Classifications for PTP3

AHA classes of HF

A: at risk; no sx yet but might have risk factors

B: Pre HF; no sx, but they have structural disease or increased filling pressures

C: symptomatic HF; currently or previously have had sx

D: Advanced HF; sx have taken over their life

NYHA classes of HF

I: no limit of PA, no sx

II: slight limitation of PA, ordinary PA causes sx no sx at rest

III: marked limitation of PA; less than ordinary PA causes sx, no sx at rest

IV: sx at rest, worse with activity

phases of cardiac rehab

1: acute

2: early outpatient or cardiac rehab

3: transition from CR to home

4: independent long term maintenance

heart block poem

- If R is far from P = first degree

- longer longer longer drop = wenkebach

- if some Ps don't get through = mobitz II

- If Ps and Qs don't agree = third degree

CBABE

chronic bronchitis

bronchitis

asthma

bronchiectasis

emphysema

blue bloaters vs pink puffers

blue: COPD

pink: emphysema

CURB-65 scale

risk stratification for CAP

- confusion

- BUN >20mg/dl

- RR >30/min

- BP

GOLDMARK

* causes of high anion-gap metabolic acidosis

glycols

oxyproline

lactate

dlactate

methanol

aspirin

renal

ketones

for low anion gap acidosis, what are the primary DDX

kidney failure

chronic diarrhea

criteria for POTS

- within 10 min of standing or head-up tilt: HR increases 30 bpm in adults or 40 bpm in adolescents

- no OH

- sx present for at least 3 months

SIRS criteria

pt has to have at least 2 specific abnormal vital signs or lab results

- temp >100.4 or

surface landmarks for margins of the lung

upper portion:

- anteriorly: 1 inch above clavicle

- posteriorly: anything above T3

lower portion

- anteriorly: level of 6th rib

- laterally: level of 8th rib

- posteriorly: below T3

middle lobe

- between 4th & 6th ribs

auscultation of heart sounds

a. 2nd intercostal space (R lateral sternal border)

b. 2nd intercostal space (L lateral sternal border)

c. 4th intercostal space (either L or R lateral sternal border

d. 5th intercostal space (mid clavicular line)

chest excursion measurements for the 3 lobes

upper: 1 inch

middle: 1.5 inches

lower: 1.5-2 inches

stages of healing

1. hemostasis - days 1-2

2. inflammation - days 3-7

3. proliferation - days 4-21

4. remodeling - day 21-1yr

classification to predict outcomes of wounds

1: uninfected - no s/s

2: mild - 2+ of the following: swelling, erythema >0.5 but

wound part of WIFI (wound, ischemia, & foot infection) for threatened lower limbs, assessing risk of amputation

wound:

- 0 = no ulcer/gangrene

- 1 = small/superficial ulcer, no gangrene

-2 = deep ulcer, gangrene only in digits

-3 = deep extensive ulcer, extensive gangrene

foot part of WIFI (wound, ischemia, & foot infection) for threatened lower limbs, assessing risk of amputation

0: ABI >0.8, ankle SBP >100 mmHg

1: ABI 0.6-0.7, ankle SBP 70-100 mmHg

2: ABI 0.4-0.59, ankle SBP 50-70 mmHg

3: ABI

ischemia part of WIFI (wound, ischemia, & foot infection) for threatened lower limbs, assessing risk of amputation

0: uninfected

1: mild local infection

2: moderate local infection

3: severe local infection with signs of SIRS

classification for skin tears

type 1: no skin loss (flap can go back over wound)

type 2: partial flap loss (flap can't cover whole wound)

type 3: total flap loss (entire wound bed is exposed, whole flap gone)

5Ps for acute compartment syndrome

pain, paresthesia, pallor, paralysis, pulselessness

Wagner classification

0: skin intact, bony deformities lead to foot at risk

1: superficial partial thickness

2: deep full thickness (reaches lig, tendon, bone)

3: full thickness with infection (abscess, osteomyelitis, joint sepsis)

4: partial gangrene

5: extensive gangrene

Rutherford classification

(arterial ulcers)

0: asymptomatic

1: mild claudication - walking pain

2: mod claudication - walking pain

3: severe claudication - walking pain

4: ischemic rest pain

5: minor tissue loss - small ulcers

6: major tissue loss - extensive ulcers/gangrene

CEAP

(venous ulcers)

C0: no visible/palpable veins

C1: telangiectasia - spider veins

C2

a: varicose veins - asymptomatic

b: varicose veins - symptomatic

C3: edema

C4: skin damage/pigmentation changes

C5: healed venous ulcer

C6: venous ulcer

braden scale

pressure wound risk

6 risk factors: sensation, moisture, PA, mobility, nutrition, fricken/shear

graded 1-4

13-14 = mod risk

10-12 = high risk

6-9 = severe risk

NPUAP pressure wound staging

1: skin intact, non-blanchable erythema

2: partial thickness, superficial

3: full thickness, no exposed muscle/tendon

4: full thickness, deep ulcer, exposed muscle/tendon, etc

unstageable: full thickness but base obscured by eschar or slough

burn degrees

1st: superficial (epidermis only)

2nd: deep (epidermis, papillary dermis) - blisters, waxy white/red

3rd: full thickness - blisters, weeping, painful

4th: full thickness - leathery eschar

burn rule of 9s

head/neck: 9% (each side 4.5)

each UE: 9% (each side 4.5)

anterior trunk: 18%

posterior trunk: 18%

each LE: 18% (each side 9)

balls: 1%

Jackson's thermal zones for burns

zone of coagulation

zone of stasis

zone of hyperemia

contraindications for ESTIM

Defibrillator

Arrhythmia

Pacemaker

Over carotid sinus

Over DVT

Pregnancy

precautions for ESTIM

Cardiac disease

Impaired sensation/ment.

Skin irritation

Malignancy

Open wounds

contraindications for ultrasound

Pacemaker

Over eyes

Over CNS tissue

Pregnancy

Malignancy

Arrhythmias

Reproductive organs

Thrombophlebitis

Joint cement

Compromised arterial circulation

Plastic components

precautions for ultrasound

Breast implants

Epiphyseal plates

Acute inflammation

Fracture

contraindications for laser

Hemorrhage

Over thyroid/endocrine glands

Malignancy

Eyes

Radiation

Low back if pregnant

precautions for laser

Photophobia

Impaired sensation/ment.

Pretreatment with photosynthesizers

Epiphyseal plates

Hoehn and Yahr stages

1: unilateral only

1.5: unilateral + axial

2: bilateral, no balance impairments

2.5: bilateral, mild balance impairment, recovery on pull test in 1-2 steps

3: bilateral, no recovery on pull test (3+ steps)

4: severe balance impairment but still ambulatory

5: wheelchair or bed bound

clinically established vs clinically probable PD

established: absence of absolute exclusion criteria, at least 2 supportive criteria, no red flags

probable: absence of absolute exclusion criteria, presence of red flags counterbalanced by supportive criteria

supportive criteria for PD

- responds well to levodopa/carbidopa

- presence of levodopa induced dyskinesia

- resting tremor

- + results from at least 1 diagnostic test of PD

absolute exclusion criteria for PD

- unequivocal cerebellar abnormalities

- downward vertical supra nuclear gaze palsy

- parkinsonian sx only in legs for 3 yrs

- taking meds that could induce parkinsonism

- no response to levodopa

- progressive aphasia

- cortical sensory or motor planning problems

- normal dopamine imaging

- another likely cause

PD 521 rule

to determine when their meds need to be increased

- taking it 5 or more times a day

- 2 or more hours of off time each day

- 1 or more hours of dyskinesias each day

rigidity scale

0: absent

1: slight, questionably present

2: mild to moderate

3: marked, but full ROM achieved easily

4: severe, full ROM achieved with difficulty

scoring for pull test

0: recovers in 1-2 steps, or ankle strategy

1: 3 ore more steps but recovers independently

2: retropulsion, needs to be assisted to prevent fall

3: very unstable, loses balance spontaneously

4: unable to stand without assistance

BEFAST screening

B: balance

E: eyes, changes in vision

F: facial drooping

A: arm or leg weakness

S: speech, difficulty speaking

T: time to call 911

5Ds of posterior stroke

dizziness

diplopia

dysarthria

dysphagia

dyslexia

modified ashworth scale

0: no increase in tone

1: catch and release, or minimal resistance at end ROM

1+: catch followed by minimal resistance through less than half the ROM

2: tone through most of the ROM

3: considerable increase in tone making passive movement difficult

4: rigid, can't move it

brunnstrom stages of stroke recovery

1: flaccidity

2: spasticity develops, limb synergies appear

3: spasticity reaches peak

4: spasticity begins to decline, starting to get out of the limb synergy

5: muscle synergies lose their dominance entirely, spasticity keeps decreasing

6: spasticity disappears, coordination approaches normal

7: full recovery

reflex grading scale

0 = no response

1+ = slight reflex, low normal

2+ = normal

3+ = brisk reflex, possibly but not always abnormal

4+ = very brisk reflex, abnormal, clonus

10 principles of neuroplasticity

use it or lose it

use it and improve it

salience matters

age matters

timing matters

interference

transference

repetition

specificity

intensity

BNP for HF

class 1 =

MONATAS

Morphine

Oxygen

Nitrates

Aspirin

Thrombolytics

Anticoagulants

Stool softeners

Sedatives

monofilament scale

4.17 - 1g pressure, decreased sensation

5.07 - 10g pressure, loss of protective sensation

6.10 - 75g pressure, absent sensation

pitting edema scale

1+ = 2mm depression, rebound immediately

2+ = 3-4mm depression, rebound in 15 sec or less

3+ = 5-6 mm depression, rebound in 60 sec

4+ = 8mm depression, rebound in 2-3 min

pulse grading

0 = absent

1+ = thready

2+ = weak

3+ = normal

4+ = bounding

5 steps of graft healing

1: adherence

2: imbibition - graft absorbs nutrients and oxygen from wound bed

3: inosculation - vessels within graft connect with vessels in wound bed

4: revascularization - graft begins to develop own blood supply

5: remodeling: collagen reorganized, nerve endings regrow, color stabilizes

rigidity scale

0 = no involvement

1 = rigidity slight or detected only with activation

2 = rigidity is mild to moderate

3 = rigidity is marked, but full ROM easily achieved

4 = rigidity is severe, ROM achieved with difficulty