1. Open Fx, Puncture Wounds, Foreign Bodies (AJM)

Question 1

MC infective organism for puncture wound/foreign body

Answer 1

staph aureus

Question 2

second most common infective organism for puncture wound/foreign body

Answer 2

beta-hemolytic strep

Question 3

puncture wound through shoe gear is most likely associated with which organism?

Answer 3

pseudomonas

Question 4

puncture wound involving soil or a farm is most likely associated with which organism?

Answer 4

clostridium

Question 5

organism most likely associated with CAT BITES?

Answer 5

pasturella multocida

Question 6

organism most likely associated with DOG BITES?

Answer 6

enterobacter/ pseudomonas / staph / bacillus, strep viridans/ capnocytophaga canimorsus

Question 7

organism most likely associated with HUMAN BITES?

Answer 7

HACEK (haemophilus, actinobacillus, cardiobacterium hominis, EIKENELLA, kingella kingae)

Question 8

What is Dr. Rozen’s first name? (Nail puncture wound through a rubber-soled shoe)

Answer 8

Nimrod

Question 9

What is the most common infecting organism with a puncture wound through rubber soled shoe?

Answer 9

staph aureus

Question 10

gustilo-anderson classification: purpose, and levels

Answer 10

for OPEN FRACTURES, grades I, II, IIIA, IIIB, IIIC

Question 11

resnick classification: purpose

Answer 11

for DEPTH OF FOREIGN BODY w/ respect to surgical layers; grades I, II, IIIA, IIIB, IV

Question 12

patzaki’s classification: purpose

Answer 12

describes anatomy where osteomyelitis occurs, and incidence zones 1 (MC, 50% incidence), 2, and 3

Question 13

what is the name of the “sign” that indicates viability when debriding bone with a cutting burr?

Answer 13

Paprika sign; characterized by punctuate cortical or cancellous bleeding

Question 14

what are the 3 tetanus statuses in the tetanus algorithm?

Answer 14

(1) unknown tetanus status (2) incomplete tetanus status (no booster w/in 5 years) (3) complete tetanus status (booster w/in 5 years)

Question 15

treatment for CLEAN wound with UNKNOWN or INCOMPLETE tetanus status

Answer 15

give toxoid, hold TIG

Question 16

tx for TETANUS-PRONE WOUND with unknown or incomplete tetanus status?

Answer 16

give toxoid, *GIVE TIG

Question 17

tx for COMPLETE TETANUS STATUS (both clean and tetanus-prone wounds)

Answer 17

HOLD toxoid, and hold TIG (so tx if booster w/in 5 years)

Question 18

describe shape and staining of Clostridium tetani

Answer 18

raquet-shaped gram-POSITIVE bacillus

Question 19

triad of sxs of tetanus

Answer 19

• RISUS SARDONICUS (smile due to sustained spasm of facial muscles) - APHAGIA (unable to swallow) - TRISMUS (lockjaw)

Question 20

what are the characteristics of a TETANUS-PRONE WOUND

Answer 20

-greater than 6 hours old, clinical signs of infxn, deep, devitalized tissue, contamination, traumatic mechanism of injury etc

Question 21

mechanism of tetanus toxin

Answer 21

clostridium tetani releases an exotoxin causing a pre-sympathetic blockade

Question 22

dosage for tetanus toxoid?

Answer 22

0.5 mL

Question 23

dosage for tetanus immunoglobulim (TIG)

Answer 23

250-300 units

Question 24

differences between RETAINED FOREIGN body and a puncture wound?

Answer 24

retained foreign body can be physically seen or physically palpated; or can be visualized indirectly with advanced imaging options (x-rays). Also using patient symptoms (pain, inflammation, local signs of infection, prolonged course)

Question 25

rule of thumb for deciding to excise in ER or OR?

Answer 25

If SUPERFICIAL TO DEEP FASCIA --\> attempt to extract in clinic/ ER If it takes \>15 minutes --\> take patient to OR

Question 26

when dissecting to extract, should the incision be parallel or perpendicular to object?

Answer 26

should be PERPENDICULAR to increased the likelihood you'll make contact with the foreign body

Question 27

describe imaging for foreign objects?

Answer 27

using TRIANGULATION (minimize radiographic views), NO OBLIQUE views, and use needle technique (grid method)

Question 28

what views are most helpful to specifically locate/extract the foreign object?

Answer 28

DP AND LATERAL views (2)

Question 29

what views should you use to identify if something is there?

Answer 29

you want as many views as possible; and oblique views are good for detection but NOT location

Question 30

what type of imaging is best for locating WOOD? how does it show up?

Answer 30

ultrasound; shows as HYPERECHOIC with a HYPOECHOIC BLACK SHADOW * Hyperechoic – more echogenic (brighter) than normal. * Hypoechoic – less echogenic (darker) than normal. * Isoechoic – the same echogenicity as another tissue

Question 31

at what size do pieces of glass show up on xray, regardless if leaded or unleaded?

Answer 31

if greater than 5 cm, should show up regardless if leaded or unleaded

Question 32

what are the 3 problems with cavitation?

Answer 32

1) greater degree of tissue damage, 2) explosion that can produce a cavity 30x the size of the bullet 3) negative pressure "sucks" surrounding environment into the wound

Question 33

what should be kept in mind with marine-related injuries?

Answer 33

diff't spectrum of infecting organisms (Vibrio vulgaris, gram negatives); venom and toxic reactions, sand gets everywhere