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Acute Care NP Exam > MSK and Trauma > Flashcards

MSK and Trauma Flashcards

1
Q

What is included in the primary survey?

A

Airway with c-spine protection
Breathing with adequate oxygenation
Circulation with hemorrhage control
Disability - What injuries are we observing that are obvious to the naked eye
Exposure/Environment - Fully undress the patient

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2
Q

First step in shock therapy for hypovolemic shock

A

IV Crystalloids

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3
Q

What are the components of the Secondary Survey?

A

History
Physical exam: Head to toe
Complete neurologic exam
Special diagnostic tests
Re-evaluation

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4
Q

When do you start the secondary survey?

A

After:
The primary survey is complete
ABCDE’s are reassessed
Vital functions are returning to normal

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5
Q

Symptoms and exam findings of hypovolemic shock

A

AMS, anxiety
Cold, diaphoretic skin
Tachycardia
Tachypnea, shallow respirations
Hypotension
Decreased urinary output

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6
Q

Treatment of hypovolemic shock

A

Fluid resucitation
–LR rather than NS because of Na
–Don’t worry about the volume. If they end up in heart failure, that’s fine. You can fix that with medicines.
–Monitor response
–Prevent hypothermia - pRBC are refrigerated

pRBC:FFP - 1:1 ratio
If infusing a lot of blood products, watch the K and Ca - can result in hyperK and hypo Ca

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7
Q

What is a battle sign indicative of?

A

Basilar skull fracture

Likely need surgery and ppx antibx

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8
Q

What is the Monro-Kellie Doctrine

A

There is only so much room in the skull so if something presses on the brain, CSF or venous volume will decrease

If there is no venous return from the brain, the brain will become hypoxic

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9
Q

Cause of epidural hematoma

A

Often associated with skull fracture

Middle meningeal artery tear

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10
Q

Clinical presentation of epidural hematoma

A

Initial LOC, followed by lucid interval, followed by vomiting and rapid decompensation to LOC

Can be rapidly fatal - needs evacuation and bone flap

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11
Q

Causes of subdural hematoma

A

Venous tear/brain laceration

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12
Q

When do you interfere with subdural hematoma

A

If >5mm of midline shift, recommend rapid surgical evacuation

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13
Q

Below what GCS should intubation be considered?

A

GCS of 8 and below should likely be intubated because the LOC could get worse

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14
Q

Why is Mannitol used in brain injury?

A

Creates an osmotic gradient that stalls cerebral swelling

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15
Q

What is the best type of imaging for facial fracture?

A

Non contrast CT Face

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16
Q

What is a LeFort Fracture?

A

The LeFort fracture is the most concerning of the maxillofacial fractures

Involves the maxilla and/or skull base

“Dish face”

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17
Q

Management of trauma to the neck

A

Unless the impaled object is acting like a lever or definitely obstructing the airway, DO NOT REMOVE IT!

If there is bleeding, compression one side of the neck - low threshold to intubate

If the injury is strangulation/hanging:
–Apply a hard collar
–Assess for hoarseness (suggests injury to the larynx/hyoid bone)
–Assess for crepitus - trachea is no longer intact
–Obtain CT c-spine and CTA head and neck

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18
Q

What is Horner’s Syndrome

A

Damage to the sympathetic trunk (nerve fibers running from the base of the skull to the coccyx).

Caused by carotid dissection or direct injury to the bundle of nerve fibers

Symptoms occur on the same side as the lesion of the sympathetic trunk:
-Miosis - constriction of the pupil
-Ptosis
-Anhydrosis - decrease in sweating

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19
Q

What is L’hermittes Sign?

A

Elicited with the neck flexed and causes an electrical sensation that runs down the back and into the limbs. Generally uncomfortable.

Indicates possible MS and compression of the spinal cord in the neck from cervical spondylosis, disc herniation, tumor and Arnold-Chiari malformation

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20
Q

What are the NEXUS criteria

A

Scale utilized to rule out the need for imaging for neck injuries

If all are negative, no need for x-ray of the neck:
-There is no posterior or midline cervical tenderness
-There is no evidence of intoxication
-The pt is A&Ox3
-There is no focal neurological deficit
-There are no painful distracting injuries

21
Q

What is a Jefferson fracture?

A

Burst fracture of C1

22
Q

What is a teardrop fracture?

A

Fracture that disrupts ant/post ligament and bone
Very unstable

23
Q

Lower back pain - red flags

A

Recent significant trauma or mild trauma with pain disproportionate to history/exam
Age >50
Unexplained weight loss
Unexplained fever/immunosuppression
History of cancer
IVDU
Osteoporosis
Prolonged use of glucocorticoids
Focal neurologic deficit or truly disabling symptoms
Duration greater than 6 weeks

24
Q

Neurogenic Shock: Causes, symptoms, treatment

A

Can occur in a spinal cord injury at or above level of T6

Is a syndrome of autonomic dysfunction
–bradycardia and hypotension
–Peripheral vasodilation causing hypothermia

Treatment goals:
–SBP >90 - use dopamine
–HR >80
–Keep warm, give warmed IVF
–Immobilize
–Insert foley, acute urinary retention is common

Treat with methylprednisolone and consult

25
Q

Treatment for cauda equina

A

Dexamethasone 10mg IV and consult neurosurgery for possible decompression surgery

26
Q

Clinical presentation of tension pneumothorax

A

Often the result of blunt trauma

Respiratory distress
Shock
Distended neck veins
Unilateral decrease in breath sounds
Hyperresonance
Cyanosis (late sign)

27
Q

Clinical manifestations of rib fractures

A

Pain localized to the area of the fracture
Pleuritic pain
Auscultatory crepitance

Flail chest: 3 or more broken ribs in 2 or more places

28
Q

Treatment of rib fx

A

Single, non-displaced: NSAIDs, spirometry

Admit 3 or more rib fx or if underlying organ damage
Admit flail segment

Usually will heal in about 8 weeks

29
Q

Early management of extremity trauma

A

Early concerns are vascular compromise and open fractures

Assess and manage vascular compromise:
-Reduce fracture
-Splint fracture
-Assess pulses by palpation or doppler
-Obtain surgical consult

Manage open fractures:
-Apply appropriate splint
-Clean/debride
-Consider time factor
-Obtain ortho consult
-Antibiotic/tentanus status

30
Q

Symptoms of Compartment Syndrome

A

Pain
Paresthesia
Pallor
Paralysis
Pulselessness
Poikiothermia (cold)

31
Q

How to assess for rotator cuff tear

A

Weakness and pain with abduction and adduction of the shoulder

Job’s Strength Test - resistance of adduction - supraspinatus muscle

32
Q

Clinical features of shoulder dislocation

A

Deformity noted plus a depression at the AC joint
Patient cannot move shoulder at all

Most common is anterior dislocation
Posterior (rare)
Inferior (very rare - arm up over head)

33
Q

Different methods of shoulder reduction

A

Cunningham - Massage and shoulder shrugs

Milch - rotation of the arm outward and up until it pops back in

34
Q

Clinical features of radial head fracture and treatment

A

Usually caused by FOOSH
Pain laterally, held at 80 degree flexion for comfort
Pain in the elbow with supination/pronation
Can see a “sail sign” in an occult radial head fracture

Treatment:
If <2mm displaced - Sling, ice, analgesia
If >2mm displaced - Sling vs ORIF
If comminuted: ORIF

35
Q

Why is it important to always reduce an elbow

A

Often associated with neurovascular compromise

36
Q

Clinical features of a scaphoid fracture

A

Most common carpal fracture although difficult to see on plain films
Must not be missed as the scaphoid is poorly vascularized

Snuff box tenderness and MOI by FOOSH
If xray negative but clinically appears to have scaphoid fx, consider CT, MRI, bone scan
Immobilize with thumb spica

37
Q

Treatment of subungual hematoma

A

Xray to assess for fracture
Relieve pressure by trephination

38
Q

Management of pelvic fracture

A

Fractures of the non-load bearing parts of the pelvis generally require no treatment aside from pain medicine and rest

Severe fractures often require ORIF

Could consider pelvic binder to stop the bleeding

CT imaging preferred to find small fx

39
Q

Tibial plateau fracture: Clinical presentation, diagnostics and treatment

A

Usually present with knee effusion and inability to bear weight

Concern for compartment syndrome with tibial plateau fx

Get CT if high suspicion and negative XR

Treatment is knee immobilizer, non-weight bearing and surgery

40
Q

Ankle Sprain: Diagnosis and treatment

A

Presentation is pain, swelling, ecchymosis

Xray only indicated for point tenderness, swelling and bruising

Treatment is Ace wrap, aircast, crutches, ice, elevation and NSAIDs

41
Q

Masionneuve Fracture

A

Proximal fibular fracture accompanying any kind of ankle fracture

Rotational forces are transmitted up to the knee

Always palpate the proximal fibula in any ankle injury and have low threshold to image the whole fibula

42
Q

Lisfranc Injury: What is it? Treatment?

A

Injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus

If <2mm displaced: Strict non-weight bearing for 6 weeks

If >2mm, ORIF is indicated

Can cause compartment syndrome and threaten the toes

43
Q

What is a Jones Fracture and how do you treat it

A

Proximal 5th metatarsal fracture
Treated with splint and crutches

44
Q

Management of traumatic pneumothorax

A

Open pneumothorax (sucking chest wound) is caused by penetrating trauma

Treatment involves 3 sided dressing and placing a chest tube

In tension pneumothorax - insert 14 gauge angiocath into the 2-3rd intercostal space, mid clavicular line

45
Q

Symptoms of compartment syndrome

A

Severe ischemic pain
Tensely swollen
Skin perfusion, arterial pulses will be normal
Paresthesia
Passive stretch of muscle is painful
Progressive loss of sensory/motor function
Repeated examinations are required to check for developing compartment syndrome

46
Q

Diagnosis of compartment syndrome

A

Use of a Stryker tonometer:
Normal is 0-8mmHg
Compartment syndrome: >30mmHg

47
Q

What is the perfusion pressure of a compartment (delta pressure)

A

Delta pressure = Diastolic blood pressure - intra-compartmental pressure

Delta Pressure <30 - indicative of the need for fasciotomy

48
Q

What is the only type of fracture that you would give an antibiotic for?

A

Open fracture

49
Q

What is the difference between a dislocation and a subluxation?

A

Subluxation is an incomplete dislocation

Acute Care NP Exam (22 decks)

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