Sports Trauma and Applied Clinical Practice Flashcards
(22 cards)
What is the full protocol for DRABCDE?
Danger
Response
Airway
Breathing
Circulation
Disability
Exposure and extricate
What is the full assessment breathing protocol?
RIPAP:
Respiratory rate - count breaths within 10 seconds
Inspect (TWELVE):
- Trachea
- Wounds
- Epiphyseal
- Larynx
- Distended veins
- Everything else
Palpation:
- Chest compression
- High and wide
- Equal and bilateral expansions
- Looking for pain, crepitus, deformity
Auscultation (Stethoscope):
- UL
- ML
- LL
- Good side then Bad side
Percussion:
- Normal noise = Resonant
- Hypo = Dull
- Hyper = Loud hollow
What is the full assessment circulation protocol?
- Check for Pulses
- Cap refill – hold finger for 5 seconds, blood should return in 2 seconds
- On the floor and 5 more – external, chest, abdomen (4 quadrants), kidneys, pelvic
fracture, long bones (femur/humerus)
What is the full assessment disability protocol?
- Assessing Pupils – pupil dilate
- Assessing Glasgow Coma Scale
- Asking Maddocks questions – Ask series of questions such as what half of the
game it is? Who are we playing? What time is it on the clock? - Deliver Gluscose
What is the correct handover algorithm for the primary survey?
ATMIST:
- Age and Sex
- Time
- Mechanism of Injury
- Injuries Suspected
- Signs
- Treatment given
What other relevant information should you gather for the secondary survey within a handover?
SAMPLE:
- Signs and Symptoms
- Allergies
- Medication
- Past Medical History
- Last Meal and Drink
- Events and Environment on Injury
What does the acronym ATOM FC stand for?
ATOM FC:
- Airway obstruction
- Tension pneumothorax
- Open pneumothorax
- Massive Haemothorax
- Flail chest
- Cardiac Tamponade
What can an obstructed airway quickly lead to?
- Hypoxia (lack of oxygen)
- Hypercarbia (Increase of Carbon Dioxide in the bloodstream)]
- Deterioration
The airway is considered obstructed if they score <8 on the Glasgow Coma Scale (GCS) or <P on the AVPU scale
What is Tension Pneumothorax?
What are the signs and symptoms?
How to manage?
What is Tension Pneumothorax?
- Progressive build up of air in the pleural space
- Usually due to a Lung Laceration
- Air is allowed into pleural space but cannot pass back out
What are the signs and symptoms?
- Increased breathlessness and increased breathing rate
- Distended neck veins
- Reduced air entry to injured side
- Hyper-resonant percussion note to the injured side
- Reduced chest expansion to the injured side
- Tachycardia (BPM above 100)
- Cyanosis (late stage) - insufficient oxygen within the blood
- Trachea deviates away from injured side (very late stage)
How to manage?
- Apply oxygen mask so they are breathing pure oxygen
- Call 999 - need a immediate decompression with a needle thoracocentesis
What is Open Pneumothorax?
What are the signs and symptoms?
How to manage?
What is Open Pneumothorax?
- Air gets into the pleural space from injury to chest
- Example: Stab wound
What are the signs and symptoms?
- Easily seen on inspection of thorax
- Similar signs to Tension Pneumothorax:
- Increased breathlessness and increased breathing rate
- Distended neck veins
- Reduced air entry to injured side
- Hyper-resonant percussion note to the injured side
- Reduced chest expansion to the injured side
- Tachycardia (BPM above 100)
- Cyanosis (late stage) - insufficient oxygen within the blood
- Trachea deviates away from injured side (very late stage)
How to manage?
- Apply oxygen mask so they are breathing pure oxygen
- The area must be covered by a Russel chest seal
- Rapid transfer to emergency department
What is Massive Haemothorax?
What are the signs and symptoms?
How to manage?
What is Massive Haemothorax?
- Blood in the pleural space
- Greater than 1500ml of blood (30% circulating volume) in pleural space
- Affects gaseous exchange and causes hypovolemia
What are the signs and symptoms?
- Tachypnoea (>20 breaths per minute)
- Tachycardia (BPM above 100)
- Reduced air entry on injured side
- Dull percussion note on injured side
- Reduced chest expansions on injured side
How to manage?
- Apply oxygen mask so they are breathing pure oxygen
- Call 999 - need of tube thoracotomy
What is Flail Chest?
What are the signs and symptoms?
How to manage?
What is Flail Chest?
- 2 or more ribs “broken” in 2 or more places
- Free floating segments
- Could lead to pulmonary contusion
What are the signs and symptoms?
- Severe pain
- Palpable crepitus
- Tachypnoea (rapid breathing more than breaths per minute)
- Shallow breaths
- Paradoxical Movement
How to manage?
- Apply oxygen mask so they are breathing pure oxygen
- Pain relief (anagelesia) (NO Entonox)
What is Cardiac Tamponade?
What are the signs and symptoms?
How to manage?
What is Cardiac Tamponade?
- Direct trauma leading to a bleed in pericardial sac
- Impairing ventricular function
- Leading to cardiac arrest
What are the signs and symptoms?
- Difficult to diagnose
- Prompt recognition is essential
- High index of suspicion with ANY anterior chest wall blow
- Mechanism of injury
- Becks Triad - Hypotension, Muffled heart sounds, Distended neck veins
How to manage?
- Apply oxygen mask so they are breathing pure oxygen
- Call 999 - Need pericardiocentesis
What are the 4 H’s and T’s?
H’s:
- Hypoxia - A lower than normal concentration of oxygen in arterial blood
- Hypovolaemia - Abnormal decrease in the volume of blood plasma
- Hyper/Hypokalaemia - Elevated/Low potassium in the blood
- Hypothermia - Abnormally low body temperature
T’s:
- Tamponade, Cardiac - A life threatening situation where a large amount of fluid (usually blood) accumulates inside the pericardial sac of the heart
- Tension Pneumothorax - The accumulation of air in the pleural space
- Toxins - A poisonous substance
- Thrombosis - The formation or presence of a blood clot in a blood vessel
What are the are the different stages tendinopathy continuum and signs and symptoms?
3 stages:
- Reactive stage - non-inflammatory response in cells and matrix, short term thickening of the tendon occurs to reduce stress by increasing cross sectional area
- Disrepair stage -occurs to attempt to heal tendon, similar to reactive stage but with greater tendon matrix breakdown. Increased production of cells including myfibroblasts, chondrocytes and proteoglycans. The increase in proteoglycans causes the seperation of collagen and attracts water to the area, thickening the tendon further. Increased vascularisation suggests an inflammatory response.
- Degenerative stage - shows progression of both matrix and cell changes. Areas of cell death due to apoptosis, trauma or tenocyte exhaustion are apparent. As a result, areas of acellularity have been described, and large areas of the matrix are disordered and filled with vessels, matrix breakdown products and little collagen
What are the red flag conditions of the lumbar/thoracic spine?
Cauda Equina Syndrome:
Spinal cord compression of the Cauda Equina (originates at L1/2)
Spinal Malignancy/Metastatic Cancer:
Spread of a primary cancer to a secondary location
Axial Spondyloarthritis:
Extra bone formation that starts to bridge the gap between the vertebrae
What are the signs and symptoms of Cauda Equina?
- Cauda Equina Syndrome:
- Persistent LBP and stiffness
- Erectile Dysfunction
- Saddle Anaesthesia
- Impaired Bladder Function
- Impaired Bowel Control
- Bilateral Dermatomal changes
- Bilateral Myotomal changes
What are the signs and symptoms of Spinal Malignancy/Metastatic cancer?
- Spinal Malignancy/Metastatic Cancer:
- Systematically unwell (e.g., fever, fatigue, chills)
- Unremitting non mechanical night pain
- Change in bladder and bowel habits
- Sores that do not heal
- Unexplained weight loss
- Thoracic spine pain
- Lifestyle factors
What are the signs and symptoms of Axial Spondyloarthritis?
- Axial Spondyloarthritis:
- Morning stiffness > 30 mins
- Eased with movement and NSAIDS
- FH of inflammatory conditions
- Alternating sacroilliac joint pain
- Possible Uveitis (eyes)
- Possible Crohns/Colitis (digestive)
- Possible Psoriasis (skin)
- Possible Enthesitis (tendon)
- Dactylitis (swollen fingers)
- Pitting and clubbing (nails)
What is Lx/Sx radiculopathy (Sciatica) and what are the signs and symptoms?
It is caused by the compression of the sciatic nerve due to stenosis of the corresponding nerve root causes heightened mechano-sensitivity of the nerve
Signs and symptoms are:
- Unilateral neurogenic pain presentation of the posterior thigh
- Can be in the absence of lower back pan
What are the 5 D’s, 3 N’s and A for the acronym DNA?
D’s:
- Dizziness
- Dysarthria - struggle to speech
- Dysphagia - difficult to swallow
- Diplopia - double vision
- Drop attacks
N’s:
- Nausea
- Nystagmus - rapid eye movement
- Numbness face/tongue
A:
- Ataxia - lack of muscle control
What is Multiple Myeloma?
A persistent dull ache or bony tenderness - often at the back, ribs or pelvis
Symptoms:
- Tiredness
- Repeated infections
- Extreme thirst, nausea, stomach pains, increased urination, constipation
- Blurred vision, headaches, dizziness (due to hyper viscosity of the blood)
- Signs of kidney failure
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