Osteomyelitis is inflammation of bone caused by infection. It most commonly affects children under 10 and is usually caused by Staphylococcus aureus. Symptoms include pain, fever, and tenderness. Diagnosis involves cultures, imaging, and biopsy. Treatment involves antibiotics, supportive care, and sometimes surgery. Nursing management focuses on pain control, wound care, monitoring for complications, and ensuring proper rest and immobilization during recovery.
classification of soft tissue injuries. gustilo anderson classification, tscheren classification, hanover fracture scale and ao soft tissue grading system, types of wounds. orthopedic open fracture classification for management of soft tissue injuries
classification of soft tissue injuries. gustilo anderson classification, tscheren classification, hanover fracture scale and ao soft tissue grading system, types of wounds. orthopedic open fracture classification for management of soft tissue injuries
Acute and Chronic Osteomyelitis - Infection of BoneRahul Singh
Acute and Chronic Osteomyelitis - Infection of Bone
http://essentialinspiration4u.blogspot.com
Osteomyelitis is defined as an acute or chronic inflammatory process of bone, bone marrow and its structure secondary to infection with micro organisms.
Duration , Mechanism & Host response.
Duration - Acute / Subacute / Chronic
Mechanism - Heamatogenous (tonsil , lungs , ear/ GIT) - Exogenous (injection , open fractures)
Host response - Pyogenic / Granulomatous
Introduction of bacteria from :
Outside through a wound or continuity from a neighboring soft tissue infection
Hematogenous spread from a pre existing focus (most common route of infection)
1) Subtrochanteric Fracture
Subtrochanteric typically defined as area from lesser trochanter to 5cm distal fractures with an associated intertrochanteric component may be called peritrochanteric fracture.
*Unique Aspect
Blood loss is greater than with femoral neck or trochanteric fractures – covered with anastomosing branches of the medial and lateral circumflex femoral arteries branch of profunda femoris trunk.
2) Femoral Shaft Fracture
Femoral shaft fracture is defined as a fracture of the diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle
The femoral shaft is padded with large muscles.
- reduction can be difficult as muscle contraction displaces the fracture
- healing potential is improved by having this well-vascularized
*Age
-usually a fracture of young adults and results from a high energy injury
-elderly patients should be considered ‘pathological’ until proved otherwise
-children under 4 years the suspected possibility of physical abuse
*FRACTURES ASSOCIATED WITH VASCULAR INJURY
Warning signs of an associated vascular injury are
(1) excessive bleeding or haematoma formation; and
(2) paraesthesia, pallor or pulselessness in the leg and foot.
~Warm ischemia in 2-3H
~If > 6H – salvage not possible
*‘FLOATING KNEE’
Ipsilateral fractures of the femur and tibia may leave the knee joint ‘floating’
3) Distal Femoral Fracture
Defined as fractures from articular surface to 5cm above metaphyseal flare
*clinical feature
The knee is swollen because of a haemarthrosis – this can be severe enough to cause blistering later
Movement is too painful to be attempted
The tibial pulses should always be checked to ensure the popliteal artery was not injured in the fracture.
Reference: Apley's System of Orthopaedic and Fracture (9th edition)
Acute and Chronic Osteomyelitis - Infection of BoneRahul Singh
Acute and Chronic Osteomyelitis - Infection of Bone
http://essentialinspiration4u.blogspot.com
Osteomyelitis is defined as an acute or chronic inflammatory process of bone, bone marrow and its structure secondary to infection with micro organisms.
Duration , Mechanism & Host response.
Duration - Acute / Subacute / Chronic
Mechanism - Heamatogenous (tonsil , lungs , ear/ GIT) - Exogenous (injection , open fractures)
Host response - Pyogenic / Granulomatous
Introduction of bacteria from :
Outside through a wound or continuity from a neighboring soft tissue infection
Hematogenous spread from a pre existing focus (most common route of infection)
1) Subtrochanteric Fracture
Subtrochanteric typically defined as area from lesser trochanter to 5cm distal fractures with an associated intertrochanteric component may be called peritrochanteric fracture.
*Unique Aspect
Blood loss is greater than with femoral neck or trochanteric fractures – covered with anastomosing branches of the medial and lateral circumflex femoral arteries branch of profunda femoris trunk.
2) Femoral Shaft Fracture
Femoral shaft fracture is defined as a fracture of the diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle
The femoral shaft is padded with large muscles.
- reduction can be difficult as muscle contraction displaces the fracture
- healing potential is improved by having this well-vascularized
*Age
-usually a fracture of young adults and results from a high energy injury
-elderly patients should be considered ‘pathological’ until proved otherwise
-children under 4 years the suspected possibility of physical abuse
*FRACTURES ASSOCIATED WITH VASCULAR INJURY
Warning signs of an associated vascular injury are
(1) excessive bleeding or haematoma formation; and
(2) paraesthesia, pallor or pulselessness in the leg and foot.
~Warm ischemia in 2-3H
~If > 6H – salvage not possible
*‘FLOATING KNEE’
Ipsilateral fractures of the femur and tibia may leave the knee joint ‘floating’
3) Distal Femoral Fracture
Defined as fractures from articular surface to 5cm above metaphyseal flare
*clinical feature
The knee is swollen because of a haemarthrosis – this can be severe enough to cause blistering later
Movement is too painful to be attempted
The tibial pulses should always be checked to ensure the popliteal artery was not injured in the fracture.
Reference: Apley's System of Orthopaedic and Fracture (9th edition)
The root words osteon (bone) and myelo (marrow) are combined with itis (inflammation) to define the clinical state in which bone is infected with microorganisms.
Osteomyelitis is an inflammation of bone caused by an infecting organism.
inflammation of bone caused by an infecting organisms. spread through bone to involve marrow, cortex, periosteum and soft tissues surrounding the bone.
it is covering introduction, etiology, clinical manifestations, pathophysiology, diagnostic test fro confirmation, medical management, surgical management and nursing management.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Objectives
At the end of the session participants will be able to :
• define osteomyelitis
• state epidemiology of osteomyelitis
• list types of osteomyelitis
• state aetiology
• describe pathophysiology
• state clinical manifestations
3. Objectives
• describe therapeutic management of osteomylitis
• describe nursing management of osteomyelitis
• list complication of osteomyelitis
• state prevention of osteomyelitis
4. Definition
• Inflammation of the bone caused by an infection,
which may spread to the bone marrow and tissues
near the bone.
• May occur at any age but most frequently is seen in
children 10 years of age or younger.
• S. aureus is the most common causative organism.
• H. influenzae has become a less common causative
pathogen: after Haemophilus influenzae type b
immunization
8. Epidemiology
• The annual incidence of pediatric osteomyelitis is
approximately 13 per 100,000 individuals.
• Osteomyelitis occurs in all patient age groups.
• Osteomyelitis occurs more commonly in males for
unknown reasons.
• Osteomyelitis occurs equally among all races.
• Osteomyelitis is more common in developing
countries.
9. Types
a. Duration of Infection:
• Acute: <2 weeks
• Subacute: 2-6 weeks
• Chronic:
– >6 weeks
– Persistent or relapsed infection
– Infection associated with prosthetic devices
– Histologic evidence of dead or necrotic cortical
bone
10. Cont’d…
b. Mechanism of Infection:
• Hematogenous
• Contiguous source (trauma, nosocomial
contamination following surgical procedure and
extension from adjacent soft tissue infection)
11. Aetiology
Causative Agent
Newborns
• Staphylococcus aureus
• Group B streptococcus
• Gram-negative enteric rods
Infants
• S. aureus (methicillin-sensitive S. aureus 70,
methicillin-resistant S. aureus 30)
• Haemophilus influenza
12. Contd…
Older Children
• S. aureus
• Pseudomonas organisms
• Salmonella organisms
• Neisseria gonorrhoeae
Adolescents and Adults
• Pseudomonas organisms
• Mycobacterium tuberculosis
13. Contd…
Acute hematogenous osteomyelitis: bloodborne
bacterium causes an infection in the bone.
Examples: Pneumonia, urinary tract infection
Exogenous osteomyelitis: direct inoculation of the
bone from a puncture wound, open fracture, surgical
contamination, or adjacent tissue infection.
14. Contd…
• Person with immunosuppression, and malnutrition
are at risk
• The body part most commonly affected include the
foot, femur, tibia, and pelvis.
15. Pathophysiology
Bacteria adhere to bone.
Suppurative infection with inflammatory cells,
edema, vascular forming an abscess.
Formation of Sequestrum and subperiosteum
abscess
16. Contd…
New bone (involucrum) is formed along the live
bone and infection borders.
Sinus tracts from perforations in the involucrum
may drain pus
19. Contd…
The pathology is different in infants, children older than
1 year of age, and adults.
In infants:
• blood vessels cross the growth plate into the
epiphysis and joint space
• infection spread into the joint.
In children:
• infection is contained by the growth plate
• joint infection is less likely
20. Clinical Manifestations
• Severe pain
• Fever
• Irritability
• Tenderness with or without local signs of
inflammation.
• Resist movement.
• In infants these symptoms may be minimal or absent
• Pus discharge may be present from infected side
21. Contd…
• Infants may have an adjacent joint effusion
• More than one bone may be affected.
22. Diagnostic Evaluation
• Obtain cultures of : subperiosteal pus along with
cultures of blood, joint fluid, and infected skin
samples.
• Bone biopsy
• CBC: leukocytosis
• Elevated erythrocyte sedimentation rate
23. Contd…
• Elevated C-reactive protein.
• A three-phase technetium bone scan
• CT can detect bone destruction
• MRI provides anatomic details of the area of
involvement
24. Therapeutic Management
Analgesic and antipyretics for symptomatic
management.
Supportive Care:
• Adequate rest and immobilization of part
• Nutritious diet
• Wound Care
• Maintenance of hydration
• Ambulation and exercise
25. Contd…
After culture specimens are obtained, empiric
therapy is started with IV antibiotics.
• For S.aureus nafcillin or clindamycin is generally
used.
• Methicillinresistant S. aureus may require
vancomycin.
• Antibiotic is initiated and continued for at least 4
weeks
26. Contd…
It is important to monitor for hematologic, renal,
hepatic, ototoxic, and other potential side effects.
Surgical Procedure:
Sequestrectomy and surgical drainage to decompress
the metaphyseal space before pus erupts and
spreads to the subperiosteal space.
28. Contd…
Nursing Diagnosis
• Hperthermia related to infection
• Acute pain related to inflammation of bone
• Impaired mobility related to pain and tenderness
• Impaired skin integrity related to open skin wound
• Anxiety related to medical procedure, prolong
hospitalization
29. Contd…
Nursing Intervention
The child is positioned comfortably with the affected
limb supported.
The child may require pain medication ,sedation and
antipyretics.
Take vital signs and record them frequently.
30. Contd…
Antibiotic therapy requires careful observation and
monitoring of the IV equipment and site.
The stability of the drugs and their toxic nature are
also considered when determining the rate of
administration.
For long-term antibiotic therapy, a venous access
device, such as a peripherally inserted central
catheter is preferred.
31. Contd…
The wound is managed according to the provider’s
directions.
The amount and character of drainage on the wound
dressing are also noted.
Intake and output are measured and recorded, and
the character of both the wound and drainage is
noted.
Use aseptic technique while doing invasive
procedure.
32. Contd…
As the infection subsides, physical therapy is
instituted to ensure restoration of optimum function.
Provide age appropriate play therapy to children
Provide emotional support to parents.
Family centred care
Home care management
34. Complications
• Bone death (osteonecrosis).
• Septic arthritis
• Impaired growth
• Skin cancer
• Fracture
35. Prevention of Osteomyelitis
• Take precautions to avoid cuts, scrapes and animal
scratches or bites.
• Clean the injured area immediately and apply a clean
bandage.
• Check wounds frequently for signs of infection.
• Treat hematogenous infection initially.
36. Summary
Inflammation of the bone caused by an infection.
Aetiology:
• Hematogenous: S. aureus, H. influenzae
• Contiguous
Types: Acute(<2weeks), Subacute(2-6weeks),
chronic(>6weeks)
Management: Symptomatic Management,
Antibiotics, Sequestrectomy
39. References
• Hockenberry, M.J., Wilson, D. and Rodgers,C.C. (2018).
Wong’s Essentials of Pediatric Nursing. 2nd ed. India: Reed
Elsevier.
• Uprety, K. (2018).Essential of Child Health Nursing. 1st
edition. Kathmandu: Akshav Publication.
• Shrestha, T. (2016). Essential Child Health Nursing. 2nd
edition. Kathmandu: Medhavi Publication.
• Kyle, T. and Carman, S.(2013). Essentials of Pediatric
Nursing.2nd edition. Philadelphia:Wolters Kluwer Health.
• Ball, J., Bindler, R., Cowen, K., Shaw, M.(2017). Principles of
Pediatric Nursing. 7th edition. America: Pearson Education.
40. References
• C. Michael Gibson.(2020). Osteomyelitis
epidemiology and demographics. Retrived on
20/8/2020 from
Gibsonhttps://www.wikidoc.org/index.php/Osteomy
elitis_epidemiology_and_demographics#:~:text=Inci
dence%20of%20osteomyelitis%20is%20approximatel
y,is%20most%20common%20in%20adults.
