarcation.

Q6. What is "Wet gangrene'?

It is a soft, swollen, infected patch of gangrene without a clear line of
demarcation.

#clinic

حَسْبِيَ اللَّهُ لَا إِلَهَ إِلَّا هُوَ، عَلَيْهِ تَوَكَّلْتُ
وَهُوَ رَبُّ الْعَرْشِ الْعَظِيمِ.

من قالها حين يصبح وحين يمسي ٧مرات
كفاه الله ما أهمه من أمر الدنيا والآخرة.💙

"إذا كثرت عليك الدعوات، ولم تمسك منها شيئاً، فعليك بهذا الدعاء العظيم:
‏(يا حي يا قيوم برحمتك أستغيث أصلح لي شأني كله، ولا تكلني إلى نفسي طرفة عين)
‏فإنه إذا تولى الله أمرك، فتحت كل أبواب الخير أمامك"❤

PDF ENT Dr Nurreden alrazgi
الدكتور وصّى ان ينزل للطلبة
منهج وصور
اللهم قد بلّغت
موفقين دكاترة وابعتوه لبعض ♥️

#ENT ⬆️⬆️