Seorang bayi yang baru lahir dirujuk ke klinik orthopedik kerana mengalami Corgenital talipes Equino varus (CTEV) di kedua-dua kakinya.

Huraikan menifestasiklinikal CTEV (6 markah)

Patofisiology dan ciri klinikal
Bila soft tisu pada bahagian medial tibia terbantut dan pendek dari normal. Kaki akan adduction ke dalam anterior tasal joint, ke mid tasal sub talar akan invertion. Ankel akan jadi planta flextion dibahagian distal tibia fibular slight inverted.


Ciri-ciri
Invertion
Adduction
Planta flextion


Kedudukan kaki kelihatan deformiti
Foot planta flexion
Fore foot adduction
Tumit kelihatan kecil dan tinggi
Betis kelihatan mengecil (atrophy)

Sebab-sebab CTEV

Unknown
Faktor genetik
Malposition jani semasa dalam uterus breech
Kegagalan perkembangan dan pertumbuhan otot posterio, media dibahagian betis semasa didalam kandungan ada juga ganguan di dalam pembesaran tulang di bahagian ini seperti tibia fibular dan talus.

Huraikan teknik reduksi dan pemasangan kas untuk keadaan ini (8m)

Betulkan deformity mengikut peringkat
Reduksi mengikut kedudukan inversion kepada eversion (serial casting)
Pemasangan kas 1/52 TCA 2/52
Rekod setiap perkembangan
Betulkan kedudukan adduction ke abduction (casting serial ) 1/25 TCA 2/52
Betulkan kedudukan planta flexion kepada dorsi flexion (serial casting) 1/52 TCA 2/52 rekod setiap perkembangan dalam buku.

Pengurusan bayi
Baru lahir pasang FLPOP dengan segera (1 bulan)
Tukar kas setiap minggu
Pemeriksaan oleh pakar setiap 2/52 untuk 2/12
Teruskan pemasangan serial casting dan tukat setiap minggu
Periksa oleh doktor pakar setiap bulan selama 3/12
Selepas bayi 3/12 lihat perkembangan yang dilakukan.
Jika rawatan berjaya pemasangan denis brown splint dipakai selama 24 jam sehingga 1/12
Pemeriksaan setiap bulan dilakukan jika abdnormal berulang pemasangan serial kas untuk 3/12 tetapi perlu ditukar setiap 2/52.
Apabila pesakit mula berjalan pemakaian AFO (ankle Foot Orthosis) pada waktu siang dan denis brown dipakai pada waktu malam sehingga bayi 3 tahun
TCA mengikut yang ditetapkan





Huraikan pengurusan surgical untuk keadaan ini (7m)
Jika rawatan tidak berjaya selepas 3/12 pemasangan serial casting diteruskan
Pembedahan akan dilakukan antara 3/12 hingg 6/12
Selepas pembedahan pemasangan casting akan diteruskan dan setiap minggu casting ditukatkan (1/52) dan pemeriksaan luka pembedahan.
Doktor akan melihat perkembangan pesakit setiap 2/52 selama 3/12
Denis brown splint di pasangdiantara 10 hingga 12 bulan
AFO dipasang pada waktu siang dan denis brown splint pada watu malam sehingga berumur 3 tahun.
TCA seperti yang diarahkan oleh dr

Senaraikan 4 komplikasi yang mungkin berlaku dalam keadaan ini (4m)
AVN pada tulang talus akibat reduction yang berlebihan/paksaan
infeksi akibat daripada open reduction/penjagaan luka yang tidak baik.
malformation
wound break down
rocker botton foot akibat menipulaction dan reduction yang memaksa

RespiratORY SYSTEM
AND RESPIRATORY DISORDERS



Respiration or breathing is the process whereby oxygen passes from the air into the blood while carbon dioxide, a waste product, is expelled.

2. This exchange of gases takes place in the lungs.

3. The Respiratory System
§ The respiratory system starts from the nose and mouth, and continues as the throat (pharynx), voice box (larynx) and trachea.
§ The epiglottis at top of the pharynx serves as a protective mechanism that prevents food or fluid entering the trachea (windpipe).
§ In chest, the trachea divides into two branches, the bronchi. Each bronchus enters a l;ung and divides into a number of small branches (bronchioles), and after repeated division it ends as numerous minute air-sacs (alveoli).
§ A fine network of blood vessels surrounds the alveoli, through which exchange of gases takes place.
§ The outer surface of the lungs is covered with a double membrane (pleura).

4. The Respiratory Process
§ The respiratory centre in the brain controls the respiratory process.
§ The mechanism of respiration is controlled by the action of the diaphragm and muscles between the ribs.
§ Air enters the body through nose and mouth, passes down throat (pharynx), through voice box (larynx) into the lungs.
§ The process whereby air is drawn into the lungs is called inspiration (breathing in).
§ Oxygen diffuses through the walls of the alveoli into the blood vessels on its surface and is distributed to all the cells of the body.
§ Carbon dioxide diffuses from the blood into the alveoli.
§ The air it is then expelled from the lungs (expiration).
§ There is a short pause between expiration and inspiration.

5. The air we breathe contains 21% oxygen, and there is still 16% oxygen left in the air we breathe out; this accounts for the effectiveness of mouth-to-mouth ventilation.

6. The average adult at rest breathes 12-18 times per minute.

7. The breathing rate and depth may vary considerably and increase if more oxygen is required (e.g. as in exercise, fever).

8. Management of Casualty with Obstructed Breathing
a. Remove any obvious obstruction:
Over the head and face – such as a plastic bag or pillows.
Around the neck – any constriction.
b. Ensure open the airway
Head tilt chin lift or jaw thrust.
c. Clear the airway
In the open airway position, any foreign matter, such as vomit, loose teeth, dentures or food that can be seen or felt should be removed, if possible.
Hook your first two fingers and sweep around inside the mouth.
Do not spend time searching for hidden obstructions.