Ortho Preferred Malpractice Insurance

Medications

Scapholunate Instability

– Discussion:      – anatomy and ligamentous contraints:            – ligaments of the wrist            – SL interosseous ligament     – SLD is most common and most significant ligament injury of wrist; (carpal instability);     – risk factors: ulna minus configuation, slope of radial articular surface, and lunotriquetral coalition;     – spectrum of injury: (increasing … Read more

Rx of Atrial fibrillation

– See:  – A. Flutter  – Causes of A. fib  – r/o WPW as a predisposing cause;  – If Unstable (or onset < 3 days): Cardio Convert (100 J)  – If Stable: (w/ rates greater than 100/min) Consider  – Digoxin: to slow the AV conduction rate  – Propanolol:  – Diltiazem  – Verapamil:   – combination of … Read more

Rickets

– See:     – Osteomalacia:     – Vit D Abnormalities: – Discussion:     – rickets is an osteomalacic syndrome in which there is an inability to mineralize chondroid and osteoid;           – lack of available calcium or phosphorus (or both) for mineralization of newly formed osteoid;     … Read more

Rifampin

– Discussion:     – for primary TB, treatment of assymptomatic carriers of N. meningitidis to eliminate meningococci from the nasopharynx;     – also used in combination with other agents (cipro, levofloxacin, zyvox) for treatment of staphyloccocus infections;     – it inhibits bacterial DNA dependent RNA polymerase activity;     – may be especially useful to eradicate … Read more

Rheumatoid Forefoot

– See:        – Hyperpronation of Rheumatoid Foot;        – Rheumatoid Arthrtis        – Rheumatoid Foot – Discussion:     – most commonly affected portion of the rheumatoid foot;     – typical forefoot deformities are hallux valgus, hyperextension of MP joints, and flexion ofthe IP joints of the … Read more

Reperfusion Injury / Crush Injury

– See: Compartment Syndrome – Discussion:     – traumatic rhabdomyolysis, or crush syndrome, is consequence of prolonged continuous pressure on the limbs;     – it reflects disintegration of muscle tissue & influx of myoglobin, potassium, and phosphorus into the circulation;     – syndrome is characterized by hypovolemic shock and hyperkalemia;     … Read more

Renal / Dialysis

– Dialysis:     – for hypercatabolic patient early and aggressive dialysis which is instituted before the Cr is > 8-10 and before BUN > 100 improves patient outcome;     – hemodialysis effciently removes aminoglycosides (50% after 4hrs) and penicillins and cephalosporins;          – hence drug doses should be given at the end of … Read more

Reflex Sympathetic Dystrophy / Complex Regional Pain Syndrome

– Definition:        – “RSD” is an imprecisely used term; has been used to describe changes in soft tissue and bone;        – RSD may not involve the sympathetic nervous system and may not be the consequence of a reflex;        – 1995: IASP Consensus Conference: “Complex regional pain … Read more

References for Osteoporosis

Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group Intermittent cyclical etidronate treatment of postmenopausal osteoporosis A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Hypothalamic … Read more