Orthopedic Essentials - Spinal Trauma and Spine Classification DENIS THREE COLUMN CONCEPT Anterior column: AAL: Anterior longitudinal ligament AAF: Anterior annulus fibrosus Middle column: PLL: Posterior longitudinal ligament PAF: Posterior annulus fibrosus Posterior column: SSL: Supraspinous ligament ISL: Interspinous ligament LF: Ligamentum flavum PC: Facet capsule DENIS CLASSIFICATION OF SPINAL TRAUMA: Compression Fracture, Burst Fracture, Chance Fracture MINOR INJURIES • Transverse process fracture • Articular process fracture • Par interarticularis fracture • Spinous process fracture Stable fractures: Don't cause spinal deformity or neurologic deficit, still able to weight bear Unstable fractures: Unable to weight bear, may progress and causing further neurological and structural damage. Criteria of unstable spine injury: • On palpation gap between 2 spinous processes increased • Neurological deficit • Vertebral compression >1/3 • Vertebral displacement >1/3 • Vertebral canal compromisation > 1/3 • Bilateral facet joints dislocation • According to Denis 3 columns concept: 2 columns disrupted TLICS: Thoracolumbar Injury Classification and Severity Score Morphology 0 No abnormality 1 Compression 2 + Burst fracture 3 Rotation/translation 4 Distraction Posterior Ligamentous complex (PLC) 0 Intact 2 Suspected / Indeterminate 3 Injured Neurological status 0 Intact 2 Root injury 2 Complete cord / conus medullaris injury 3 Incomplete cord / conus medullaris injury 3 Cauda equina Treatment TLICS <= 3: non-operative TLICS = 4: consider for operative or non-operative intervention TLICS >=5: operative #Spinal #Fracture #Trauma #Spine #Classification #Orthopedics #diagnosis #localization

Zones of the Neck - Landmarks and Anatomic Structures #Anatomy #Neck #Zones #III #Anatomic #Structures

Shock - Diagnosis and Management Summary • Hypotension: SBP<90, SBP drop >40, MAP<65 (Normotension, HTN possible w/ early shock state) • Tachycardia > 100 BPM • Oliguria • Altered Mental Status (SBP<60) • Elevated lactate • qSOFA/SOFA and SIRS 1) Prepare • Full Set of Vital Signs • Establish IV/IO Access - 2-large bore (18-gauge) peripheral IV's, Consider IL NS/LR infusion • Room Setup - Ultrasound, code cart in rom - Patient on monitor, telemetry, 12-Lead EKG • Ensure adequate support - Call appropriate code - Notify Seniors 2) Readily Reversibles 3) Stabilize and Survey 4) Workup 5) Analyze and Reverse • Obstructive Shock - Distended neck veins, dilated IVC - Cardiac >> Constrictive pericarditis, Pericardial Tamponade - Pulmonary >> Acute PE, Tension Pneumothorax • Hypovolemic Shock - Dry, Flat, collapsible IVC - Hemorrhagic >> Transfuse to Hgb>7 - Non-hemorrhagic >> Aggressive volume resuscitation • Cardiogenic Shock - MI, arrhythmia, valvulopathy - Diffuse crackles, elevated JVP, echo abnormalities - Cath lab? Terminate arrhythmia? Cardiac surgery? • Distributive Shock - Septic Aggressive IVF , ABX - Anaphylactic >> IM Epinephrine - Neurogenic >> Vasopressors, Inotropes - Adrenal Insufficiency >> Corticosteroids Dr. Michael Jones @Jonesy_MA #Shock #Diagnosis #Management #Summary #criticalcare #treatment #workup

Non-Invasive Positive Pressure Ventilation Indications: • COPD exacerbation (↓ intubation, ↓ mortality), Cardiogenic pulmonary edema (↓ mortality), Other causes of respiratory failure, DNI status, Extubation to NIPPV Contraindications: • Unresponsiveness/coma, Inability to trigger breath, Inability to protect airway / remove mask, Risk of emesis / copious secretions, Recent head/neck surgery Interfaces: Helmet, Full Face, Partial Face, Nasal Modes: • CPAP - Continuous positive airway pressure • s/T - Spontaneous Time (a.k.a BiLevel, BiPAP) • AVAPS - Adaptive volume assured pressure (a.k.a. NAPS) by Nick Mark MD @nickmmark #NIVPPV #NonInvasive #Positive #Pressure #Ventilation #diagnosis #management #indications #pulmonary #interfaces

The parasympathetic and sympathetic systems - Activation and inhibition pathways by organ system #Sympathetic #Parasympathetic #Systems #Pathways #Innervation #Receptors #Preganlionic #Postganglionic #Anatomy

Sweat gland tumors - Pathology Made with lots of help from @JMGardnerMD's paper on adnexal tumors for the surgical pathologist, https://doi.org/10.5858/arpa.2018-0189-RA Dr. Laura Brown https://twitter.com/lauraebrown #Sweat #gland #tumors #Pathology #Diagnosis

Coagulation Cascade - Anticoagulant Targets Here's the brief overview of where the main anticoagulants work on the cascade: - Warfarin - II, VII, IX, X (Protein C, Protein S) - Heparins - lla & Xa - Xa Inhibitors (-xaban's) - Xa - Dabigatran - lla Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Coagulation #Cascade #Anticoagulant #Targets #Anticoagulation #Pharmacology

Causes of Acute Liver Injury - Differential Diagnosis Hepatocellular - Liver Parenchyma • Infectious: Hepatitis C, A, E, B, D, EBV, CMV, HSV • Toxic: Alcohol, Medication, Recreational Drugs, Mushrooms • Hereditary: Hemochromatosis, Wilson's Disease, Alpha-1 Antitrypsin • Other: NAFLD, Autoimmune hepatitis, Acute biliary obstruction, HELLP Syndrome, Celiac Disease Hepatocellular - Vasculature • Hepatic Vein: Budd-Chiari, Congestion/CHF • Hepatic Artery: Shock Liver, Thrombus, Vasospasm Cholestatic - Intrahepatic • Obstructive: Malignancy, 1° PBC, 1° PSC, Cystic Fibrosis, Infiltrative Disease, Sickle Cell, VOD, GVHD • Toxic: Medication, Pregnancy, Alcoholic Hepatitis, TPN • Infectious: Sepsis, Viral Hepatitis, TB Cholestatic - Extrahepatic • Biliary: Choledocholithiasis, Stricture, Malignancy, Liver Fluke, Ascariasis, Choledochal Cyst • Pancreatic: Pancreatitis, Pancreatic Pseudocyst, Cancer - Sophia Hayes MD @Sophia_Hayes_MD #Liver #Injury #Differential #Diagnosis #Causes #Acute #algorithm #hepatology

Gastrointestinal Causes of Iron Deficiency Anemia • Mass lesions: Carcinoma, Large polyps • Inflammatory: Reflux esophagitis, Cameron lesions, Erosive gastritis, Gastric ulcer, Duodenal ulcer, SB or colon ulcer, Celiac sprue, Whipple's disease, Meckel's diverticulum, Idiopathic ulcers, Crohn's disease, Ulcerative colitis • Vascular: Vascular ectasia(s), Portal hypertensive lesions, Watermelon stomach, Hemangiomas, Blue rubber bleb nevus syndrome • Infectious and Miscellaneous: Hookworm, Hemoptysis, Epistaxis, Stronglyoidiasis , Amebiasis, Ascariasis, Tuberculous enterocolitis, Long-distance running, Factitious #Gastrointestinal #Iron #Deficiency #Anemia #Causes #differential #diagnosis

Pathways Involved in Protein and Amino Acid Metabolism in Chronic Kidney Disease. The tricarboxylic acid (TCA) cycle comprises a series of chemical reactions that can metabolize amino acids. Amino groups are the products of amino acid deamination. Urea is synthesized through the urea cycle in the liver from the oxidation of amino acids or from ammonia. These mechanisms serve to trap and neutralize the highly volatile and toxic ammonia that is released from α-amino groups on transamination of amino acids in the liver. #Pathophysiology #Nephro #Nutrition #CKD #ProteinMetabolism #AminoAcidMetabolism #Pathways #NEJM