PhysioguidebydivyaA

Common Carotid Artery Beginning, course and termination It is a branch of brachiocephalic trunk on right side and a direct branch of arch on the left side. The artery runs upwards along medial border of sternocleidomastoid muscle enclosed within the carotid sheath. The artery ends by dividing into internal carotid and external carotid at the upper border of thyroid cartilage Area of distribution :- This artery has only two terminal branches. These are internal carotid and external carotid. 

  Tracheostomy: It is an operation in which the trachea is opened and a tube inserted into it to facilitate breathing.  It is most commonly done in the retro thyroid region after retracting the isthmus of the the thyroid gland.  A supra thyroid tracheostomy is liable to stricture, and an infra thyroid one is difficult due to the depth of the trachea and is also dangerous because numerous vessels lie anterior to the trachea here 

  Lumbar puncture in adult : Patient is lying on side with maximally flexed spine. A line is taken between highest points of iliac spine at L4 level. Skin locally anaesthetized, and lumbar puncture needle with trocar inserted carefully between L3 and L4 spines.  Needle courses through skin fat, supraspinous and interspinous ligaments, ligamentum flava, epidural space, dura, arachnoid, subarachnoid space to release CSF

  Handicaps The WHO has identified six handicaps: Locomotor handicap ( which forms 60%  of all handicaps)  Visual handicap Hearing and speech handicap Cardiopulmonary handicap Intellectual handicap and Emotional disturbed.  Many patients suffer from multiple handicaps, which include combinations of any of the six given above. 

  Modification in the daily activities   for Rheumatoid and other forms of arthritis Using western toilets Bath aids and railings Long handle broomstick and mop to clean the floors Use of walking sticks while walking, climbing, etc.  High chairs.  Avoid squatting on the ground for food, etc. Use of dining table and chairs are recommend.  To avoid squeezing clothes after washing and just rinsing them dry To avoid walking on hard and uneven and rough surface s.  To sleep on a hard surface. 

  Erb's Palsy  This is due to injury to the C5 nerve root and rarely the C6 nerve root is also injured.  It occurs either very early in life due to birth trauma (obstetric palsy, due to faulty application of forceps) or in young adults due to bike trauma Klumpke's Paralysis This is also due to either a  birth trauma or a bike trauma.  The C8 T1 nerve roots are involved and there will be paralysis of the wrist flexors, finger flexors and intrinsic muscles of the hand. This results in a claw hand deformity. 

Varieties of Compound Fractures Type I Wound is less than 1 cm in size. It is usually due to a low-velocity trauma. Type II Wound is more than 1 cm and less than 10 cm but there is no devitalisation of soft tissue and is associated with very little contamination. Type III Wounds moderate and severe in size (> 10 cm). And the soft tissues are devitalized and contaminated. Type IIIA Extensive soft tissue injury but with adequate soft tissue to cover the fractured bone.   Type IIIB Extensive soft tissue damage and loss. Bone cannot be covered and is exposed to the atmosphere.  Type IIIC Compound fractures with arterial injuries.  Classification (Gustillo and Anderson's Classification)