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Acute Care > Trauma & orthopaedics > Flashcards

Trauma & orthopaedics Flashcards

1
Q

Where can a catastrophic haemorrhage be?

A

floor, chest, abdomen, pelvis, long bones

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2
Q

5 ways to stop bleeding

A 
Tourniquet
Lift it up
Pelvic binding
Interventional radiology (intravascular coagulation)
Packing
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3
Q

What is cerebral perfusion pressure?

A

MAP - intracranial pressure

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4
Q

Most important blood test in trauma?

A

Group and save!

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5
Q

Which fractures need fixation?

A

Open
Neurovascular damage
Displaced (loss of function, arthritis)
Unstable (non union, DVT/PE)

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6
Q

3 classifications of fracture and subcategories

A

Traumatic #
• Direct: e.g. assault, metal bar
• Indirect: e.g. fall on an outstretched hand → clavicle #
• Avulsion

Stress #
• Bone fatigue due to repetitive strain e.g. foot #s in marathon runners

Pathological #
• Normal forces but diseased bone
• Local: tumours
• General: osteoporosis, Cushing’s, Paget’s

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7
Q

6 parts of describing a fracture

A 
1. Demographics
•	Pt. details
•	Date radiograph taken
•	Orientation and content of image
2. Pattern
•	Transverse
•	Oblique
•	Spiral
•	Multifragmentary
3. Anatomical Location 
4. Intra- / extra-articular
•	Crush
•	Greenstick
•	 Avulsion
•	Dislocation or subluxation
5. Deformity (distal relative to proximal) 
•	Translation
•	Angulation or tilt
•	Rotation
•	Impaction (→shortening)
6. Soft Tissues
•	Open or closed
•	Neurovascular status
•	Compartment syndrome
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8
Q

What do you need before describing a fracture?

A

Pt details
Radiographs at right angles
At least 2 views
Need images of join above and below #

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9
Q

What are the 4 R’s of fracture management?

A

Resuscitation
Reduction
Restriction
Rehabilitation

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10
Q

What is involved in resuscitation (1st R of fracture management)

A
  • Trauma care (ABCDE, 1º survey, C-spine)
  • Neurovascular status and dislocations
  • Consider reduction and splinting before imaging (reduce bleeding, pain and risk of neurovascular injury)
  • X-ray once stable
  • Open fractures need: analgesia, wound swab, irrigation, dressing, alignment, anti-tetanus and antibiotics
  • Gas gangrene is most dangerous complication of open fracture: debridement and clindamycin + benpen
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11
Q

What is involved in reduction (2nd R of fracture management)

A
  • All displaced fractures should be reduced, alignment is more important than opposition
  • Manipulation/closed reduction (under local/regional/general anaesthetic, traction to disimpact, manipulation to align)
  • Traction (not usually used)
  • Open reduction and internal fixation (accurate but risks of surgery, used in open and intra-articular #s or if conservative management fails)
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12
Q

What is involved in restriction (3rd R of fracture management)

A
  • Fixation to decreases strain and lead to bone formation
  • Slings, elastic supports
  • Plaster of paris (full cast only after 48hrs due to risk of compartment syndrome)
  • Functional bracing (only bone shaft supported, free to move joints)
  • Continuous traction
  • External fixation (pins & wires connected to external frame, allows wound access and decreases infection risk)
  • Internal fixation (pins, plates, screws, IM nails, perfects anatomical alignment, increases stability and aids early mobilisation)
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13
Q

What is involved in rehabilitation (4th R of fracture management)

A
  • Mobilisation to keep muscle and bone mass up, decreases joint stiffness
  • Maximise mobility of uninjured limbs
  • Quick return to function, less chronic morbidity
  • Physiotherapy
  • OT (splints, mobility aids, home modification)
  • Social services (meals on wheels, home help)
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14
Q

What are the types of complication you would list for fractures?

A

General
Specific
Early
Late

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15
Q

Give 5 general complications of fractures

A
  • Haemorrhage
  • Pain
  • Muscle damage (rhabdomyolysis)
  • Anaesthesia (teeth damage, aspiration, anaphylaxis)
  • Prolonged bed rest (UTI, pneumonia, pressure sores, DVT, PE, reduced bone mineral density
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16
Q

Give 2 specific complications after fractures

A

Neurovascular damage

Visceral damage

17
Q

Give 3 early complications after a fracture

A
  • Compartment syndrome
  • Infection
  • Fat embolism
18
Q

Describe pathophysiology of compartment syndrome

A 
Oedema after #
Pressure can’t be released due to fascia
Decreases venous drainage
If compartment pressure>capillary pressure= ischaemia
Pain on passive muscle stretching
Warm erythema
Weak/absent peripheral pulses
19
Q

Name 6 late complications after a fracture

A
  • Problems with union of bone (ischaemia, infection, interposition of tissue between fragments, malignancy, malnutrition)
  • Avascular necrosis (eg femoral head, scaphoid. Soft and deformed bone)
  • Growth disturbance (crush injury may injure physis and lead to growth arrest)
  • Post traumatic osteoarthritis
  • Pain (complex regional pain syndrome affecting neighbouring area, sensory and abnormal blood flow)
  • Myositis ossificans (bone tissue formed within muscle after trauma, restricted painful movement, can be excised)
20
Q

Define a burn

A

An injury to the body tissues as a result of extremes of energy

21
Q

What are the 6 functions of skin

A

1) Sensory Organ
2) Endocrine
3) Thermoregulatory
4) Immune Response
5) Barrier to fluid loss
6) Social

22
Q

Name 6 types of burn

A
  • Heat (dry flame, sunstroke, wet scalds)
  • Electrical
  • Chemical
  • Radiation
  • Mechanical (friction)
  • Cold
23
Q

What are burns associated with?

A 
(Mad Bad Glad Sad)
•	Carelessness
•	Accidents
•	Epilepsy/stroke/psychiatric problems
•	Alcohol/substance misuse
•	Extremes of age
24
Q

Pathophysiology of burns

A
  • Hypovolaemic shock (tissue damage-> inflammatory mediators-> leaking vessels-> vascular resistance
  • Capillary leakage mediators (histamine, prostaglandins, oxygen free radicals)
  • Vasoconstriction and burn extensions (thromboxane, catecholamines)
  • Multisystem shock and reduced cardiac output
  • Blood cells lost in urine
25
Q

What are the zones of a burn?

A

Central->peripheral
Zone of coagulation
Zone of stasis
Zone of inflammation

26
Q

Survival rates of people with >50% burns is ____

Why has survival rates improved?

A
  • 75% patient with 50% burns or more survive

* Improved resus, inhalation injury care & surgical techniques

27
Q

How do you assess severity of burns?

A
  • BSA (rule of nines, hand=1%, Lund&Browder chart) These don’t include erythema.
  • Depth of burn (erythema, partial thickness, full thickness)
28
Q

Differences between partial and full thickness burn

A
  • Partial thickness (blistered, painful, tissue paper appearance, wet, swelling, fluid loss)
  • Full thickness (painless, thick and leathery, no blisters, dry, dark red/brown, no blanching, swelling in limbs)
29
Q

Management of burns

A
  • ABCDE (intubate? Escharotomy if full thickness? Fasciotomy if compartment syndrome)
  • Remove heat source and cool for 10mins minumum
  • Fluid resuscitation if>15% BSA in adults of >10% BSA in children
  • Monitor urine output (1ml/kg/hr), replace lost sodium
  • 4ml/kg/% burn in 1st 24 hrs (half in 8 hrs, remainder in 16hrs)
  • More fluid if myoglobinuria, electrical injuries, skeletal trauma
  • Add maintenance in children
  • Pain relief
  • Non adherent dressings (cling film?)
30
Q

How are chemical burns treated?

A
  • Dilution is the solution to pollution
  • Mustard gas-> treat with dilute hydrochloric acid
  • Caustic soda-> Treat with 1% acetic acid
31
Q

What do acids and alkalis do to the skin?

A
  • Alkali’s-> saponification

* Acids’s-> coagulative damage

Acute Care (11 decks)

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