Ortho week 1 - trauma call

Question 1

What does E4 indicate on GCS ?

Answer 1

spontaneous eye opening response (normal)

Question 2

What does E3 indicate on GCS ?

Answer 2

Eye opening in response to speech

Question 3

What does E2 indicate on GCS ?

Answer 3

eye opening in response to pain

Question 4

What does E1 indicate on GCS ?

Answer 4

no eye response

Question 5

What does M6 indicate on GCS ?

Answer 5

can physically obey commands

Question 6

What does M5 indicate on GCS ?

Answer 6

can move to localised pain

Question 7

What does M4 indicate on GCS ?

Answer 7

can flex away from pain

Question 8

What does M3 indicate on GCS ?

Answer 8

abnormal flexion (decorticate)

Question 9

What does M2 indicate on GCS ?

Answer 9

abnormal extension (decerebrate)

Question 10

What does M1 indicate on GCS ?

Answer 10

no motor response

Question 11

What does V5 indicate on GCS ?

Answer 11

patient is oriented to time, place and person (normal)

Question 12

What does V4 indicate on GCS ?

Answer 12

patient is confused

Question 13

What does V3 indicate on GCS ?

Answer 13

patient uses inappropriate words

Question 14

What does V2 indicate on GCS ?

Answer 14

patient uses incomprehensible sounds

Question 15

What does V1 indicate on GCS ?

Answer 15

no verbal response

Question 16

what GCS score classes as ‘comatose patient’ ?

Answer 16

8 or less

Question 17

what GCS score classes as ‘totally unresponsive patient’ ?

Answer 17

3

Question 18

What is included in a primary survey of a trauma call patient ?

Answer 18

Airway maintenance and cervical spine control
Breathing and ventilation
Circulation with haemorrhage control
Disability (neuro status)
Exposure (completely undress patient to assess injuries)

Question 19

How is a lower limb fracture managed in A&E?

Answer 19

• examine neurovascular status
• remove contamination
• take medical photos
• cover in saline soaked gauze
• splint the limb
• IV antibiotics
• theatre for wound washout, debridement and stabilisation

Question 20

What are the main principles of treating fractures ?

Answer 20

• reduce
• stabilise and preserve blood supply
• rehabilitate

Question 21

What methods are used to stabilise a fracture ?

Answer 21

• casts
• splints
• intramedullary devices
• plates and screws
• tension band wires
• k wires
• external fixators

Question 22

what is a soft tissue injury ?

Answer 22

an injury to the muscles, ligaments and tendons

Question 23

what are the 3 steps of the WHO analgesic ladder ?

Answer 23

1. non-opioid with/without adjuvant analgesic
2. opioid for mild to moderate pain, plus meds from step 1
3. opiod for moderate to severe pain, plus meds from step 1

Question 24

What does the term ‘patient controlled analgesia’ (PCA) mean?

Answer 24

patient is in control of their pain by self administering a small bolus of IV opiod via pressing a button to release a set dose.

there is a ‘lock out’ period that inhibits over use

Question 25

what opioids are suitable for use in patient controlled analgesia ?

Answer 25

morphine, pethidine and fentanyl are most common, but all IV preparations can be used in renal failure fentanyl is preferred as is short acting

Question 26

where is morphine broken down?

Answer 26

in the liver

Question 27

What condition is likely in fracture patients that are not responding to analgesia?

Answer 27

compartment syndrome

Question 28

what is compartment syndrome ?

Answer 28

pressure within a fascial compartment exceeds perfusion pressure within the compartment, **causing ischaemia** to the tissues in that compartment

Question 29

what should you do for a patient with suspected compartment syndrome?

Answer 29

- take full history - examine patient (check neuromuscular status of limb) - release dressings/casts that cause external pressure - position limb to heart level

Question 30

if you have tried to help a patient with suspected compartment syndrome and their pain continues to be unresponsive to analgesia, what should you do ?

Answer 30

contact a senior doctor as patient may need an **emergency fasciotomy**

Question 31

What factors contribute to a delayed/non-union of a fracture ?

Answer 31

**local factors** = fracture location, blood supply to area, stability, infection, pattern of fracture **systemic factors** = diet, diabetes, HIV, smoking, medications (steroids and NSAIDs)

Question 32

Use of which medications increase risk of a failed fracture union?

Answer 32

- corticosteroids - NSAIDs

Question 33

what is a good system for reading fracture xrays?

Answer 33

1. **site** = which bone and what part of bone 2. **type** = transverse, oblique, spiral 3. **simple or comminuted** 4. **angulated or displaced** 5. is the bone of **normal consistency or not**

Question 34

what is a comminuted fracture ?

Answer 34

a fracture that fragments at the site of fracture

Question 35

which is the main nerve at risk with a mid shaft humerus fracture ?

Answer 35

radial nerve

Question 36

which is the main nerve at risk with a fibula neck fracture ?

Answer 36

common peroneal nerve

Question 37

which is the main nerve at risk with a supracondylar fracture ?

Answer 37

median nerve

Question 38

which is the main nerve at risk with a shoulder dislocation ?

Answer 38

axillary nerve

Question 39

which is the main nerve at risk with a hip dislocation ?

Answer 39

sciatic nerve

Question 40

what is neuropraxia?

Answer 40

reversible nerve conduction block due to injury to the axon sheath

Question 41

what is axonotmesis ?

Answer 41

disruption to the myelin sheath and the axon

Question 42

what is neurotmesis ?

Answer 42

complete nerve division and disruption of the endoneurium

Question 43

what is the WHO definition of osteoporosis?

Answer 43

Bone mineral density of 2.5 or more SDs below the average value for a young healthy person of the same sex and race as the patient

Question 44

what is the most sensitive method for diagnosing clinically relevant compartment syndrome ?

Answer 44

**pain on passive stretch** as well as disproportionate pain