General

Question 1

what should be noted while applying splints?

Answer 1

respect the soft tissue:

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

Question 2

complications of casts and splints

Answer 2

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

Question 3

two types of traction

Answer 3

1. skin traction: limited force; soft tissue

2. skeletal traction: more powerful;

Question 4

gardner-wells tongs

Answer 4

used for cervical reduction + traction (skull)

Question 5

spanning external fixation

Answer 5

Damage Control Orthopaedics (DCO): temporary

Question 6

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

Answer 6

high-velocity trauma

Question 7

polytrauma definition

Answer 7

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

Question 8

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

Answer 8

1. malposition (endotracheal tube)
2. pneumothorax
3. hemothorax

Question 9

indications for intubation

Answer 9

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

Question 10

Rx of flail chest

Answer 10

1. fluid
2. intubation
3. PEEP

Question 11

Hemodynamic stability

Answer 11

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

Question 12

Serial Hct monitoring in a shock patient can guide

Answer 12

blood replacement

Question 13

Beck triad

Answer 13

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

Question 14

NEXUS criteria

Answer 14

C-spine image if:

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

Question 15

+ peritoneal lavage

Answer 15

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

Question 16

open fx

Answer 16

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

Question 17

consequences of soft tissue injuries in an open fx

Answer 17

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

Question 18

assess skin & soft tissue damage

Answer 18

emergency setting

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

Question 19

sx of compartment syn

Answer 19

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

Question 20

compartment syn pressure

Answer 20

w/ 30 mmhg of DBP

Question 21

is distal p a sensitive indicator of compartment syn?

Answer 21

no

Question 22

nl ABI

Answer 22

> 0.9

Question 23

classifx of open fx (Gustilo)

Answer 23

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

Question 24

what should be given in emergency room for open fx?

Answer 24

1. IV Abx

2. Tetanus toxoid+_tetanus Ig

Question 25

factors of muscle viability

Answer 25

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

Question 26

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

Answer 26

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

Question 27

complications of open fx

Answer 27

1. infxn | 2. compartment syn

Question 28

fx in benign tumors vs. 1st malignant tumors

Answer 28

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

Question 29

chem panel in pathologic fx

Answer 29

ca2+, po43-, alb, glob, alp

Question 30

how to r/o myeloma in pathologic fx?

Answer 30

SPEP, UPEP

Question 31

how to r/o Paget Disease in pathologic fx?

Answer 31

24hr urine hydroxyproline

Question 32

causes of pathologic fx

Answer 32

* Systemic: - osteoporosis - metabolic - Paget * Localised(major) - primary - hematologic - metastatic

Question 33

80% pathologic fx from metastatic disease arise from

Answer 33

breast, lung, thyroid, kidney, prostate

Question 34

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

Answer 34

10-21ds

Question 35

fixation of patho fx

Answer 35

internal fix

Question 36

CNS toxicity of local anesthetics

Answer 36

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

Question 37

areas not to use epinephrine

Answer 37

nose, hose, fingers, toes

Question 38

onset and duration of morphine

Answer 38

5min | 3-4hr

Question 39

which opioids may have bad interactions w/ MAOI?

Answer 39

meperidine(demerol)

Question 40

atropine given before _____(dissociative anesthetic) to decrease salivation

Answer 40

ketamine

Question 41

hematoma block

Answer 41

replace the fx hematoma w/ local anesthetic | analgesia for closed reduct

Question 42

which nerves are involved in elbow block?

Answer 42

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

Question 43

which nerves are involved in axillary block?

Answer 43

1median, 2ulnar, 3radial, 4musculocutaneous

Question 44

which nerves are involved in ankle block?

Answer 44

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

Question 45

Bier block

Answer 45

regional IV anesthesia (hand/wrist)

Question 46

the tourniquet in Bier block must stay inflated for

Answer 46

25-30 min

Question 47

when to inflate distal tourniquet?

Answer 47

if tourniquet pain: | inflate distal tourniquet then deflate prox tourniquet

Question 48

preparations for sedation

Answer 48

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