Power point #1
Sciatica. Reply to Claire

Sciatica is directly related to nerve pain in the lumbosacral nerve root. Any compression of the sciatic nerve results in sciatica.

Etiolgy: The most common cause of sciatica is a herniated or bulging disc. Any vertebral misalignment can result in sciatic pain

Epidemiology: It is estimated that those with low back pain in the L1 to L4 region of the lumbar spine are 1.6%-43%. The risk factors for sciatica are age, height, obesity, smoking, occupational exposure to vibration, and mental stress.

Pathophysiology: Sciatica can have multiple cause in additions to compression or herniation of the lumbar region which include chemical and immune responses. An example of chemical stimulation and immune response is the inflammatory process triggered by antigens leading to lesions in the lumbar area.

History and Physical: An extensive history and physical are required, including spinal inspection and palpation, neurological exam, straight leg raises, and psychological signs for stress reactions that cause pain symptomology. The incidence of trauma or malignancy must also be investigated.

Differential Diagnosis: Differential diagnosis can be listed with muscle spasm, epidural abscess and a herniated disc of the lumbar region.

· A muscle spasm is an involuntary reaction of the muscle contracting which is forceful and painful. (Ahmad, 2016)

· An epidural abscess is the result of an infection of the epidural space in the spinal column that can lead to radicular pain and back pain. (Akhondi & Baker, 2023)

· A herniated disc is damage to the spinal cord usually in the center of the disc causing compression of the nerved leading to pain (Dydyk et al., 2023)

Treatment

Sciatica is based upon clinical findings, which show the importance of thorough history and physical skill assessment by a nurse practitioner. An MRI is warranted after prolonged symptoms.

Treatment is more conservative with exercise to strengthen the back and abdomen, proper posture and lifting techniques, and applying heat and cold packs. Medication is for reducing inflammation and relaxation of the muscles. Alternative therapy may include acupuncture.

Prevention:

Sciatica mainly stems from lifestyle habits of smoking, being overweight, and occupation. This can be prevented with smoking cessation and physical exercise.

Education and Follow up: The best way to relieve sciatica is through regular and enjoyable exercise. If it is not enjoyable, then it will not be continued. Proper body mechanics for lifting and bending are important protective factors. If symptoms do not improve within 2-4 weeks, other methods for evaluation should be explored.

Back pain resulting from bladder or bowel incontinence with leg weakness could indicate cauda equina syndrome. (Chou, 2021)

Conclusion: Sciatica is debilitating and impacts daily life but has modifiable factors that can reduce this pain through exercise, weight loss, and smoking cessation. A complete history and physical are paramount in this clinical diagnosis. Treatment involves nonsteroidal medication, acupuncture, application of heat or cold, and physical therapy.

Power point #2
Cat Bites Reply to Nozomi

· 400,000 per year in the U.S.

· 10% of all animal bites

· More common in women and

adults

· Hands and arms

· 89% = provoked incident

30-50% infection (most common complication

· Risk factors for infection: Immunosuppressed

· Bite in hand or foot

· Bite near prosthetic joint or vascular graft

· Crush/ puncture wound

· Delayed presentation

· Teeth puncturing and/or tearing of soft tissue

· Narrow and deep

· Bites and hold: cat does not shake/pull its head, unlike dogs

Pathophysiology

· Seals itself quickly anaerobic environment for bacterial growth

· Superficial infection with or without abscess

· Deep infection: abscess, septic arthritis, osteomyelitis, tenosynovitis, bacteremia, necrotizing soft tissue

· Appears less harmful delay in care

·
Infection: Polymicrobial

·
Oral flora of cats:

·
Pasteurella multocida (75%): incubation period 1-3 days

·
Capnocytophaga species: inbcuation peiiod 1-3 days

·
Bartonellis henselae: incubation period 7-14 days

·
Moraxella species

·
Corynebacterium species

·
Neisseria species

·
Human skin flora:

·
Staphylococcus

·
Streptococcus

Clinical manifestations: if superficial: fever, tenderness, erythema, swelling/warm, purulent drainage, lymphangitis, tender erythematous abscess. Deep bite characterized by pai, crepitus, joint swelling, fever, signs of infections despite wound care antibiotics.

· Initial treatment: Airway, breathing, circulation

· Direct pressure

· Foreign bodies

(e.g. broken tooth, claws, dirt, plants)

remove

· Clean wound with soap and water/ antiseptic solution

· Irrigate with tap water or sterile saline

Wound care:

· Preferred: open to heal by secondary intention

· Primary closure

· Face: cosmetic

· < 24 hours old

· No tissue adhesive

· No infection: debride prior

· Surgical consult: complex; bone, tendon, joint, nerves

· Treatment antibiotics Indications:

· Signs of infection

· Primary closure

· Deep wound (penetrates dermis)

· Hand, foot, face, genital area, joint/vascular graft

· Venous or lymphatic compromise

· Crush injury

· Immuno-compromised

·
First line: Amoxicillin-clavulanate 875/125 mg twice daily

· Prophylaxis: 3-5 days

· Infection: 5- 14 days

·
Alternatives:

· Doxycycline 100 mg twice daily

· Ciprofloxacin 500 to 750 mg twice daily

PLUS: Metronizadole 500 mg 3 times daily – anaerobic

· IV: Ampicillin-sulbactam 3 g every 6 hours

· Prophylaxis:
Rabies (Rabies virus)

· Healthy; available for 10-day observation no vaccine

· Rabid; suspected rabid Immediate vaccine

· Unknown Consider immediate vaccine

· Human diploid cell vaccine (HDCV) 1mL IM day 1, repeat days 3, 7, 14, 28

(CDC, 2019)

·
Tetanus (
Clostridium tetani)

· Unknown; < 3 doses of tetanus-toxoid containing vaccine vaccinate

· >3 doses, but > 5 years (major wound), >10 years (minor wound) booster

· Major wounds: Unknown/ <3 doses Human tetanus immune globulin

Diagnostics:

Only with clinical signs of infection/immuno-compromised:

· CBC- leukocytosis

· Wound culture

· Imaging:

· MRI: Deep infection (e.g. osteomyelitis, abscess)

· CT, Ultrasound: If MRI not available

Patient and family education

· Prevent infection: clean hands prior to touching site or dressing changes

· Wound care techniques

· Take antibiotics as directed

· Signs of infection: erythema, swelling, drainage, tenderness, fever

Follow up

· Prevent infection: clean hands prior to touching site or dressing changes

· Wound care techniques

· Take antibiotics as directed

· Signs of infection: erythema, swelling, drainage, tenderness, fever

Conclusion

· 10% of all animal bites

· High risk for infection

· Antibiotic therapy

· Tetanus and Rabies prophylaxis

· Wound care