Lower Limb Amputation

1) Hemipelvectomy
     Also called hindquarter amputation, which involves the excision of part of the pelvic bone

2) Hip disarticulation 
    Which is the amputation of the limb at the hip level

3) Transfemoral amputation (Above Knee Amputation)

4) Knee disarticulation

5) Transtibial amputation (Below Knee Amputation) 

6) Syme amputation 
     Amputation at the level of the ankle joint, where the heel pad is preserved to provide 
     a platform for weight bearing

7) Amputation of the foot: 
    Amputation is performed at the mid-foot, it is called a Chopart 
    Amputation near the metatarsal is called a Lisfrance
    Amputation through the metatarsal bones is called a Transmetatarsal amputation
    Amputation of toe(s) plus part of metatarsal bone(s) is called Ray Amputation

8) Disarticulation of Toe(s)

Algorithm Management of Diabetic Foot Patient

* cut & paste from Malaysian Diabetic Foot CPG

Types of Brian Herniation

Supratentorial herniation

1-Uncal 

2-Central (transtentorial) 

3-Cingulate (subfalcine) 

4 Transcalvarial 

Infratentorial herniation

5-Upward (upward cerebellar or upward transtentorial) 

6 Tonsillar (downward cerebellar)

Proper X-Ray of Fractured Bone Must Have?

* Rules of 2

1) 2 View --> AP & Lateral View
2) 2 Joints --> prox & distal
3) 2 Limbs --> in children particularly
4) 2 Injuries --> exclude injuries elsewhere
5) 2 Occasion --> repeat 1/ 2 weeks later

Obstetric Ultrasound

1^st Trimester (10-14 weeks)

-          Viability

-          Dating scan (CRL)/ REDD (if diff > 7)

-          Gross anatomy – anencephaly, cystic hygroma, bladder outflow obstruction

-          Multiple pregnancy – chorionicity, amnionicity

2^nd Trimester (18-24 weeks)

-          Dating Scan (Biparietal diameter/ Head circumference)/ REDD (if diff >14)

-          Structural anatomy – brain, face, heart, kidneys, abdomen, spine, hands, feet, genitalia, bladder

-          Fetal growth – IUGR/PE/Oligo

-          Fetal Sex – 99% accuracy

-          Placental site – recheck @ 34 weeks

3^rd Trimester

-          EFW: FL, AC, BPD

-          Fetal Progression, well being, presenting part

-          Placenta Location (> 28 weeks) 

List Of Medical Problems in Preterm Baby

1) BRAIN
    - Interventricular Hemorrhage

2) EYE
    - Retinopathy of Prematurity

3) RESPI
    - ARDS
    - Pneumothorax
    - Bronchopulmonary Dysplasia

4) CVS
    - PDA

5) GIT
    - GERD
    - Jaundice

6) METABOLIC
    - Hypoglycemia
    - Hypothermia
    - Hypocalcemia
    - Malnutrition --> Need more
    - Anemia

7) IMMUNOSUPRESSED
    - Risk of Infection

HyperKalemia VS HypoKalemia

* Normal Serum  K⁺ : 3.5 - 5.0 mmol/L