Trauma call

Question 1

What does the primary survey include?

Answer 1

Airway maintenance with cervical spine control
Breathing and ventilation
Circulation with haemorrhage control
Disability: neurological status
Exposure and environment control (completely undress the patient to check for hidden injuries, but prevent hypothermia)

Question 2

What is the secondary survey?

Answer 2

Involves a complete and systematic exam of the patient from head to toe and also GCS.

Question 3

How would you manage lower limb injuries?

Answer 3

1. Examine neurovascular status
2. Open fracture should have gross contamination removed and photograph of wound taken
3. Wound should be covered in saline soaked gauze and the limb splinted
4. IV antibiotics within 1 hour of injury and every 8 hours until wound debridement
5. Taken to theatre for wound washout and debridement, and stabilization of fracture within 24 hours

Question 4

How would you assess neurovascular status?

Answer 4

CT angiogram

- Knee dislocations have a high rate of peroneal nerve and popliteal artery injuries

Question 5

What are the principles of treating fractures?

Answer 5

• Reduce
• Stabilise and preserve the blood supply
• Rehabilitate

Question 6

What are stabilising methods for fractures?

Answer 6

• Casts/splints
• Intra-medullary devices
• Plates and screws
• Tension band wires
• K-wires
• External fixators

Question 7

How are soft tissue injuries managed?

Answer 7

• Conservatively by splinting and physiotherapy
• Direct surgical repair - two ends are reattached or reattached to bone
• Reconstruction with new tissue

Question 8

What is Patient Controlled Analgesia (PCA)?

Answer 8

The patient can control their pain by self-administering a small bolus dose of IV opioid. Pressing a button delivers a set dose of the analgesic. This should be pressed at the onset of discomfort rather than when the patient is in severe pain.

Question 9

What drugs are most frequently used for PCA?

Answer 9

Morphine, pethidine and fentanyl (good for renal failure patients)

Question 10

What is the sedation score system for PCA?

Answer 10

0 Awake
1 Dozing intermittently, easy to waken
2 Mostly sleeping, easy to waken
3 Difficult to waken

Question 11

What is compartment syndrome?

Answer 11

When the pressure within the fascial compartment exceeds the perfusion pressure within the compartment, causing ischaemia of the tissues in the compartment.

Question 12

What do you do if you suspect compartment syndrome?

Answer 12

• Take a history
• Examination - neurovascular status and compartment syndrome signs
• Review analgesia
• Release any dressings/casts which may be causing external compression
• Position the limb level with the heart
• If they do not respond to analgesia contact a senior doctor, they may need an emergency fasciotomy

Question 13

What is the main sign of compartment syndrome?

Answer 13

Pain exacerbated by passive stretch

Question 14

What are the local factors affecting bone healing?

Answer 14

• Location (scaphoid, distal tibia and base of 5th metatarsal are at risk due to blood supply)
• Stability
• Infection
• Pattern (segmental fractures are higher risk)

Question 15

What are systemic factors affecting bone healing?

Answer 15

• Diet
• Diabetes mellitus
• Smoking
• HIV
• Medications e.g. corticosteroids and NSAIDs

Question 16

What neurovascular supply will be affected by the location of a fracture?

Answer 16

Midshaft humerus fracture = radial nerve
Fibula neck fracture = common peroneal nerve
Supracondylar fracture = median nerve
Shoulder dislocation = axillary nerve
Hip dislocation = sciatic nerve

Question 17

What are the classifications of nerve injuries?

Answer 17

Neuropraxia = reversible conduction block due to injury to the axon sheath
Axonotmesis = disruption to the myelin sheath and axon
Neurotmesis = complete nerve division and disruption of the endoneurium

Question 18

What is the WHO definition of osteoporosis?

Answer 18

Bone density 2.5 standard deviations below that of a young subject from the same race and sex.

Question 19

What are common sites of adult osteoporotic fractures?

Answer 19

• Neck of femur
• Wrist
• Colles (radius)

Question 20

What compartment of the leg is most likely affected by compartment syndrom?

Answer 20

Anterior compartment