Emergency War Surgery, Chapter 9 Soft-Tissue and Open Joint Injuries Flashcards
Wound debridement is preferably done within how many hours of wounding?
6 hrs
What are the 4 C’s when trying to determine the extent of muscle damage?
color
contraction
consistency
circulation
of the four C’s, which is the best predictor of muscle viability?
Consistency
How much solution is recommend for irrigating significantly contaminated, large open wounds?
6-12L
What is the preferred solution for irrigating wounds?
0.9% normal saline
What is the abbreviation NPWT?
Negative Pressure Wound Therapy
What are antibiotic beads normally made from?
1g Vacomycin
1.2g Tobramycin
40g poly(methylmethacrylate) PMMA cement
How many hours after surgery do wounds undergo second debridement and irrigation?
24-48 hours - if using NPWT timeline can be extended
What conditions can be caused by crush syndrome?
Rhabdomyolysis
Reperfusion injury - third spacing - hypovolemic shock
Acute Renal Failure (AFR)
What conditions occurs when there is an efflux of potassium, nephrotoxic metabolites, myoglobin, purines and phosphorous into circulation?
Rhabdomyolysis
What are two conditions Rhabdomyolysis can result in?
Renal and Cardiac dysfunction
What IV fluids should be avoided in patients with crush injuries?
potassium and lactate containing IV solutions
What medication can be used if amputation in necessary to rescue entrapped casualties?
Ketamine 2mg/kg IV - Use a proximal TQ
What should the urine output be for a patient with significant crush injury?
> 100 cc/h until pigments have cleared the urine
