Sunday, December 10, 2017

USMLE Step 3 CCS: Fracture of the hip / femur

Hello!
Here are orders for the hypothetical case - let me know if I missed out on something! :)

Physical examination as needed, Include HEENT to look for hematoma.

IVA
Morphine
Bed rest, complete
Pulse ox
BP monitor
Cardiac monitor
Immobilize (hip not there in CCS software, consider for knee / shoulder fractures)

CT scan, femur

Preop orders:
NPO
CBC
BMP
PT/ PTT/ INR
FOBT
Blood group, cross match
UA
Urine output
EKG 12 lead
CXR (AP, portable)
Stockings, anti-embolism
Pneumatic compression stockings

Preop meds:
Cefazolin
LMWH

Orthopedic surgery consult
Hip replacement / hip hemiarthroplasty

Post surgery orders:
DEXA*
Calcium
Vitamin D
Alendronate
Ambulate at will
Physical therapy
Calcium enriched diet

*Why? Hip fracture patients should be treated with bisphosphonate therapy for osteoporosis, regardless of bone density results. Patients with a recent hip fracture should be evaluated with bone densitometry to establish a baseline to monitor treatment response but not to determine whether to initiate treatment.

-IkaN

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