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Orthopaedics > General > Flashcards

General Flashcards

1
Q

what should be noted while applying splints?

A

respect the soft tissue:

  1. pad all bony prominence
  2. allow for post injury swelling
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2
Q

complications of casts and splints

A
  1. loss of reduction
  2. pressure necrosis as early as 2 hrs
  3. tight cast / compartment syndrome
  4. thermal injury
  5. cuts and burns(removal )
  6. THROMBOPHLEBITIS / PULMONARY EMBOLUS
  7. joint stiffness
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3
Q

two types of traction

A
  1. skin traction: limited force; soft tissue

2. skeletal traction: more powerful;

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4
Q

gardner-wells tongs

A

used for cervical reduction + traction (skull)

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5
Q

spanning external fixation

A

Damage Control Orthopaedics (DCO): temporary

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6
Q

no.1 cause of death in the 18-to 44-yrage group worldwide

A

high-velocity trauma

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7
Q

polytrauma definition

A
  1. injury severity score (ISS)>18
  2. hemodynamic instability / coagulapathy on admission
  3. > 1 system: CNS, pulmonary, etc
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8
Q

most common reasons for the ineffective ventilatin after establishment of an airway

A
  1. malposition (endotracheal tube)
  2. pneumothorax
  3. hemothorax
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9
Q

indications for intubation

A
  1. loss of airway control
  2. prevention of aspiration in unconscious
  3. hyperventilation for ^ intracranial p
  4. obstruction from facial trauma and edema
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10
Q

Rx of flail chest

A
  1. fluid
  2. intubation
  3. PEEP
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11
Q

Hemodynamic stability

A

nl vital signs that are maintained w/ only maintainence fluid volume

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12
Q

Serial Hct monitoring in a shock patient can guide

A

blood replacement

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13
Q

Beck triad

A
  1. distended neck v
  2. low BP
  3. muffled heart sounds
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14
Q

NEXUS criteria

A

C-spine image if:

  1. post. cerv. tender
  2. neurologic deficit
  3. painful distracting injuries
  4. altered level of alertness
  5. evidence of intoxication
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15
Q

+ peritoneal lavage

A
  1. gross blood, bile, fecal
  2. > 100,000 RBC/ml
  3. > 500 WBC/ml
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16
Q

open fx

A

osseous diruption in which
a break in the skin and
underlying soft tissure communicates directly w/ the fx and its hematoma

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17
Q

consequences of soft tissue injuries in an open fx

A
  1. contamination
  2. soft tx compromise
  3. method of immobilization+healing+function
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18
Q

assess skin & soft tissue damage

A

emergency setting

  • immediate surgery: none
  • delay surgery (>24hr): irrigate, remove FB, moist, sterile dressing
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19
Q

sx of compartment syn

A
  1. severe pain
  2. sensation ↓
  3. pain to passive stretch of fingers/ toes
  4. tense extremities
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20
Q

compartment syn pressure

A

w/ 30 mmhg of DBP

21
Q

is distal p a sensitive indicator of compartment syn?

A

no

22
Q

nl ABI

A

> 0.9

23
Q

classifx of open fx (Gustilo)

A

Wound, Contamination, Soft tissue, Bone
I <1cm, clean, minimal, simple, minimal comminution
II>1cm, mod, mod, some muscle, mod com
III
IIIA >10cm, high, severw/crush, com,cover
IIIB >10cm, high, loss of cover need reconstruct, poor cover, mod-severe com
IIIC >10cm, high, vascular

24
Q

what should be given in emergency room for open fx?

A
  1. IV Abx

2. Tetanus toxoid+_tetanus Ig

25
Q

factors of muscle viability

A

4C

  1. color: beefy red(exclude CO)
  2. consistency: firm
  3. capacity to bleed
  4. contractility
26
Q

why serial debridement should be performed q24-48hr in open fx?

A

to see there is no evidence of necrotic soft tissue/ bone

27
Q

complications of open fx

A
  1. infxn

2. compartment syn

28
Q

fx in benign tumors vs. 1st malignant tumors

A
  1. benign more common
  2. benign most common in child
  3. malignant antecedent nocturnal pain
  4. malignant rad
  5. malignant image
  6. malignant local recur
29
Q

chem panel in pathologic fx

A

ca2+, po43-, alb, glob, alp

30
Q

how to r/o myeloma in pathologic fx?

A

SPEP, UPEP

31
Q

how to r/o Paget Disease in pathologic fx?

A

24hr urine hydroxyproline

32
Q

causes of pathologic fx

A
  • Systemic:
  • osteoporosis
  • metabolic
  • Paget
  • Localised(major)
  • primary
  • hematologic
  • metastatic
33
Q

80% pathologic fx from metastatic disease arise from

A

breast, lung, thyroid, kidney, prostate

34
Q

when should rad and chem be performed after patho fx surgery?

A

10-21ds

35
Q

fixation of patho fx

A

internal fix

36
Q

CNS toxicity of local anesthetics

A

dizziness, tongue numbness, nystagmus, seizures(tonic-clonic)

37
Q

areas not to use epinephrine

A

nose, hose, fingers, toes

38
Q

onset and duration of morphine

A

5min

3-4hr

39
Q

which opioids may have bad interactions w/ MAOI?

A

meperidine(demerol)

40
Q

atropine given before _____(dissociative anesthetic) to decrease salivation

A

ketamine

41
Q

hematoma block

A

replace the fx hematoma w/ local anesthetic

analgesia for closed reduct

42
Q

which nerves are involved in elbow block?

A

1median,
2ulnar,
3radial,
4lat. antebrachial cutaneous

43
Q

which nerves are involved in axillary block?

A

1median,
2ulnar,
3radial,
4musculocutaneous

44
Q

which nerves are involved in ankle block?

A
  1. tibial
  2. superficial peroneal
  3. deep
  4. saphenous
  5. sural
45
Q

Bier block

A

regional IV anesthesia (hand/wrist)

46
Q

the tourniquet in Bier block must stay inflated for

A

25-30 min

47
Q

when to inflate distal tourniquet?

A

if tourniquet pain:

inflate distal tourniquet then deflate prox tourniquet

48
Q

preparations for sedation

A
  1. NPO
  2. equipment
  3. O2
  4. revers meds(naloxone, flumazenil)

Orthopaedics (4 decks)

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