Trauma and Injury to the Extremities - CA

Question 1

Isolate trauma to an extremity with associated vascular injury has ______ percent rate of mortality or limb loss?

Answer 1

10

Question 2

Are injuries involving the LE or UE more common?

Answer 2

Lower extremity

Question 3

What are the two most common injured blood vessels?

Answer 3

Femoral and popliteal

Question 4

What four things do we look at to evaluate the extent of an injury?

Answer 4

Nerves, bones, soft tissues, vascular supply

Question 5

What are two most common causes of penetrating trauma?

Answer 5

Gunshot wounds and Stab wounds

Question 6

Do gunshot or stab wounds have a more predictable pattern of injury?

Answer 6

Stab wounds

Question 7

Absent or diminished distal pulses, obvious arterial bleeding, large expanding or pulsatile hematoma, audible bruit, palpable thrill, and distal ischemia are all signs of?

Answer 7

Vascular trauma

Question 8

If you are 1000% sure your patient has vascular injury to an extremity, what should you do?

Answer 8

Vascular surgery consult!

Question 9

If you are highly suspicious of vascular injury, what step should you take?

Answer 9

CT angiography

Question 10

If your patient has no signs of vascular injury, what test should you do?

Granted, if your patient has no signs of injury i don’t know why you would do this – think about peripheral vascular disease

Answer 10

ABI’s

Question 11

What test should you get before CT angiography with contrast?

Answer 11

Creatinine

Question 12

If concern for significant blood loss, what lab should you order?

Answer 12

CBC

Question 13

Complete disruption of the joint

Answer 13

Dislocation

Question 14

partial disruption of a joint

Answer 14

Subluxaiton

Question 15

Tearing injury to muscle fibers

Answer 15

Strain

Question 16

Tearing injury to ligaments of a joint

Answer 16

Sprain

Question 17

What are four examples of orthopedic emergencies?

Answer 17

1. Open fracture
2. Subluxation and dislocation
3. Neurovascular injury
4. Compartment syndrome

Question 18

Is it possible for pain of fracture or dislocation to be referred to another area?

Answer 18

Yes

Question 19

Are all dislocations visible on standard x-ray series?

Answer 19

No – some require special views

Question 20

What signs may indicate that a fracture is being missed?

Answer 20

Exquisite tenderness to palpation, pain on weightbaring, and passive ROM

Question 21

What would Shayne Foley say about x-raying injuries?

Answer 21

Always look above and below – x-ray those joints as well because injury may coexist with long bone fracture

Question 22

Gross deformity is pathognomonic for?

Answer 22

Fracture

Question 23

When palpated, what are some things you can look for that indicate a fracture?

Answer 23

Point tenderness, bony step-off

Question 24

Which three nerves extend into the hand?

Answer 24

Radial, median, and ulnar

Question 25

When describing a fracture, what 6 things need to be in your description?

Answer 25

1. Open vs closed 2. Location 3. Orientation of fracture line 4. Displacement and separation 5. Shortening 6. Angulation

Question 26

Before you reduce a dislocation what should you do?

Answer 26

Get x-rays! and then get x-rays after

Question 27

Why is it important to reduce a fracture deformity quickly?

Answer 27

Alleviate pain, relieve tension on nerves and vessels, minimize possibility of converting an open fracture to a closed fracture, and restore circulation to pulseless distal extremity

Question 28

What are two examples of when we splint?

Answer 28

1. fracture | 2. after reduction of a dislocated joint

Question 29

A clavicle fracture, AC separation, shoulder dislocation, and humeral neck fracture should have what type of immobilizer?

Answer 29

Shoulder immobilizer

Question 30

Nondisplaced radial head fracture should have what type of arm displacement?

Answer 30

Arm sling

Question 31

Elbow fractures and elbow dislocations should get what type of splint?

Answer 31

Long-arm gutter splint

Question 32

Wrist or forearm fracture should get what type of splint?

Answer 32

Sugar tong splint

Question 33

Metacarpal or proximal phalanx fracture should get what type of splint?

Answer 33

Short-arm gutter splint

Question 34

Scaphoid fracture, thumb metacarpal or proximal thumb phalanx fracture should get what type of splint?

Answer 34

Thumb spica splint

Question 35

Patellar fracture or subluxation, knee dislocation, tibial plateau fracture, knee ligament or meniscus injury/tear should get what type of immobilizer?

Answer 35

Knee immobilizer

Question 36

Ankle dislocation, unstable ankle, widened medial mortise, or metatarsal fracture should get what type of splint?

Answer 36

Posterior ankle mold splint

Question 37

Simple ankle sprain or stable lateral malleolar fracture should get what type of immobilizer?

Answer 37

Ankle stirrup

Question 38

Toe fracture or metatarsal fracture should get what type of immobilizer?

Answer 38

Hard-soled shoe

Question 39

What type of immobilizer can be used for some toe or foot fractures where weightbearing is allowed?

Answer 39

Short-leg walking boot

Question 40

What are your typical discharge instructions?

Answer 40

RICE! Rest, elevate, ice, remain non weightbearing until cleared by ortho Use pain medication as needed

Question 41

when is it necessary for patients to return to ED immediately after discharge?

Answer 41

Pain is severe or increasing Numbness is new or worsening Skin discoloration distal to the splint

Question 42

Neurologic deficit, vascular injury, compartment syndrome are all?

Answer 42

complications of extremity injury

Question 43

What is a delayed complication that can result in fatal respiratory failure?

Answer 43

Fat embolus -- usually originating from marrow of fracture in large bones. Occurs within first few days of injury