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ctjghjkbgf > Plastics > Flashcards

Plastics Flashcards

1
Q

List 4 clinical signs of potential inhalation injury

A
  • Smoke exposure
  • Burns on the face
  • Singed nasal hairs
  • Soot in sputum or visible in upper airway
  • Wheezing or rales
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2
Q

BSA % in adults for burns

A
  • Each arm is about 9% TBSA
  • Each leg is 18% TBSA
  • Anterior and posterior torso area each 18%
  • Head is 9%
  • Perineum is 1%
  • Child palm including fingers is about 1%
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3
Q

Layers / types of burns

A

superficial (sunburn)
superficial partial thickness (blisters)
deep partial thickness (paler, drier, speckled appearance of dry vessels)
full thickness (no pain, leather, charred)

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4
Q

indications hyperbaric chamber in CO poisoning?

A 
o	LOC at scene
o	persistent neurological symptoms
o	evidence cardiac injury
o	significant elevation carboxyhemoglobin level (greater 25%)
o	pregnant and >20%
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5
Q

When to treat empirically for cyanide poisoning

A

closed house fire
history of CPR, abnormal vital signs, intubation, evidence hypoxic injury, severe metabolic acidosis

Tx before level back (hydroxycobalamin)

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6
Q

Fluid resus in burns?

A

parkland formula 4 ml/kg/% BSA over 24 hours (1/2 first 8 hours then ½ over 16 hours) (children less than 5 maintenance added using isotonic fluids with dextrose); monitor urine output with catheter with goal 1 ml/kg/hr

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7
Q

Burns - 5 indications for admission

A
  • 5-10% TBSA burn
  • 2-5% full thickness burn
  • high voltage injury
  • concern for inhalation injury
  • circumferential burn
  • significant associated trauma or medical comorbidity (ex. Diabetes or SCD)
  • more than 1% BSA burns to face, perineum, hands and feet or overlying joints
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8
Q

Burns - 5 indications for transfer to burn center

A
  • greater 10% TBSA burn
  • greater 5% TBSA full thickness burn
  • high voltage burn
  • chemical burn
  • known inhalation injury
  • burn to face, hands, feet, perineum or joints
  • significant comorbidities that could affect treatment
  • intentional burns
  • major associated injury
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9
Q

What are 2 priorities in wound care?

A
  • Minimizing infection
  • Ensuring sterility
  • Minimizing fluid loss
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10
Q

Which wounds require abx prophylaxis

A

heavily contaminated wound, dog (if sutured)/cat/human bites, puncture wounds to hand, stellate laceration, laceration near joints or open fractures, immunocompromised patients, consider in wounds contaminated soil or feces

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11
Q

What are 2 structures that may be injured in a cheek laceration?

A
  • Facial nerve

- Salivary gland and duct

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12
Q

What are 2 structures that may be injured in an eyelid laceration?

A
  • Levator palpebrae muscle

- Nasolacrimal duct

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13
Q

What bug is responsible for necrotizing faciitis?

A

Group A strep, Staph aureus, mixed anaerobes (bacteroides, clostridium)

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14
Q

What are 3 conditions that put him at risk for necrotizing faciitis?

A
  • History of underlying skin conditions (ie: eczema)
  • Recent varicella infection, insect bite
  • Immunocompromised state
  • Minor laceration or blunt trauma
  • type 2 DM
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15
Q

What are 4 life threatening complications of necrotizing faciitis?

A
  • Toxic shock syndrome
  • Renal failure
  • Sepsis
  • Multiorgan failure
  • DIC
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16
Q

How to transport amputated finger?

A

transport amputated finger in saline moistened gauze, in a bag/Ziploc, then place in a ice-water mixture

17
Q

When to drain subungual hematoma?

A

trephination/ drainage is recommended when greater than 50% nail bed surface area, to evaluate for underlying nailbed laceration or symptomatic relief of pain

18
Q

When do you refer a finger fracture to Plastics (list 5)?

A
  • Open fracture (seymour fracture is nail bed injury with distal phalanx SH-1 fracture and is an OPEN fracture)
  • Rotational deformity
  • Angulation or displacement that cannot be reduced
  • Condylar fracture (joint surface becomes disrupted - issues with articulation)
  • Unstable fracture (complete spiral, oblique, proximal phalanx fractures)
  • Disruption of joint surface
  • Digital nerve injury
  • Amputation
  • Concern for tendon rupture
  • Volar plate # or avulsion injuries
  • Proximal MCP # of thumb (risk of UCL injury)
  • Physeal fractures associated with displacement or deformity (ie: Boney mallet finger)
19
Q

what is the Terry Thomas sign

A

Gap > 3 mm seen in scaphoid lunate dislocation

20
Q

What is a Bennett fracture? Tx?

A

bennett’s fracture: inter-articular fracture at base thumb metacarpal = special attention (thumb carpometacarpal joint is critical) = closed reduction/CRIF/ORIF = urgent plastic referral

21
Q

What is a Rolando fracture? Tx?

A

comminuted fracture base of thumb metacarpal = closed reduction/CRIF/ORIF = urgent plastic referral

22
Q

Acceptable angulation for metacarpal fractures?

A

10-20 degrees index finger increasing to 40 degrees for small finger unless UNSTABLE

23
Q

What are two joint positions that need to be maintained in an ulnar gutter? Why do hands in a split have to be positioned in a specific way?

A
  • Wrist needs to be in slight extension at 20o
  • MCPs in 70-90o flexion
  • PIP/DIP slight flexion at 5-10o

Goal:
o Minimize stiffness or contractures
o Neutral position / position of comfort
o Balance between flexor and extensor tendons to avoid risk of displacement by increased flexor tendon or extensor tendon activity

24
Q

Broken and reduced 5th metacarpal - what type of splint and position of the MCP in the splint plus indications for closed reduction

A

● Ulnar gutter
● Slight dorsiflexion at wrist, 90 degrees flexion at MCPJ, 20 degrees flexion at interphalangeal joints

Closed reduction if:
■ Rotational deformity of fingers or scissoring with MCP flexion
■ Angulation of MCP head >30-40o
■ Pseudo-clawing

25
Q

Active adduction of the thumb tests which nerve?

A

ADduction: Ulnar nerve = innervates adductor pollicis

ABduction: Median nerve = innervates opponens pollicis

26
Q

What is a Skier’s or gamekeeper’s thumb

A

rupture ulnar collateral ligament due to abduction and hyperextension, rule out avulsion fracture

27
Q

What is a Seymour fracture?

A

displaced DIP SH I/II fracture of distal phalanx associated with exposure of proximal aspect of nail and damage to germinal matrix

28
Q

You are seeing a 14 year old boy with a fracture of the 5th proximal phalanx, which is closed, salter-harris II and angulated 30 degrees ulnarly.

Assuming you cannot consult orthopedics, how would you manage this injury?

A
  1. Analgesia through an ulnar nerve block or digital ring block
  2. Closed reduction (exaggeration (minimal) -> traction (minimal) -> correction)
  3. Ulnar gutter splint (down to forearm)
  4. Close follow-up with ortho or plastic surgery for re-evaluation and proper casting (1 week)
29
Q

3 ways to remove a ring

A
  1. string pull
  2. string compression of skin
  3. ring cutter
30
Q

How to remove a hair tourniquet

A
  • blunt metal probe
  • hair remover
  • incision

ctjghjkbgf (21 decks)

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