Kaap 619 final

what are the 4 mechanisms of heat dissipation?

1. conduction

2. convection

3. radiation

4. evaporation

what is conduction?

direct contact

what is convection?

contact with cool air air or water mass

what is radiation?

heat generated from metabolism

what is evaporation?

sweat evaporating from the skin

what are the signs and symptoms or heat exhaustion?

- faint or dizzy

- excessive sweating

- cool, clammy skin

- nausea or vomiting

- rapid, weak pulse

- muscle cramps

what are the signs and symptoms of heat stroke?

- throbbing headache

- no sweating

- red, hot, dry skin

- nausea or vomiting

- rapid, strong pulse

- may lose consciousness

what are key differences between heat exhaustion and heat stroke?

- if someone has heat exhaustion they will be profusely sweating, with heat stroke there is no new sweat

- heat exhaustion will present a weak pulse, heat stroke will have a strong pulse

- heat exhaustion will have cool skin, heat stroke will have hot and dry skin

- heat stroke is a medical emergency

at what temperature does shivering stop?

85-90F body temp

what body temperature is life threatening?

below 77-85F

what are signs and symptoms of frost nip?

skin appears firm with cold painless areas that may peel and blister (24-72 hours)

how do you treat frost nip?

- firm pressure

- blowing warm air or hands in armpits

- do not rub

what is superficial frostbite?

- involves only skin and subcutaneous tissue

- appears pale, hard, cold and waxy

- when re-warming the area will feel numb and burn

- it may blister and be painful for several weeks

what is deep frostbite?

- indicates frozen skin requiring hospitalization

- gradual re-warming is necessary (100-110F)

- tissue will become blotchy red, swollen, painful and may become gangrenous

how do you prevent cold disorders?

- waterproof and windproof fabrics

- wick moisture away from the skin allowing passage of heat and sweat

- layers and adjusting them are key to maintaining body temperature

what is the flash to bang ratio?

1. begin counting with sighting a lightening flash

2. stop counting when the associated bang (thunder) is heard

3. divide the count by 5 to determine the distance to the lightening flash in miles

how long after a lightening strike can activity resume?

30 minutes after last strike

what are the 3 types of altitude sickness?

1. acute mountain sickness (AMS)

2. high altitude pulmonary edema (HAPE)

3. high altitude cerebral edema (HACE)

what are signs and symptoms of acute mountain sickness?

- headache

- sleep disturbance

- fatigue

- shortness of breath

- dizziness

- loss of appetite

- vomiting

what is the determining altitude for acute mountain sickness?

above 8,000ft

how long after an ascent does acute mountain sickness present?

1-2 days

what elevation does high altitude pulmonary edema occur?

above 10,000ft

what are signs and symptoms of high altitude pulmonary edema?

- shortness of breath

- dry cough

- mild chest pain

- weakness

- insomnia

- rapid pulse

- cyanosis

- rales or gurgling sounds

how long after an ascent will high altitude pulmonary edema present?

3-4 day, possibly later

what elevation does high altitude cerebral edema occur?

above 12,000ft

how long after ascent does high altitude cerebral edema present?

4-7 days

what are signs and symptoms of high altitude cerebral edema?

- severe headache

- vomiting

- irregular breathing

- ataxia -- irregular gait or lack of coordination

- unconsciousness

what are red flags for altitude sickness?

- persistent cough

- shortness of breath while resting

- noisy breathing

- loss of balance

- confusion

what are key differences between hipaa and ferpa?

- HIPAA addresses personal health information and FERPA addresses academic records

what are key differences between ICD-10 and CPT codes?

- ICD-10 addresses the diagnosis and inpatient procedures and is used by all healthcare providers

- CPT codes are numerical codes that track tests, surgeries, evaluations, and any other procedures conducted by a medical professional

- ICD-10 -- explains why the patient is being treated

- CPT -- explains what was done to treat the patient

what are key differences between EMR and EHR?

- EMR -- digital version of paper charts (treatment notes, lab results)

- EMRs are rarely shared outside of the medical practice

- EHR -- stores all data found in an EMR, but is designed to be easily shared across medical practices

- EHR is more of a complete picture of the patient's health, EMR is specific to one provider

- EHRs are accessible to the patient through a portal

what does the HOPs method used for?

systematic evaluation

what does HOPS stand for?

- history

- observation

- palpations

- special tests

what is involved in the history section of the evaluation?

- MOI

- underlying medical conditions

- present vs past medical history

- impact the injury may have the patient's life

what is MAPPSS used for?

gathering patient history during evaluation

what does MAPPSS stand for?

- MOI

- acute or chronic

- pain

- palpation

- sounds

- signs and symptoms

what are the normal PROM end feels?

1. soft -- soft tissue approximation

2. firm -- muscular, capsular, or ligamentous stretch

3. hard -- bone contacting bone

what is an example of a normal soft end feel?

knee flexion

what is an example of a normal hard end feel?

elbow extension

what is an example of a normal firm end feel?

- hip flexion with knee extended

- extension of MCP joints

- forearm supination

what are the PROM abnormal end feels?

1. soft -- sooner or later in ROM than usual, normally firm or hard end feel, boggy

2. firm -- sooner or later in ROM than usual, normally soft or hard end feel, increased muscle tone or capsular/muscular/ligamentous shortening

3. hard -- sooner or later in ROM than usual, normally soft or firm end feel, bony block

4. spasm -- motion stopped by involuntary or voluntary muscle contraction

5. empty -- no end feel because end ROM never reached due to pain and guarding

what could cause an abnormal soft end feel?

edema or synovitis

what could cause abnormal hard end feel?

loose bodies, fracture

what could cause abnormal spasm end feel?

inflammation, strain, or joint instability

what could cause abnormal empty end feel?

bursitis, fracture

what is the difference between PROM and AROM

PROM the clinician is moving for the patient without muscle contraction, AROM the patient is moving for themselves

what is normal AROM vs PROM findings?

PROM should be > AROM

what should you suspect if AROM is < PROM

muscular weakness or tissue lesion

what should you suspect if PROM = AROM and are deficient?

suspect capsular adhesions or joint tightness

what is the purpose of manual muscle testing?

assess the strength and provocation of pain by relatively isolating the muscle or muscle group

what is a break test?

isometric MMT in joint's mid range

what is the purpose of a break test?

assess muscle pathology vs. injury to non-contractile structure

what is a key difference between manual muscle testing and break test?

break test is isometric whereas MMTs move

how are MMTs graded?

- normal -- 5/5 -- the patient can resist against maximal pressure

- good -- 4/5 -- the patient can resist against moderate pressure

- fair -- 3/5 -- the patient can move the body part against gravity through the full range of motion

- poor -- 2/5 -- the patient can move the body part in a gravity eliminated position through the full range of motion

- trace -- 1/5 -- the patient cannot produce movement, but a muscle contraction is palpable

- gone -- 0/5 -- no contraction is felt

what are upper and lower quarter screens for?

neurological screening

what do upper and lower quarter screens evaluate?

- sensation

- motor function

- deep tendon reflexes

what can upper and lower quarter screens identify?

- nerve root impingement

- peripheral nerve damage

- CNS trauma

- disease

what are indicators during an upper or lower quarter screen?

- numbness

- paresthesia -- pins and needles

- muscular weakness

- pain of unexplained origin

- injury to cervical or lumbar spine

L1

- ASIS

- hip flexion

- no reflex testing

L2

- anterior thigh

- hip flexion

- patellar tendon

L3

- medial aspect of knee

- knee extension

- patellar tendon

L4

- medial lower leg

- ankle dorsiflexion

- patellar tendon

L5

- lateral lower leg and dorsum of foot

- great toe extension

- tibialis posterior tendon

S1

- lateral plantar aspect of foot

- ankle eversion

- achilles tendon

S2

- posterior thigh and posterior lateral heel

- knee flexion

- lateral hamstring tendon

C1-C2

- sides and back of the head

- neck flexion

- no reflex

C3

- neck

- lateral neck flexion

- no reflex

C4

- top of shoulder

- shoulder elevation

- no reflex

C5

- deltoid

- shoulder abduction

- biceps tendon

C6

- lateral forearm, thumb and index finger

- elbow flexion and wrist extension

- brachioradialis tendon

C7

- middle finger

- elbow extension and wrist flexion

- triceps tendon

C8

- medial forearm, ring finger, pinky finger

- opposition

- no reflex

T1

- medial elbow

- finger abduction/adduction

- no reflex

what is a nonunion fracture?

a fracture that fails to heal within 9 months of expected time required

what is a malunion fracture?

a healed fracture that leaves the bone in a functionally unacceptable position

what is the Salter Harris System?

classification based on location of fracture relative to the rest of the bone, the magnitude of fracture lines, and the shape or direction of fracture

what is salter harris type I classification?

fracture extends through the physis, separating the two segments

what is salter harris type II classification?

fracture starts through the physis and ends on the shaft, creating a displaced wedge

what is salter harris type III classification?

the fracture line extends perpendicularly through the joint surface and then transversely across the physis, resulting in a partial displacement of the segment. Growth of the involved physis may be compromised

what is salter harris type IV classification?

similar to type III, but the transverse fracture line extends across the physis into the shaft. Surgical fixation is often required, and physeal growth may be affected

what is salter harris type V classification?

crushing injury compresses the physis. If undetected, avascular necrosis may occur, and growth may be inhibited

what is an avulsion fracture?

tearing away of ligament or tendon from bony attachment

what are signs and symptoms of an avulsion fracture?

- can resemble a sprain

- obvious deformity due to the recoil of large tendons

- pain

- tenderness

what is heterotropic ossification/myositis ossificans?

- formation of bone within muscle belly, fascia and other soft tissues

- occurs secondary to traumatic injury and can lead to compartment syndrome

what is a grade I sprain?

- ligament is stretched with little or no tearing of its fibers

- no abnormal motion

- normal firm end feel

- local pain, mild point tenderness, slight swelling

what is a grade II sprain?

- partial tearing of ligament fibers resulting in joint laxity

- soft but definite end feel

- moderate pain and swelling

- loss of function

what is a grade III sprain?

- complete rupture of ligament causing gross joint laxity

- possible instability or empty end feel

- swelling

- may be limited pain due to nerve damage

- complete loss of function

what are osteochondral defects?

- result from trauma or gradual softening of the underlying bone

- severity is based on depth of defect and proportion of articular surface involved

- partial thickness -- outer layering of articular cartilage

- full thickness -- expose underlying bone

- more challenging if surface is weight bearing

what areas are commonly affected by osteochondral defects?

- talus

- femur

- patella

- capitellum

- humeral head

what is osteochondritis dissecans?

free floating bony fragments within the joint space, not related to a specific trauma

what are signs and symptoms of osteochondritis dissecans?

- joint locking

- loss of ROM

- decreased function

what is a tensile force?

- longitudinal tearing stress

- muscle tissue, ligaments and fascia are most prone to injury as a result of tensile forces

- results from motions that stretch the structure beyond normal limits and exceeds the tissue's tensile strength

- muscle strains are the result of dynamic overload

- muscle is contracting eccentrically while an antagonistic muscle attempts to elongate the muscles

what is a compression force?

stresses applied at each end of a structure

what is an example of an acute MOI compressive force?

FOOSH

what is an example of a chronic MOI compressive force?

vertebral disc herniation from repetitive forces

what is a sheer force?

- occur perpendicularly across the long axis of a structure

- results in transverse fracture of a bone or dislocation of a joint

what is a torsion force?

- occur with twisting forces

- effects are magnified by shoe wear that fixes the foot to the ground

what is an example of a torsion force?

knee rotates during change of direction

what is the most common form of orthopedic injury?

soft tissue pathologies

what is a grade I strain?

- stretching of the fibers or damage to the myofibrils

- trauma to less than 5% of the MT unit

- movement is painful but full range present