if dont want to study anatomy anymore..do this..!!

http://anatomy.med.umich.edu/courseinfo/mich_quiz_index.html

exam stuff contd

hey guys a small mistake about the SAQ's, there is a possibility that socio can come as an SAQ, i think its higly unlikely though as we have got many socio question last sem more or less covering everythin the 2nd years got last year.. but it is possible tht maybe one question can come.. I was thinking law and clinical skills can come as SAQ's

most probably material risk and maybe some MSE stuff,

but im not sure im jus guessing all of this.. if u have time id suggest running through the main stuff in socio like sick role, antibiotic resistence spread, biographical disruption, whitehall studies, social class gradient, good death dr and patient perspective, palliative care, good and bad patients, norms and values, access, equity, needs, barriers to access structure and agency, social integration and regulation by durkhiem, critics of the sick role, definition of socialisation and the agents of socialisation and the medical gaze..

hehe thts alot and i still havent even covered half of 2nd sem :(

but id say pay more attention to ur epidemiology, anatomy, neuro, pharmaco, muscle function, sensory system, development, law and clinical stuff that we did this sem.. and of course sivalal's stuff and try and make summin up if we cant revise socio and if SAQ comes from it..

exam stuff

hey everybody

i dunno if any of you will see this or not, these are few tips i got from some second years and heard from a few of my friends about exams.. it is upto u all to decide if this is important for you, im not telling you shud follow this jus a few things that im doin and i feel i thought id share with you all, if u all think i have missed anythin please do let me kno =)

1. make sure u go through all the anatomy practicals and pay attention to the clinical aspects and study around tht cos most of the exam questions come from the practicals, FORGET goin through the whole book now, its not a time to be a DEEP learner, now is the time to study SMART n pass exams =)

2. make sure u go through epid stuff and the epid quizzes on blackboard.

3. there will be NO SAQ's on HEP, SOCIO and EPID or Jambu's stuff so chill =) make sure u focus on the stuff on the HEP revision lecture of first sem and the last lecture of looking ahead by sivalal, the looking ahead seems to cover both sems..

4. Study Law and be more focused on material risk but dont forget the basics as well cos basics can come for mcq but i think material risk has a greater chance of comin for SAQ (this is my hunch and i dont kno if it is true so to be on the safe side go through the other stuff also)

5. study pharamaco, no tips there, but go through amudha's last 3 lectures first and then the rest it becomes easier and covers most of the rest done during the begining of sem, revise pharmcodynamics and pharmacokinetics of this sem if u have the time.. dont worry bout it too much but please do kno the therapeutic index thingy and also there was summin about sum volume summin.

6. go through sensation and motor systems and muscle function and do the muscle physio quizz on blackboard

7. be familiar with bone and skin histo

8. no need of studyin antibiotics in detail but kno the main classes and the drugs

9. go through the australian lecture notes for cranial nerves, hearing, balance, vision, smell and taste. more
important is the vision and hearin physio. this is cos these lecturers do not kno wut is important according to our syllabus and wut they have covered is a ltl too extensive for first year for us.

10. MSE stuff the definition of hallucination, illusion, delusion, misinterpretation and tht kind of stuff and the MMSE

11. the framework of clinical reasoning by shah

12. micro bio from first sem about the different tests involved in identyfing bacteria such as the catalase and gram staining stuff

13. Embryology, gastrulation, neurulation, limb development

14. first sem bio chem try to focus on the more important aspects which hav popped up hear and there in lectures.

try to focus more on the last half of sem after mid sem exams.. most of what we will be getting will come from the theory leanrt during tht time so dont be too nervous if u cant finish everythin from first sem

Please dont get me wrong this isnt like what is coming for exams or anythin but wut my friends in 2nd year told me and somethings that i heard from ppl from higher up. i can vouch for 1,2,3,5,6,9,10 and tht if u follow those u wont go wrong in those areas.. for those are wut i follow and ive done ok in those areas.

it is upto each of you to think about wut i have written and if you feel its important then follow it, cos i am jus sharing wut i heard and i cannot take any responsibility as to whether it will help u or not.. if u feel it is not helpful and will interfere with the way u study then please dont listen to me..

GOOD LUCK to everyone... we are at the brink of finishin our first year at med school =) let us not get side tracked and jus finish it off with a BANG =) All the best guys good luck with ur studyin..

STUDY HARD!!! STUDY SMART!!!

Treatment Sore Foot

by Syukriah

Causes- sore foot

¢Occur when the skin is pressed between the bones of the skeleton and a hard surface.

¢Restricts the normal flow of blood, oxygen, and nutrients to the area. Subsequently the skin cells die.

¢Spina bifida patients have a reduced circulation in the area due to their lack of movement. Usually the brain sends a message to the body to change position so that the cells will once again receive a proper blood supply.

¢A person with spina bifida has areas of skin which do not have any feeling and often have partial or complete paralysis, and so does not receive these messages. If the pressure continues the blood supply is cut off, causing pressure sores.

COMMON PLACE

¢On the behind.

¢Behind the knees

¢On the heels

¢On the feet, ankles, and hips.


PREVENTION

¢Regular visual checks are essential.

¢Checking the skin every day to identify any areas that appear red, white or brown in colour, as discolouration could be the first sign of a pressure sore forming.

¢Shifting position every 15 minutes can help by allowing circulation to flow into different areas.

¢Suitable wheelchairs, footwear, and braces must be fitted.

¢Special air cushion to sit on if they are on the floor or in the wheelchair.

¢Wearing loose clothing can help prevent rubbing. Tight clothing can reduce circulation.

¢Avoid storing objects in pockets or on the seats of wheelchairs. A cigarette packet, for instance, if sat upon can pinch skin.

¢Hygiene! Ensuring the skin is kept clean and dry will help protect from rashes and bacteria.

¢Exercising regularly may improve circulation considerably lessening the risk of pressure sores.

¢Don't smoke! Smoking reduces the circulation in the body.

DIET..!! fluids helps to keep the skin supple and hydrated. Complex carbohydrates (bread, rice, pasta) will keep the muscles healthy. Iron-rich food, such as spinach, will help the blood carry the oxygen around the body to the cells. Vitamin C and zinc (a mineral) both help wound healing, as does an adequate supply of proteins (found in meat, fish and dairy products).

Grade

¢Grade 1 – skin discolouration, usually red, blue, purple or black.

¢Grade 2 – some skin loss or damage involving the top-most skin layers.

¢Grade 3 – necrosis (death) or damage to the skin patch, limited to the skin layers.

¢Grade 4 – necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone

treatment depends on the grade of the sore

basically grade 1 and 2 only need pressure relieve and daily check up of the foot. if there is any open wound, clean and dressing to avoid infection. not much different with prevention.

for grade 3 and 4-- need surgical flap reconstruction

• the V-Y advancement flap reconstruction.
  

other treatment i'm not sure. I'll check with Arma and post it later. =)

Make a Smilebox scrapbook

Tweatment & Management

* Jess, feel free to add stuff :) *

Surgery
· May be used to close the lesion and reduce the risk of infection.
· 1 to 2 days after birth.

Ventriculoperitoneal Shunt
· To treat hydrocephalus
· Insert a tube into the ventricles in the brain where the spinal fluid is produced.
· This is to reduce the pressure on the brain by draining and diverting extra fluid.
· The shunt has a one-way valve on the skull, under the skin behind an ear.
· This allows the excess cerebrospinal fluid to drain out of the brain via another tube into the abdomen or the heart.

Orthopaedic surgery
Leg and feet operations to improve the patient’s mobility.

Aids
· Walking aids
· Crutches
· Wheelchairs


Bladder surgery
To increase bladder size and tighten muscles.
For urinary incontinence
Faecal or urinary bags.

Physical Therapy
Therapists teach parents how to exercise the infant's legs and feet. Walkers, braces, and crutches will often be needed for mobility later in life.

General measures
Regular monitoring of kidney, bladder, shunt and spine functions is required.

The importance of folate

· B-group vitamin.
· Taken daily one month before conception and each day during the first three months of pregnancy, can prevent the occurrence of up to 70 per cent of neural tube defects.
· Women who are pregnant or likely to become pregnant should be offered folic acid supplements of 0.4mg daily.


People in the ‘high risk’ category need to take a higher dose. High risk groups include people who have a:
Previous child with a neural tube defect (NTD)
Family history of NTDs on one or both sides
Close relative with an NTD
Close relative with a child with an NTD
Women taking some anti-epileptic medications such as valproic acid.


Alternative Treatment

Women of child-bearing age should ideally consume up to three kiwifruits a day, take more asparagus, spinach, oranges, bananas and legumes. They should also consume foods fortified with folate, such as some breakfast cereals and bread.

Biofeedback
More aware of signals from the patient’s body.
This may help them regain control over the muscles in the bladder and urethra.

Acupuncture
Provides symptom relief for incontinence.
It helps tone muscle and increase blood flow to the bladder.
It can boost the immune system, soothe inflammation and restore balance to the hormones.

Nutrition
Eliminate foods and drinks that can irritate your bladder, including alcohol, caffeine, foods high in acid (such as tomato or grapefruit), spicy foods, sweetener substitutes and sugars.

References
http://kidshealth.org/parent/system/ill/spina_bifida.html#
http://www.babycenter.com.my/baby/health/spina-bifida/
http://www.myhealth.gov.my/myhealth/eng/template.jsp?showMe=31&storyid=1244538477926
http://healthlibrary.epnet.com/GetContent.aspx?token=70ff5260-81bd-4de1-9998-14fc98aa9133&chunkiid=11542
http://stanford.wellsphere.com/general-medicine-article/alternative-treatments-for-incontinence/809695
http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2725875/k.BDDF/Hydrocephalus_and_Shunts_in_the_Person_with_Spina_Bifida.htm

Ankle and Subtalar Joint Practical

hey guys and girls make sure u do the ankle and subtalar joint practical and not the foot practical =) I hope you all do this and come since we have the whole morning free... Please let us finish the practical off with a BANG!!!!!!!!! =)=)=) so here is how it is divided;

Activity 1 - Bones

Daksha, Ridzuan, Syukriah

Activity 2 - Muscles, fascia and ligaments

Carrmen, Chang Thai, Jess

Activity 3 - Joints

Jasmin, Arma, Sandhya

Activity 4 - Surface Anatomy

Shakir, Zhi Mei

Activity 5 - Radiology

Viran

What, types and risk factors of Spina Bifida by ridz

I do not post the dermatome things yet..haha

What is spina bifida?
Spina bifida, also called myelodysplasia, is a condition in which there is abnormal development of the back bones, spinal cord, surrounding nerves, and the fluid-filled sac that surrounds the spinal cord. This neurological condition can cause a portion of the spinal cord and the surrounding structures to develop outside, instead of inside, the body. The defect can occur anywhere along the spine.

Are There Different Types of Spina Bifida?
Yes. There are three forms:
1. Spina bifida Occulta
Spina Bifida occulta is often called hidden Spina Bifida. In this usually harmless form of Spina Bifida, the spinal cord and the nerves are usually normal and there is no opening on the back. There is a small defect or gap in a few of the small bones (vertebrae) that make up the spine. The underlying neural tube defect is completely covered with skin. Frequently, there are telltale signs on close examination of the back. There may be a defect in the vertebrae of spine bones, or the skin overlying the defect may be dimpled, thickened, pigmented or hairy. In some cases there may be a soft swelling overlying the spine, composed of fatty tissue (lipoma). Not frequently, the fatty tissue extends into the spinal canal, where it can expand and press on the spinal cord. Although there may be no motor or sensory impairments evident at birth, subtle, progressive neurologic deterioration often becomes evident in later childhood or adulthood.
In many instances, however, Spina Bifida occulta is so mild that there is no disturbance of spinal function at all. The arches of the vertebrae may be incomplete, but the spinal cord itself is normal. Spina Bifida occulta of this sort probably occurs in 3-5 percent of the population and is usually a chance finding that is of no clinical significance. People often don't even know they have it.
1. Meningocele
The protective coatings (meninges) come through the open part of the spine like a sac that is pushed out. Cerebrospinal fluid is in the sac and there is usually no nerve damage. Individuals may suffer minor disabilities. New problems can develop later in life.
1. Myelomeningocele @ Spina bifida cystica
This occurs when the meninges (protective covering of the spinal cord) and spinal nerves come through the open part of the spine. This is the most serious type of Spina Bifida, and it causes nerve damage and more severe disabilities. Hydrocephalus, or water on the brain, often occurs in 70-90 percent of children with myelomeningocele. This happens when the cerebrospinal fluid, which cushions and protects the brain and spinal cord, is unable to drain normally because of the spinal defect. Fluid collects in and around the brain, causing the head to become enlarged. Without treatment mental retardation may result. Hydrocephalus also occurs in children who do not have Spina Bifida.

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Most risk factors for spina bifida are related to the mother's health. Risk factors include:
• maternal age (spina bifida is more commonly seen in teenage mothers)
• history of miscarriage
• birth order (first-born infants are at higher risk)
• socioeconomic status (Children born into lower socioeconomic families are at higher risk for developing spina bifida. It is thought that a poor diet, lacking essential vitamins and minerals, may be a contributing factor).
• Race. Spina bifida is more common among whites and Hispanics or Caucasian.
• Family history of neural tube defects. Couples who've had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect. That risk increases if two previous children have been affected by the condition. In addition, a woman who was born with a neural tube defect, or who has a close relative with one, has a greater chance of giving birth to a child with spina bifida. However, most babies with spina bifida are born to parents with no known family history of the condition.
• Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a fetus. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects.
• Some medications. Anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, perhaps because they interfere with the body's ability to use folate and folic acid.
• Diabetes. Women with diabetes who don't control their blood sugar well have a higher risk of having a baby with spina bifida.
• Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida.
• Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early months of pregnancy may increase the risk of spina bifida. Elevating your core body temperature by about 3 to 4 degrees Fahrenheit above normal — about 2 degrees Celsius — due to fever or the use of saunas, hot tubs or tanning beds, has been associated with increased risk of spina bifida.

http://emedicine.medscape.com/article/979902-overview
http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2700307/k.5A79/What_Is_Spina_Bifida.htm
http://www. http://www.healthsystem.virginia.edu/UVAHealth/peds_hrnewborn/spinbif.cfm
mayoclinic.com/health/spina-bifida/DS00417/DSECTION=risk-factors
http://www.doctorsofusc.com/condition/document/11542

PSYCHOSOCIAL

School days: Junaida might soiled her clothes, could not hold urine or stools adequately.
- Problems with friends. Been teased off, uncaring teachers might find it irritating and develop prejudice thinking towards her.
- Have to carry a few change of clothes.
- Have to take lessons on how to control bowels and bladder problems.

Life long medical attention: starts with an antenatal diagnosis
- Neurologist: hydrocephalus and birth defects
- Pediatric neurologist: neurological problems.
- Nephrologist: kidney
- Rehabilitation physicial: overall MSK problems
- Orthopaedic surgeon: look into deformity, corrections when appropriate

Since Junaidah has spina bifida, this increases the risk of a child with spina bifida or other neural tube defects. Thus, when she is pregnant later in life, she has to take a higher dose of folic acid compared to normal people ( 10 x 400micrograms).

Doctor: vital role
Doctor must brief parents and prepare them by giving them a rough idea on what is going to happen after the baby is born.
Doctors must brief parents on how to take care on the baby and what to take note on, challenges the baby will face as the baby gets older. This is because problems do not stay the same all the time in spina bifida patients and their needs also change over time.

Provide support for the family members.
Support groups:
Spina Bifida Association Malaysia (SIBIAM) aims to improve the life chances of a person with spinal bifida and congenital/childhood spinal disorders.
KIWANIS

Video on Abigail branson : http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2644693/k.8A2E/Real_Stories.htm

Reference:
http://thestar.com.my/health/story.asp?file=/2008/6/15/health/21447192&sec=health
http://thestar.com.my/health/story.asp?file=/2008/6/15/health/20080615075253&sec=health
http://www.myhealth.gov.my/myhealth/eng/kanak_content.jsp?lang=kanak&sub=0&bhs=may&storyid=1186466245941

Epidemiology of Spina Bifida by ARMA

On Friday, I’ll present about the causes of the spina bifida, the prevalence of hydrocephalus and prevalence of complications of spina bifida at intermediate and low level of lesion. Syukriah and I will also present about the treatment of the sore foot but we’ll post about this treatment later. Thank you.

Epidemiology of spina bifida

Spina Bifida is a neural tube defect that affects approximately 3,000 pregnancies each year. According to the Spina Bifida Association of America, it is estimated that more than 70,000 people in the United States are living with this birth defect.

Up to 90 % of children with the worst form of spina bifida have hydrocephalus (fluid on the brain) and must have surgery to insert a “shunt” that helps drain the fluid—the shunt stays in place for the lifetime of the person.

In fact, 95 % of neural tube defects (NTDs) occur in women with no personal or family history of NTDs.

A previous NTD-affected pregnancy increases a woman’s chance to have another NTD-affected pregnancy approximately 20 times.

http://www.americanpregnancy.org/birthdefects/spinabifida.html

A STUDY CONDUCTED IN MALAYSIA

There were 66 children who attended the clinic on a regular basis during that period, with ages ranging from two to 17 years.

None of the children with low level lesions used any appliances; in contrast all children with high level lesions required one, the majority of whom (88.9%) used wheelchairs.

Of the 26 children with intermediate level lesions who required an appliance, 16 (61.5%) used a wheelchair.

Ten (15.2%) children developed skin breakdown at some point during the study period. The incidence of skin breakdown among the children with low level lesions was lower than those with intermediate or high level lesion.

Fifty-three (80%) children had a documented urinary tract infection necessitating treatment at some point during the study period, with similar rates of infection among the three levels of lesions.

Twenty-eight (42.4%) children had hydrocephalus, of whom 25 (89.3%) underwent a shunting procedure in early infancy. Nine (36%) of those shunted had a shunt malfunction (blockage with or without concomitant infection) at some point in life. Children with low-level lesions were less likely to develop hydrocephalus than those with intermediate or high level lesions, but the rates of shunting and shunt complications were similar for children with hydrocephalus in all three groups.

Forty (60.6%) children in the study were of school-going age (Table III). Of these, 25 (62.5%) were attending normal class, 8 (20%) attended either special classes in integrated schools or schools for the handicapped while 7 (17.5%) did not attend school at all.

More children with low-level lesions attended mainstream school (normal or integrated classes) compared to those with intermediate or high- level lesions (93.3% vs 64%), but this did not reach statistical significance (p = 0.059).

The children with high or intermediate-level lesions cited multiple problems (transport problems, inaccessible classrooms and toilets, social stigma of wetting and soiling) as the reasons for not attending school. The sole child with low-level lesion who was not schooling was an adolescent who cited poor academic performance and difficulty with proper toilet access to perform CIC as the reasons for dropping out of school.

Like others(1,4,7), the incidence of hydrocephalus was higher among children with thoracic or lumbar lesions than those with sacral lesions. However, the long-term impact on intellectual ability in these children is determined by the occurrence of shunt dysfunction rather than the presence of hydrocephalus per se.

The cumulative incidence of skin breakdown is known to increase with age

http://www.sma.org.sg/smj/4301/4301a1.pdf

What Causes Spina Bifida?

No one knows for sure. Experts think that both genetics (one or more genes) and the person’s environment might interact to cause Spina Bifida. It is possible that a person inherits multiple genes that make them susceptible to having Spina Bifida, but something in the environment triggers the Spina Bifida to develop.

http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2642343/k.8D2D/Fact_Sheets.htm

U.S. birth certificate data in this report demonstrate a 24% decline in spina bifida in 2001 births (based on preliminary data) compared with the occurrence of spina bifida in 1996 (before folic acid fortification).

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5113a3.htm

http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2642343/k.8D2D/Fact_Sheets.htm

Good site :)

Friday's Line Up.

1. Embryology - neurulation and gastrulation Sandhya and Viran.
How does this condition develope.
Why at this level?
2. What is spina bifida ( dermatomes, types ) , risk factors Ridzuan.
What is the patient's type of SB?
What predisposed her to that?
How? Why?
Sensation of her feet?
3. Epidemiology Arma
Her case?
4. Symptoms, Complications ( hydrocephalus, tethered spinal cord. incontinence of bladder and bowel, lack of sensation, gait ) Chang Thai
Healing affected?
5. Sore foot Syukriah and Arma.
So what treatment should she get?
6. Sabak Bernam Syukriah
How can seh access to treatment? What should be done?
7. Psychosocial :Development in children - mentally and physically.Support groups.Prognosis.Zhimei, Jasmine and Shakir
How is her school life affected?
Future? Marriage? Sex? Children? Work?

PART B

8. Diagnosis, Investigation and Screening ( Folic acid and all those stuff. ) Daksha.
9. Treatment and Management ( ven. shunt & alternative treatment of urinary incontinence ) Jesslyn and Carr Men.

PART C, Q & A, Summary, Objectives. * more detailed info in the previous post. * Okay? Get ready. :) May be asking some questions.

Treatment&Management

First Aid
 Check the airway, breathing and circulation.
 If there is bleeding, treat it first.
 Squeeze a main artery if necessary.
 Immobilize the leg.
 REST
 ICE
 COMPRESSION
 ELEVATION

REST
 Have the injured person lie down. Head slightly lower than the trunk or elevate the leg. Reduces the risk of fainting by increasing blood flow to the brain.
 Immobilize the limb using anything that can support like newspaper, tree branch etc. Make sling using any rope, tree root or your shoelaces.
 2 splint- 1 inner and 1 outer part
 Tie the limb together for additional support.
 Do not try to realign the bone

Compression
 Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
 Maintain pressure until the bleeding stops. Hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped.
 Don't remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, don't remove it. Instead, add more absorbent material on top of it.
 Squeeze a main artery if necessary. Apply pressure to the artery delivering blood to the area of the wound. Pressure points of the leg are just behind the knee and in the groin. Squeeze the main artery.


First Aid (Leg Fracture)
Check for pulses to the end of the limb
►Bandage any wounds that are bleeding
►Place the uninjured leg immediately adjacent to the fractured leg
►If available, a wooden splint can be used instead
►Tie both legs together
►Use padding between the natural hollows of the legs and the splint
►Tie the ankles with a figure of eight bandage, first making sure the feet are even
►Place a narrow/broad fold bandage above and below the fracture and place other bandages as necessary
►Handle gently and check circulation before and after splinting. This can be done by either checking the pulse past the injury or comparing skin colour of injured limb to the uninjured limb

(Knee dislocation)
 First aider should be more concern about possible injury to the popliteal artery that located behind the knee joint (popliteal area). Because this artery supply the leg below the knee.
 Check the ankle pulse (posterior tibialis) and if pulse absent make attempt to realign the leg to restore blood circulation (once only)
 Do not try realign the leg if pulse present.


Shock management

Various signs and symptoms appear in a person experiencing shock:
 The skin is cool and clammy. It may appear pale or gray.
 The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal.
 The eyes lack luster and may seem to stare. Sometimes the pupils are dilated.
 The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious.

If you suspect shock, even if the person seems normal after an injury:

 Have the person lie down on his or her back with feet higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still.
 Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR.
 Keep the person warm and comfortable. Loosen belt(s) and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth.
 Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth.
 Seek treatment for injuries, such as bleeding or broken bones.


Surgical Intervention

 Surgical treatment of limb-threatening injuries must start as soon as life-threatening condition has been managed. Best done within 6 hours of injury.
 Prevention of wound infection and surgical approach to high-energy limb trauma:
 wound extension
 wound excision
 skeletal stabilization
 muscle compartment release

Treatment of a leg injury depends on the x-ray findings
 Contusions and minor fractures
- ice compresses, elevation, and rest.
- Acetaminophen, aspirin, or an anti-inflammatory (ibuprofen) are helpful in the management of pain.
 Fractures that are displaced or angulated
◦ Realignment : closed / open

Closed realignment ( if it’s a displaced fracture)
 Manipulate the pieces back into their proper positions before applying a splint — a process called reduction.
 Muscle relaxant, a sedative or even a general anesthetic before this procedure is needed depending on the amount of pain and swelling

Open realignment
First of all, to relate it back to James’ condition… He has a COMPOUND fracture
◦ Exposed through a skin laceration
◦ Increased likelihood for bacterial contamination
◦ Usually requires aggressive wound cleansing
◦ Fixation needed!
◦ ***Antibiotics intravenously before and after the operation

What can/ should be done?
FIXATION
 Intramedullary
◦ Inserting a rod (intramedullary nail) into the center of the bone
◦ Rod secured with surgical screws
◦ Rod provide support while the fracture heals

• Plating
 Securing a plate
 screws into the bone
 keep it in proper position while it heals

 External (James’ case)
◦ Frame aligned on the outside of the leg
◦ Secured with surgical pins
◦ Keep bones from moving while healing takes place

• Casting
 Treat tibia shaft fractures IF the bones are in good alignment
 People who are not suitable for surgery
 *Long leg cast (covers knee and ankle) – provide support and stability

Why internal fixation?
 Allows shorter hospital stays
 Enables individuals to return to function earlier
 Reduces the incidence of nonunion (improper healing) & malunion (healing in improper position).

Before going on to post-operative, it’s important to take note of pre-operative procedure =)
 examine the injury with the patient under anesthesia
 understand fracture stability without causing pain to the patient
 begin with extensive irrigation and debridement of devitalized tissue and bone
 successful treatment of contaminated open tibial fractures include radical debridement of necrotic tissue, pulsed lavage of the area to remove bacteria, and prophylactic intravenous antibiotics

Post-operative
 Patient should be monitored in the postanesthesia care unit until stable
 patient's vital signs should be monitored repeatedly, with careful attention paid to any abnormalities
 Prognosis improve with early detection
 First postoperative day, the patient should be examined by the surgical team and a complete blood count should be obtained

Follow up
 Patient usually is seen in a clinic 2-3 days after discharge
 Radiographs are taken to view the reduction.
 If the reduced fracture is still properly positioned, the patient returns on a regular, less-frequent basis for radiographic and clinical examination of the leg
 Many tibial nails are not removed and may remain in the patient indefinitely
 Also, physical therapy after surgery is important to…
Help gain
◦ strength
◦ motion
◦ function

Possible Complication – Tetanus

Treatment
 Directed toward the treatment of muscle spasm, prevention of respiratory and metabolic complications, neutralization of circulating toxin to prevent the continued spread, and elimination of the source.
 Consider prophylactic intubation in all patients with moderate-to-severe clinical manifestations. Intubation and ventilation are required in 67% of patients
 Tetanus immune globulin (TIG) is recommended for treatment of tetanus. It help remove unbound tetanus toxin BUT cannot affect toxin bound to nerve endings
Medication
 Anticonvulsants
 Skeletal muscle relaxants
These agents can inhibit both monosynaptic and polysynaptic reflexes at spinal level, possibly by hyperpolarization of afferent terminals.
 Antitoxins
These agents are used to neutralize any toxin that has not reached the CNS.
 Antibiotics
Administer to patients with clinical tetanus. However, efficacy is questioned
 Neuromuscular blocking agents
These agents inhibit the transmission of nerve impulses at neuromuscular junctions of skeletal muscles and/or autonomic ganglia.

Alternative Treatment ?
 Calming herbs are often useful for relief of pain and tension.
 Cups of chamomile (Matricaria recutitca), catnip (Nepeta cataria), or lemon balm (Melissa officinalis) tea can be given freely for a calming effect.
 Fifteen drops of skullcap (Scutellaria lateriflora), St. John's wort (Hypericum perforatum), or valerian (Valeriana officinalis) tincture can be given every half hour as needed.
 A tea to encourage the bone tissue to knit and heal. (Refer to blog).
 Application of contrast hydrotherapy to foot below the area of the fracture can be used to assist healing by enhancing circulation.
 Contrast hydrotherapy uses an alternating series of hot and cold water applications.


References
 http://www.indiaparenting.com/raisingchild/data/raisingchild146.shtml
 http://www.mayoclinic.com/health/first-aid-fractures/FA00058
 http://www.mayoclinic.com/health/first-aid-severe-bleeding/FA00038
 http://www.mayoclinic.com/health/first-aid-shock/FA00056
 http://firstaid.webmd.com/tetanus-treatment
 http://findarticles.com/p/articles/mi_g2603/is_0003/ai_2603000373/pg_2/?tag=content;col1
 http://members.medscape.com/article/826304-treatment
 Book : First aid, CPR and AED by Alton L Thygerson
 http://emedicine.medscape.com/article/786414-treatment
 http://orthoinfo.aaos.org/topic.cfm?topic=A00196
 http://m.sooperarticles.com/health-fitness-articles/first-aid-articles/learn-first-aid-home-how-treat-fractures-wounds-poisons-38-more-6277.html
 http://m.sooperarticles.com/article-tags/broken-leg-treatment/p/2
 http://www.catzpti.com/tabid/8653/mid/13865/ContentPubID/762/ContentClassificationGroupID/-1/Default.aspx
 http://www.health-care-information.org/injuries/leg-injury-fractures-contusions.html
 http://www.ncbi.nlm.nih.gov/pubmed/12584901
 www.jortho.org/2007/4/1/e10/index.htm

In myelomeningocele, the baby's spinal canal remains open along several vertebrae in the lower or middle back. Because of this opening, both the membranes and the spinal cord protrude at birth, forming a sac on the baby's back. In some cases, skin covers the sac. Usually, however, tissues and nerves are exposed, making the baby prone to life-threatening infections.

A newborn may have a sac sticking out of the mid to lower back. The doctor cannot see through the sac when shining a light behind it. Symptoms include:
• Loss of bladder or bowel control
• Partial or complete lack of sensation
• Partial or complete paralysis of the legs
• Weakness of the hips, legs, or feet of a newborn
The exposed spinal cord is susceptible to infection. Other symptoms may include:
• Hair at the back part of the pelvis called the sacral area
• Dimpling of the sacral area

Complications may include:
• Physical and neurological problems. This may include lack of normal bowel and bladder control and partial or complete paralysis of the legs. Children and adults with this form of spina bifida might need crutches, braces or wheelchairs to help them get around
• Hydrocephalus. Accumulation of fluid in the brain. Most babies will need a shunt —this tube might be placed just after birth, during the surgery to close the sac on the lower back, or later as fluid accumulates.
• Meningitis. Some babies may develop meningitis, causing brain injury and can be life-threatening.
• Tethering spinal cord- By the time a child is born, the spinal cord is normally located opposite the disc between the first and second lumbar vertebrae, in about the upper part of the lower back. In a baby with Spina Bifida, the spinal cord is still attached to the surrounding skin, and is prevented from ascending normally; the spinal cord at birth is therefore tethered. Although the myelomeningocele is separated from the skin and closed at birth, the spinal cord, which has grown in this position, stays in roughly the same location after the closure. As the child continues to grow, the spinal cord can become stretched; this damages the spinal cord both by directly stretching it and by interfering with the blood supply to the spinal cord. The result can be progressive neurological, urological, or orthopedic deterioration.

Other complications
Additional problems may arise as children with spina bifida get older. Children may develop learning disabilities, including difficulty paying attention. Children with spina bifida may also experience latex allergies, skin problems, urinary tract infections, gastrointestinal disorders and depression.


Links
1) http://www.mayoclinic.com/health/spina-bifida/DS00417/DSECTION=symptoms
2) http://www.nlm.nih.gov/medlineplus/ency/article/001558.htm
3) http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2700295/k.6B9E/Tethering_Spinal_Cord.htm