Trauma and orthopaedics Flashcards
(62 cards)
What is the most likely bacterial cause of septic arthritis? (1)
Most common location
Staphylococcus aureus
Knee
What fluids will you send for culture in septic arthritis (2)
Synovial fluid culture
Blood culture (most common cause is hematogenous spread)
Name 2 inflammatory markers raised along with the WCC in septic arthritis
ESR, CRP
Outline immediate management plan in septic arthritis
Analgesia
Take blood and fluid cultures BEFORE empirical antibiotics
IV antibiotics: flucloxacillin or clindamycin if allergic for 4-6 weeks
What would be the role of orthopaedics do in septic arthritis (1)
Joint aspiration / wash out to decompress joint
What other organism should be considered in septic arthritis if a metal prosthesis was in situ in the joint
Staphylococcus epidermis
Give 2 risk factors for developing septic arthritis (2)
Penetrating injury
Immunocompromised
Infections elsewhere e.g. gonococcal
Diabetes
Most likely cause of septic arthritis in sexually active patient (1)
Neisseria gonorrhoea (gonococcus)
Name 4 rotator cuff muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Where does the supraspinatus attach to the humerus? (1)
Greater tubercle
What muscle takes over abduction of the arm after the supraspinatus initiates movement (first 10-15 degrees) (1)
Deltoid 15-90
(Trapezius 90-180)
What 2 muscles are innervated by the accessory nerve? (2)
Teres minor
Deltoid
What 2 methods are used to image the supraspinatus and to assess whether any labral tears are present? (2)
MRI and ultrasound
ABCDE approach: RTA, spinal board with collar, blocks and tape immobilising his cervical spine, snoring-like sound from airway
a) What manoeuvre should you perform initially? (1)
b) What adjunct is available to help manage the patient’s airway? (1)
a) Jaw thrust
(presume cervical spine is unstable so do not perform head tilt-chin lift)
b) Oropharyngeal airway (Guedel)
(nasopharyngeal cannot be used as there is a possibility of basal skull fracture)
ABCDE approach
What can you do improve a patient’s ‘breathing’
Oxygen 15L non-rebreathe mask
ABCDE approach
Tachycardiac, hypotensive, no obvious site of bleeding
a) Give 2 initial steps you would take to manage his circulatory problems (2)
b) What 4 urgent blood tests would you request at this point (4)
a) Insert two wide-bore cannulae, IV 0.9% normal saline bolus
b) FBC, U&E, cross-match, clotting
Below what GCS is the airway at risk of not being maintained?
< 8
ABCDE approach
a) Name 2 images you would request in a trauma series (2)
b) What 2 forms of complex imaging would allow you to fully assess the extent of the injuries (2)
a) chest, pelvic and cervical X-ray
b) CT head and adbomen
Hyper-resonant percussion and tracheal deviation most likely diagnosis (1)
Tension pneumothorax
Management of pneumothorax
a) minimal symptoms
b) symptoms but not high-risk
c) high-risk characteristics (haemodynamic compromise, >50)
a) conservative care
b) needle aspiration (wide-bore cannula into the 2nd intercostal space mid-clavicular line), if unsuccessful then chest drain
c) chest drain (triangle of safety)
Massive haemothorax
a) Percussion sound (1)
b) Acute management (1)
a) Dull percussion
b) Wide-bore chest drain (tube thoracosotomy)
3cm laceration entering the chest wall around the 6th intercostal space, give 2 structures that could be damaged (2)
liver, heart
Initial imaging test for haemothorax (1)
Chest X-ray
Test for integrity of anterior cruciate ligament (1)
Anterior drawer test
