TIA

TIA = transient ischaemic attack

Briefl focal loss of function with full recovery occuring in 24hrs

5-10% of people who experience this will go on to have a stroke.

STROKE

A stroke is also known as a CEREBROVASCULAR ACCIDENT (CVA)


It usually results in HEMIPLEGIA (paralysis to one side of the body) which is contralateral to the side of the brain in which the lesion occurs e.g. stroke on L = hemiplegia on the R

An interruption of blood flow to the brain leaves the patient with a focal loss of function of varying severity.

Motor deficit is the the most common but other neurological deficits can include:

• Visual
• Perceptual
• Sensory
• Communication
• Swallowing

84% of strokes are ISCHAEMIC in origin

• Cerebral thrombosis (mainly affects older population with Hx of high cholesterol)

When a thrombus (blood clot) develops in a cerebral artery (usually one affected by atherosclerosis)

• Emobolic (mainly affects those with heart disease/previous heart surgery)

When a clot forms elsewhere in the body and becomes lodged in a cerebral artery

16% of strokes are HAEMORRHAGIC in origin

Major Risk Factors:

• Hypertension
• Raised cholesterol
• Cardiac disease
• Diabetes
• Smoking
• Atherosclerosis

Minor Risk Factors:

• Obesity (too much Maccie Dees!)
• Physical inactivity (being a lard arse!)
• Contraceptive pill (use a condom!)
• Excessive alcohol consumption ('boozing'!)

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/ischemic-stroke/

ISCHAE

Finding the culprit

Yesterday's physio session at Ox city after the game revealed a new lesson after discussion with Leigh.

Player comes in complaining of tightness in anterior proximal thigh.

Q. Which muscle is it?

Process: Think what's likely to be tight in footballers? Running. What muscles originate from that area?

A. Narrowed it down to rec fem and sartorius. You had to palpate deep but resisted isometric strength test for sartorius came out on top. Resisted hip flexion did not.

The process of elimination!

I was helping out at Ox city footy club again earlier this week and we came across an acute adductor strain. When trying to diagnose which adductor muscle it was I was given a handy tip by Leigh:

"it's easier to cross off all the one's it's not than try to immediately pick which one it is"

Turned out to be adductor magnus after I'd originally guessed gracilis. When I thought about it, you could quickly cross off pectineus and brevis because they're only one joint muscles and much higher up than where the patient was complaining. Longus potentially but the magnus 2 heads:

Oblique head
ORIGIN: inferior ramus of pubis & ischial ramus
INSERTION: gluteal tuberosity, linea aspera, proximal supracondylar line of femur

Vertical head (hamstring head)
ORIGIN: ischial tuberosity
INSERTION: adductor tubercle

Remember that anatomically speaking the oblique head FLEXES & ADDUCTS the thigh @ hip
(much like pectineus) and the vertical head EXTENDS thigh at hip (like a hamstring!)

The important thing to remember though is that these muscles work differently in function, but that's for another day.

Bronchiectasis

Classed as an obstructive lung disease in which there's localised irrevisble dilation of the bronchial tree.

Involved bronchi DIE! ... By which I mean the bronchi are:

DILATED
INFLAMMED
EASILY COLLAPSIBLE

This results in:

• Airway obstruction
• Impaired clearance of secretions

http://www.youtube.com/watch?v=zMKaJEgmTT4

Causes:
Necrotizing (flesh eating) bacterial infection

S&S:
Look for frequent GREEN/YELLOW SPUTUM
Smell for bad breath
Productive cough

Frozen Shoulder aka Adhesive Capsulitis

Mr. Francis Lam is an upper limb surgeon and shoulder consultant, he gives some really great explanations on frozen shoulder in a simple easy to understand way.

Q. What is frozen shoulder?
A. Essentially a chronic fibrosing condition in which fibroblast cells become overactive and lay down abnormally thick layers of collagen causing marked thickening of the shoulder joint capsule. The capsular lining of the joint subsequently contracts and leads to shoulder joint stiffness and pain.

Q. What are the features of frozen shoulder?
A.

• Slow onset of pain felt near insertion of deltoid
• Trouble sleeping on affected side
• Restriction in both active and passive elevation & external rotation

Q. What's the difference between primary and secondary frozen shoulder?

http://www.shoulderspecialist.org/Frozen_Shoulder.html

See also Bowen technique

ABG's Normal Values

Interpreting ABG's is an important especially if working in a respiratory setting, but to recognise abnormalities you need to know the normal values of blood gases.

pH - 7.35 - 7.45

pCO2 - 4.7 - 6.0 kPa (35-45 mmHg)

pO2 - 11 - 14 kPa (80-100 mmHg)

HCO3 (bicarbs) - 22 - 26 mmol/l

BE (metabolites) - +2 - -2