GoTthemedSG (PDF)

_________________________________________________________________________________________________________

OSTEOGENESIS IMPERFECTA: WHITE WALKERS
-Dominant congenital disorder of collagen synthesis
-AVOID steroids, Rotation, long lever arms
-DO educate on handling, increase bone mass

*Triangle face, blue eyes,
Type 1: Mildest form with normal growth (into
adulthood),
Type 4: Moderate with Fxs prior to adulthood
Type 3: Moderate to Severe, thick skull, and increased
osteoporosis

 Type 2 is the worst: Death by childhood

^^ Osteoporotic and fractures
easily

SPINAL CORD INJURY: BRAN
-T12 complete resection of Spinal Cord (named for highest level of motor function)
-Spinal Shock=complete cessation of motor function below lesion for several days
-ASIA A likely, no sensation or motor function below level of insult
-Independent with Bed mobility, WC mobility (no curbs), feeding
-High risk for pressure soresWeight shift 15mins, Position Change 2 hours, DVT
-Work on Functional mobility and independence with ADLs
-Methylpredisone within 8 hours in order to decrease necrosis in SC due to
inflammation

HYPOPITUITARISM: TYRION
-Decreased secretion of hormones from the Anterior Pituitary
-Results in Dwarfism, decreased growth and development
-At risk for Diabetes Insipidus: “I Drink and I know Things”
-Rare disorder

CUSHINGS SYNDROME: SAM
-Hyperfunction of the Adrenal Gland or Long term Glucocorticoid drugs
- Increased ACTH
-Hyperglycemic, “Moon Face”, “Buffalo Hump” and weakness, Trunkal
Obesity
-Treatment to block production of hormones
-Prolonged use of glucocorticoids (prednisone) predisposes individuals
for osteoporosis, increased risk of infection (depresses immune
response) and slows healing time down.
-Also increases BP

HYPERPITUITARISM: WUN WUN
-Excessive secretion of growth hormonesAcromegaly
-Often times due to tumor on the pituitary gland resect
-Enlargement of hands, face, excessive bone thickness
-Treatment can stop progression but physiologic changes are permanent

TURNER SYNDROME: ARYA
Turner Syndrome/ Female Hypogondism
-Decreased production of sex hormones LH & FSH
-Female patients look much younger
-Short stature, and failure to go through puberty
-Hormone replacement therapy

MALE HYPOGONADISM: VARYS
-Klinefelters syndrome: decreased production of testosterone due to testes not
responding to LH/FSH (or Eunuchs)
-Can also be due to failure of Pituitary/HypoThal to secrete Lh/FSH
-Decreased Body Hair, underdeveloped muscles/bones
-decreased libido, Erectile Dysfunction, Infertility

FULL THICKNESS/ SUBDERMAL BURN: VISERYS
-Complete destruction of entire epidermis, dermis (Full thickness) and
Subcutaneous tissue (Subdermal)
-Minimal pain due to loss of nocicoceptors, Eschar tissue
-Requires grafts in order to heal, prone to contractures, hypertrophic scarring
-Compression of 20-30mm to decrease scarring
^Deep Partial Thickness: Surrounding areas will have significant Edema,
moderate levels of pain
-21-35 days to heal, broken blisters

TRAUMATIC AMPUTATION: JAMIE LANNISTER
Wrist Disarticulation relatively uncommon level of amputation
-Poor cosmesis and poor function
*Kingslayer should have requested amputation five centimeters proximal to the distal
radius
-Transradial Amputations=most common level of UE amputation
-Functionally preferred to wrist amputation
-Diagonal wrapping patterns with compression distally
-Proper fitting of prosthesis for improved function and cosmesis

PSORIASIS AND SKIN CONDITIONS: STANNIS’ DAUGHTER
(credit-Nicole)
Psoriasis: Scaly skin/rash from immune response and often times can involve the joints,
inflamed tendons,
-10% have arthritis joint involvement

Cellulitis: Bacteria enters compromised skin and produces redness, swelling, pus, fever,
chills, and general fatigue.
-Common side effect of lymphedema
Dermatitis: Irritation of the skin producing rash, itching, and hives.
-Associated with allergic reaction, NO Fever

OSTEOPOROSIS: (OLD) LADY MELISANDRE
-Thinning of bone in postmenopausal women (trabecular) or geriatrics (Cortical)
-Risk increased in thin, older, Caucasian women (and 400 year old witches)
-Also can be caused from glucocorticoids use
-Diagnosed via Bone Density Scan (T Score < -2.5)
-Promote weight bearing activities at low level (walking),
-AVOID Flexion, heavy resistance, ballistic movements
-Calcium supplements

SEIZURE/STROKE: HODOR
- Frontal lobe Infarc Altered mental ability and decreased cognition
-Preseveration (HODOR HODOR), Akinetic Mutism,
-Expressive Aphasia, possibly to Brocas region (MCA)

-Seizure: Interrupted brain function, common in Epilepsy
-DO remove all unsafe objects from a patient when they are having a
seizure, Position in SideLying (Per the PEAT)
-DO NOT: hold them down, depress their tongue.
-Penobarbital and Phenytoin to reduce seizures (but can be sedative)

WOUNDCARE: KHAL DROGO
Healing of wounds is phase based and may overlap:
-Inflammatory (1-10) clots and restores homeostasis Proliferative (3-21)
begins new tissue formation Maturation up to 2 years
-Primary intension: heals occurs with minimal tissue loss, whereas
Secondary intension allows granulation tissue to fill in wounds that cant
approximate
 Full thickness wound: extends through the epidermis and dermis but not
into bone or tendon (secondary intention to heal)
-Dressings applied to improve healing: Use the Hydros to keep dry wounds moist; Foam and Alginates to absorb drainage
-For infections: Silver or Iodine for anti-microbial properties; Infection SepsisNew Khal

SPOILER: BRAN STARK GETS A WHEELCHAIR
Does it fit him properly?
-Depth measured from posterior buttock to popliteal fold MINUS 2in
-Width: Widest aspect of buttocks/hips PLUS 2 in
-Height: Seat to Bottom of Axilla MINUS 4 in (Brans might be a little too high)
-Armrest: Height of olecranon PLUS 1in
-Considerations: This is Brans primary transport, so it should be both
lightweight and nonfolding to increase durability
-Small diameter handrims for fast propulsion
-Winter tires? WINTER IS HERE

ARTHRITIS: MAESTER PYCELLE & DORAN MARTELL
 Osteoarthritis: degenerative changes in articular cartilage common in those
55 years old and above
-Persistent pain, loss of range of motion, impaired mobility
-The maester may have had some psychosocial aspects to his pain, as he is
frequently seen “malingering” and walking around fine when no one is looking

 Gout (A form of arthritis) was capable of disabling the prince of Dorne
-Occurs due to Uric Acid buildup in the blood which crystalizes in joints
-Most often occurs in the Big toe
-Marked by redness, extreme pain, swelling
-Patients may walk with an antalgic gait, and will benefit from NSAIDS

MAESTER AEMON: DEMENTIA & PNEUMONIA
-Most common form is Alzheimers, characterized by progressive decline in
cognitive function due to loss of Acetylcholine producing NTs
-20% of individuals over 80 will become diagnosed
-End stage=loss of most ADLs: incontinence, inability to speak, aphasia
-Most die due to infection (Aemon Targaryen died of a nasty “Chill”)

PULMONARY DYSFUNCTIONS: KING JOFFREY
- “The Strangler” closed Joffreys airways causing bronchospasm of the airways
-Wheezes would likely be heard during auscultation as turbulent
airflow attempts to enter the lungs
-Eventual collapse of the lung (atelectasis)=decreased breath sounds
but increased fremitis (as would pulmonary Edema and consolidation)
-Pulmonary disorders are most common reasons for clubbing of the nails
-Had anyone wanted to save lil’ Joffrey, the CPR steps are as follows: Alert the
Maesters for EMS responseOpen the Airway2 rescue breaths followed by
30 chest compressions
-Mouth to mask precautions, specially when the king is coughing up
blood

HAPPY STUDYING AND GOOD LUCK ON TUESDAY