Case 1 - Trauma

Question 1

What is in the “trauma triad of death” (when blood loss exceeds blood replacement)?

Answer 1

1. Acidosis (lactic acid from hypovolaemia - affects heart → worsens hypothermia)
2. Coagulopathy (leads to more bleeding → hypovolaemia → acidosis)
3. Hypothermia (stops enzymes in coag cascade → ↑ coagulopathy)

Question 2

How should you deal with an open fracture in A&E?

Answer 2

1. A→E
2. examine neurovascular status of the limb
3. gross contamination removed and a photograph of the wound taken (in order to avoid repeatedly taking the dressing on and off).
4. The wound should be covered in a saline soaked gauze and the limb should be splinted, usually in a backslab.
5. IV antibiotics as soon as possible, and every 8 hours until
6. wound debridement within 24hrs

Question 3

What is osteogenesis imperfecta?

Answer 3

“brittle bone disease”

a group of disorders of collagen metabolism resulting in bone fragility and fractures. The most common, and milder, form of osteogenesis imperfecta is type 1

Question 4

What are the features of osteogenesis imperfecta?

Answer 4

1. presents in childhood
2. fractures following minor trauma
3. blue sclera
4. deafness secondary to otosclerosis
5. dental imperfections are common

Question 5

With supsected fracture how should you examine?

Answer 5

Look - deformity, swelling, bruising, open or closed fracture

Feel - localised pain, radiating anywhere

Move - can the patient move it themselves?

+ is the limb neurovascularly intact?

Question 6

What system should you use for describing x-rays?

Answer 6

1. Site of fracture (which bone and which part of the bone)
2. Type of fracture (Transverse, oblique, spiral)
3. Simple or comminuted (shattered)
4. Displaced or not
5. Angulated or not (twisted)
6. Is the bone of normal consistency or not