Soft Tissue Trauma Flashcards
What is triage?
A system of prioritising problems in patients
What are the 4 categories to triage an MSK patient?
–P1 - Life threatening Immediate treatment (airway obstruction)
–P2 – Urgent (fracture)
–P3 – Minor Delayed treatment (skin wounds)
–P4 – Dead
What are the 3 things we use triage for in veterinary practice?
–Decide how urgently a patient needs to be seen
–Decide which patient needs to be seen first
–Decide which problems in a patient should be addressed first
Wha are the 7 steps to approach a trauma case?
- Telephone triage
- Gaining access to / transporting patient
- Situation control
- Initial assessment of patient
- Physical examination
- Diagnostic tests
- First aid
Name 10 cases which is a true emergency (12)
–Respiratory distress
–Neurological abnormalities
–Bleeding from body orifices
–Rapid, progressive abdominal distension
–Dystocia
–Collapse
–Extreme pain
–Fractures
–Severe wounds
–Urinary obstruction
–Persistent vomiting
–Toxin ingestion
What essential info do we need in the case of an emergency?
–Who is the client? Who is the patient? Where are they? What are their contact details? Details of problems? How is it progressing?
What extra considerations do we need to make with the approach to larg animals compared to small animal?
Public safety, owner / rider safety, patient safety and personal safety – involvement of other service (police, fire service, ambulance)
As a vet, you are often the primary erson in charge, what considerations do you need to make?
•Public / owner safety (distressed animals react unpredictably, no room for heroes)
–If the animal injures the owner around you – its your fault
- Owner consent (e.g. RTA with no owner present)
- Distressed owners (don’t forget the owner, may need to separate from situation / animal)
- Experienced handlers are invaluable (nurses or colleagues)
- Safety of staff involved (your safety and those working around you)
What do the 4 classes of triage mean?
–Immediate action (P1)
–Do not move (P2)
–Requires urgent attention (P3)
–Delayed action (P4)
What are priority 1 cases in triage? What do you do?
•Immediate action – ‘I might die’
–History of head or spinal trauma
–History consistent with internal injuries
–Life threatening haemorrhage
–Cardiorespiratory compromise
- Diagnose cased on history, observation and physical examination
- Re-assess – cardiovascular function can deteriorate, CNS signs may become more obvious
What triage priority is this?
2
What do priority 2 casses need?
Stabilisation / support before attempting to move the animal
Name 2 examples of a MSK priority 2 case (4)
–Fracture
–Tendon rupture / laceration
–Joint instability
–Vascular or neurological damage
What do priority 3 cases need?
To recognise the complications and treat them urgently or the prognosis will be compromised.
Name 2 examples of a priority 3 case (3)
–Synovial involvement
–Bony involvement
–Contaminated wounds
What are priority 4 cases?
- Delayed action
- These are cases that do not require emergency or urgent action
- You must rule out all the previous problems, and be prepared to re-evaluate your findings and diagnosis
What can we look at do assess gross abnormalities and observe stance and demeanour?
–Degree of lameness
–Conformation / Gross abnormalities
–Location and discharge from wound
–Degree of Blood loss
–Degree of contamination
–Nerves, vessels, tendons, sheath, synovial joint
If you have a superficial wound with lameness, what should you look for?
- Severe contusions / muscle damage
- Tendons / ligaments
- Joints / bones
- Neurological involvement
If you have a horse which has normal cofirmatio when not weight bearing, but when weight bearingdoes this, what is it?
DDFT laceration
As well as the location, what else do you need to look at with the wound?
Discharge from the wound
What 3 things are essential to investigate a wound?
- Gloves
- KY jelly
- Probe
What do we look for on a physical exam?
- Presence / absence of crepitus (crunching) (distinguishing fractures and emphysema)
- Degree of contamination
- Soft tissue involvement
- Bony involvement
- Swellings and effusions
What 2 things can cause a prescence of crepitus?
–Gas within s/c tissues
–Bone fractures / fragments
What do these black arrows show?
Pneumothorax
If there is a degree of contamination in a wound, what 2 things do we need to consider?
–type of material (hair, soil, faeces, foreign bodies)
–consider swabs for culture;
What do we need to consider on the physical exam when there is a bony involvement?
–site of injury
–normal anatomy
- Consider radiography where you suspect or anticipate bone damage
What is region 1 of splinting?
Alignment of dorsal cortices, splint placed dorsally (commercial splints)
What is region 2 of splinting?
Splint placed laterally and caudally
What is region 3 of splinting?
Splint placed laterally (and medially)
What is region 4 of splintting?
Forelimb - stabilise carpus
