Plastics Flashcards

Question

Referral criteria for metacarpal fractures

Answer 1

Head - all intra-articular and displaced Neck - volar angulation: Index and middle >10-15 deg Ring >30-40 deg Little >50-60 deg Shaft - volar angulation: Index and middle >10 deg Ring and little >20 deg >5mm shortening (spiral fractures) Any shortening for other fractures Intraarticular Rotational deformity Neurovascular compromise Tendon injury Compound fracture Subluxation

Answer 2

Capitate - FOOSH, extension + radial deviation Hamate - body: punch, hook: direct blow (pain with tight grip) Trapezium - axial load/hyperextension on adducted thumb, usually intra-articular Pisiform - FOOSH wrist extension, direct blow

Answer 3

Capitate - Scaphoid fracture, metacarpal fracture, perilunate dislocation, median nerve injury Hamate - ulnar nerve injury Trapezium - radial nerve injury Pisiform - FCU rupture, ulnar nerve injury at Guyon's canal

Answer 4

Intraconal haemorrhage: Proptosis, chemosis, ophthalmoplegia, reduced VA, globe firm to palpate Compartment syndrome Irreversible ischaemia in 2 hours

Answer 5

Decreased visual acuity and pupillary reflex 10% have delayed reduced VA

Answer 6

Painful restriction eye movement/diplopia No subconjunctival haematoma Nausea +/- vomiting Raised vagal tone Entrapment of infraorbital nerve Permanent restriction of ocular movement if not treated within 48 hours

Answer 7

High speed deceleration, midface/maxilla vs stationary object LeFort I - Straight on/downwards force on upper teeth LeFort II - Straight on blow lower/mid maxilla LeFort III - Slight downward force nasal bridge + upper maxilla

Answer 8

Life threatening haemorrhage - Epistaxis (II and III) Upper airway obstruction Ocular injury Cribiform plate disruption - CSF leak (II and III)

Answer 9

LeFort I - Transverse fracture through maxilla above root of teeth - 3 walls of maxillary sinus, pterygoid process Unilateral or bilateral LeFort II - Pyramidal fracture through bridge of nose, medial + inferior orbit, hard palate and pterygomaxillary buttress. Usually bilateral LeFort III - Bridge of nose, medial + inferior + lateral orbit, zygomatic arch ie. craniofacial dissociation

Answer 10

Dog infection rate 1-20% High risk: Cats, rodents, bats, humans, monkeys Hands, feet, genitalia Delayed presentation >8 hours Sutured dog bite wounds Immunocompromised/diabetes/lymphoedema/poor blood supply Large/dirty wound Muscle/tendon/joint/bone involvement

Answer 11

Dog: Pasteurella multocida, Pasteurella canis, Staphylococcus, Streptococcus, Corynebacterium, Capnocytophaga canimorsus Tetanus, rabies, mycobacterium - rare Cat: Pasteurella multocida, Capnocytophaga canimorsus, Staph, Strep Human: Staph aureus, Strep viridans, Bacteroides, coagulase neg Staph, Fusobacterium, Corynebacterium, Peptostreptococcus Eikenella corrodens (fist bite) Augmentin 15-30mg/kg, 625mg tds 7 days OR Metronidazole 7.5mg/kg, 400mg tds + - adults: doxycycline 200mg day 1, 100mg OD day 2-7 - children: co-trimoxazole 24mg/kg BD 7 days Update tetanus

Answer 12

Spider - Lactodectus (black widow), antivenom in severe pain + systemic symptoms (<20%) Toxic fish - Stingray, catfish, lionfish, scorpionfish, weaverfish, stonefish, toadfish, ratfish, rabbitfish, leatherback, some sharks - Neuro-cardiac toxicity - Soak in warm water for 30-60mins, surgical removal of barb, antivenoms for some Blue-ringed octopus, Octopus joubini - releases tetrodotoxin, histamine, serotonin - Numbness paralysis, hypotension, resp failure - No anti-venom Venomous sea snake - rhabdomyolysis, hyperkalaemia - Anti-venom Cone shell - neurotoxicity, 15-20% mortality - Neostigmine, supportive therapy Jellyfish (Portugese man of war, box jellyfish, bluebottle) - nematocysts with neurotoxicity Box jellyfish mortality 15-20% Bathe in seawater, then vinegar. Avoid water, ETOH (causes nematocyst to discharge). Anti-venom. Supportive care. ======== Seal, sea lion bite - Micrococcus infection, tetracycline 2g QID 1/12 Corals - cellulitis + secondary infection (Vibrio, Alteromonas) Clean with antiseptic, soap + water, hydrogen peroxide Sponges - irritant dermatitis. Florida fire sponges give toxic rash, erythema multiforme. - Remove spicule, bathe in vinegar, topical steroid Sea urchins - secondary infection, some toxic (glycosides, acetylcholine, serotonin) - Remove spines, treat infection Starfish (Acanthaster planci) - chronic painful local lesions Marine bristleworm - irritation, some venemous. Remove spines with tape. Soak in dilute ammonia

Answer 13

Epidermal Red, no blister, normal cap refill, normal sensation, good healing Superficial dermal Pale pink, small blisters, normal cap refill, painful, good healing Mid dermal Dark pink, large blisters, reduced cap refill, +/- sensation, intermediate healing Deep dermal Blotchy red, +/- blisters, no cap refill, no sensation, poor healing Full thickness White, no blisters, no cap refill, no sensation, poor healing

Answer 14

>15% TBSA Normal saline, 1mL x % TBSA /10kg over 1 hour

Answer 15

Temp >38.9 Hypotension - systolic <90 or <5th percentile for age for children Diffuse macular erythroderma Dysfunction of 3+ organ systems

Answer 16

Upper: Perioral burns Soot in nostrils/sputum Singed nasal hairs Pharyngeal oedema Laryngeal oedema (hoarseness, stridor) Lower: Above plus: Wheeze Bronchorrhoea Reduced peak flow Reduced sats (be wary of carbon monoxide poisoning) Altered LOC

Answer 17

Upper: - Nebulised humidified air/O2 +/- beclomethasone - Non-patent - tracheal intubation (using smaller ET tube), cricothyrotomy if significant facial trauma Lower: - Nebulised salbutamol - IV fluids: 1mL per %TBSA per 10kg - Consider abx

Answer 18

>10% TBSA adult, >5% TBSA child Airway injury Circumferential burn Full thickness burn >5% Burn to hands, feet, face, genitalia, joints Chemical burns Electrical burns Extremes of age Comorbidities that can affect recovery Concerns for abuse

Answer 19

>30% adult, >15% child Prolonged ventilation requirement High voltage injuries with underlying tissue damage Significant chemical burns Full thickness burns to hands, feet, face, genitalia, joints

Answer 20

Large, deep wounds Contaminated wounds/infection Irregular wound edges, crush, burst wounds Devitalised tissue, foreign body Delayed presentation/wound closure Dependent location (lower limb) Sutures - too many/too tight Trauma during suturing Movement during healing Elderly Immunocompromised, peripheral vascular disease, oedema, chronic steroids, diabetes, renal disease, IHD, heart failure Poor nutrition Smoking Obesity

Answer 21

Lignocaine 1-2% - 3-5mg/kg Lignocaine 1% + adrenaline - 6mg/kg Prilocaine 0.5% - 5mg/kg Prilocaine 1% + adrenaline - 8mg/kg Bupivacaine 0.25-0.5% 2mg/kg Topicaine (lignocaine 4%, adrenaline 0.18%, tetracaine 0.5%) - 0.1mL/kg More cardiotoxic

Answer 22

End arteries - ears, nose, genitalia, ?fingers Crush/contaminated wounds On beta blockers with unopposed alpha receptor stimulation - hypertensive crisis Peripheral vascular disease

Answer 23

Lower concentration No adrenaline Warmed Buffered with NaHCO3 1:10 Small gauge needle - 26-30G Inject through wound margins Inject slowly Inject subdermal Small volumes (reduce tissue distortion)

Answer 24

Diphenhydramine 1% Benzyl alcohol Tetracaine (ester) ?SC tramadol

Answer 25

0.9% saline, tap water, 1% povidine iodine Aiming 1L irrigation 30-60mL syringe 18G needle Aiming 5-8 PSI Stingray injuries - use hot saline (<40 deg)

Answer 26

Short (<4cm) Low tension (<5mm gaping) Clean

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