SCI
Paradoxical breathing - Upper chest collapses during inspiration and belly rises excessively
Patient presents with crescent shaped area of blood clot on Brain CT scan. Whats the possible diagnosis ?
Subdural hematoma
What is autonomic storming
increased BP, fever, Tachycardia (>130), RR >40, pupillary dilation, diaphoresis, and extension posturing. Common with TBI
What are the emergencies/crisis that could occur due to sickle cell and why
Acute Chest Syndrome - Chest pain fever cough respiratory distress
Splenic Sequestration - sickle Blood cells stuck in spleen. LUQ, Tachy and Hypotension (LEFT SHOUDLER?)
Priapism - obstruction of blood flow in erectile tissue.
Aplastic crisis - Bone marrow stops producing blood cells --> anemia
+ANA, -ANA, HLA B27
Oligoarthritis impacts <5 joints, muscle atrophy, must rule out infection, cancer, lyme
1 - Non-Blanchable erythema of intact skin
2 - Partial thickness skin loss involving epidermis and or dermis. Ulcer is superficial and presents like na abrasion, blister or shallow crater
3 - Full thickness skin loss involving damage or necrosis of subcutaneous tissue
4 - Full thickness loss with destruction of muscle bone or supporting structures
What impacts treatment more than ICP, what is its normal level.
CPP 70-90. <70 stop treatment
Leukemia will presents with: Anemia, Thrombocytopenia, increased WBC, Pallor, Bleedining, Petechiae, Hepatomegaly, Splenomegaly
Lymphoma will only talk about involving different lymphoma tissue cells (Sternberg from lymphocytes T&B etc)
Why do many people with hemophillia need joint replacements
Becuase they have excessive blood in the area leading to destruction of cartilage, loss of joint space, bony overgrowth, and subchondral osteolysis.
Becuase the inflammatory response triggers pannus formation which is destructive in nature leading to epiphyseal damage and premature epiphyseal closure (sometimes asymmetrical)
What levels assists with cough?
Abdominals T6-L1
Intercostals T1-11
Quadratus lumborum - T12-L4
Serratus Posterior inferior T9-T12
(LOT OF THORACIC T1 on)
What is considered a mild, moderate, or severe TBI on the Glasgow coma scale
Mild - 13-15
Moderate - 9-12
Severe - 3-8
What disorder leads to small areas of hyperaeration and atelactasis next to each other in the lung leadign to a honey comb pattern on Xray. How do we treat as PT.
CF - Airway clearance techniques, Bronchodilaters before then antibiotics, teaching coughing and huffing,postural drainage, percussion, breathing exercises, cardiovascular training, postural awareness, UE and trunk strength
What is the treatment for Sickle cell crisis
PT: Heat, Tens, E-Stim, gentle stretching, hydrotherapy, body weight exercises, light intensity, breathing exercises, NO HIGH ALTITUDES
What is the physiology of GBS
Immune system (Macrophages and T Cells) attack myelin sheath. Myelin allows for conduction via saltatory propataion. Damage = slow conduction.
Describe the levels of ambulation for (Hard one sorry.)
T4-T6
T9-T12
L1-L4
L4-5,
S1 below
T4-T6 - Standing frame or RGO
T9-T12 - Household with B KAFO and AD
L1-L4 - Functional ambulation may need KAGO or AFO
L4-L5 - AFO (if no gastroc innervation)
S1 and below - depends on weakness.
What is cushings triad and what is that a sign of
Bradycardia, Systolic hypertension (Widening pulse pressure), and irregular respiration --> Increased ICP
What is the criteria for diagnosing pots
HR >30 0r 40 within 10 minutes of standing (Focus on LE to enhance venous return and core strengthing for postural control.)
double question (Sorry) 1. What are the most common joints affected by hemophillia? 2. how do you treat hemophillia A vs Hemophillia B (Christmas disease)
1. Hinge joints (Knee, Elbow, Ankle)
2. Hemophillia A - Factor a, Hemophillia B - Factor 9
What is the treatment in the acute phase of GBS
Low resistance and avoid antigravity movmeent until MMT is at least 3/5, frequent rest, based on patient tolerance.
What is a pivotal functional advantage at a C6 SCI
Stability and power of the shoulder girdle in addition to wrist extension with tendonesis grasp.
(Can achieve independence with sliding board to level surface, indepednet pressure relief with lateral or foward lean, males can be indepdent with bladder)
Describe the Ranchos levels (or write them on the board)
1 - No response, total
2 - Generalized, Total
3 - Localized, Total
4 - Agitated confused, max
5 - Inappropriate confused, max
6 - Appropriate confused, Mod
7 - Automatic, appropriate, min
8 - Purposeful, appropriate, stand by
What levels are high with Heterotopic Ossificans (HO).
Alkaline Phosphatase
What types of exercises are beneficial for patients with hemophillia
What are important things to invlude in screening for JIA
Active screen, functional movement, temperature (systemic), palpation, effusion measurement, postural for joint deformities. Watch for AA instability.