In the POP room

Posted: November 25, 2011 by gerardloh in Orthopaedics & Traumatology

CMR and POP

CMR under sedation (prepare in 5cc syringe)

* request drugs from sister or staff nurse, return ampule to sister!

 

Sedation  
1) Midazolam 1ml + 4ml H20 (1cc=1mg)

Adults give 2.5cc (half ampule/2mins)  Peds : 0.1mg/kg

(antidote = flumazenil 0.02mg/kg) 1 amp

2) Pethidine 1ml + 4ml H2O (1cc=10mg)

Adults give ½ dose 2.5cc over 2 mins   Peds: 1mg/kg
(antidote = naloxone: 0.01mg/kg) 1 amp

Peds dose:
20kg = 1 cc
30kg = 1.5cc
40kg = 2cc
50kg = 2.5cc
max 2.5 cc in 2 minutes


Post POP xray

Normal values:
1. Radial height = 10-13mm

2. Radial tilt 11 (2-20)

3. Volar tilt 10 degrees

4.  Radial Inclination = 21 -25 degrees


POP

1. prepare 2-3 rolls POP, orthoban, prepare bucket of warm water

2. apply orthoban around hand starting distal to proximal

3. dip plaster in water until bubbles disappear

4. apply POP, starting from distal to proximal (max around hand 2 layers only)

5. smoothen the plaster and press on affected part to fix plaster (moulding)

6. make sure 90degrees (AEPOP)

7. Perform post POP Xray!!!

Back slab

1. Take plaster and measure length required (from below MCPJ to cubital fossa)

2. Place orthoban, slightly longer than plaster (for folding)

3. Start layering plaster (up to 15 layers)

4. Prepare a pail of water, fold and dip plaster in water, going in at angle of 45 degrees, until bubbles disappear

5. Remove from water and squeeze lightly excess water from plaster using 2 fingers

6. Place plaster on orthoban, smoothen the plaster and fold edges of orthoban on to the plaster (sandwich)

7. Place this sandwich  with orthoban contacting skin

8. Smoothen the plaster to fit limb

9. Wrap with Crepe bandage starting from proximal end to distal.

10. Secure with tape and allow to dry

 

Volar slab

1. Position patient’s hand with wrist extended 45 degrees and fingers pointing at 90 degrees

2. Measure length from DIPJ to cubital fossa

3. Layer up to 15 layers of plaster and place on slight longer orthoban

4. Submerse in water at a 45 degree angle until bubbles disappear, squeeze and place on orthoban

5. Sandwich the plaster and orthoban

6. Place sandwich, hand first, making sure the angles are kept

7. Wrap with crepe bandage

POP

1. Start by bandaging with Orthoban, from distal to proximal, overlapping 1/3

2. Hold on to one end of plaster and Submerse whole roll of plaster in water, squeeze slightly

3. Start bandaging plaster over the orthoban from wrist to hand, then to proximal, overlapping 1/3

4. Smoothen the plaster and apply next roll. The wrist should be square shaped, and the proximal end spherical

POP advice

1. Do not wet, draw, spoil POP
2. Do not put long objects inside/scratch
3. TCA stat if pain/numbness/blue

Comments
  1. loshini says:

    hahhaha… good one😉

  2. sudhirian says:

    hey gerard good write up, you need to add in one extra thing for the radial/ulna/wrist joint normal values which you have put under post POP x-ray which is the radial ulna step off and gap displacement which is normally 2mm, if greater then it needs intervention, but usually this is hard to evaluate if not obvious in a normal X-ray due to the operator’s experience in producing a credible X-ray, which is rarely the case. Most of the time this kind of deformity is overlooked and is thought to be a normal X-ray of the wrist and patient is sent back home.

    Info from one of my senior MOs when i was having a teaching session. Hope this helps. Cheers.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s