Trauma & Ortho

Question 1

Supracondular fractures most commonly injure which nerve?

Answer 1

Anterior intraosseous nerve (branch of the median nerve) - supplies FPL, FDP, Pronator quadratus
OK sign to check

Question 2

What are the 6 potentially life threatening thoracic injuries in trauma?

Answer 2

TOM CAT
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Cardiac tamponade
Airway
Tracheobronchial injury

Question 3

Indications for adult CT head in 1 hour: (7)

Answer 3

GCS <13 on IA
GCS < 15 2 hours post injury
Focal neuro deficit
Seizure (not known epileptic)
Open/depressed skull fracture
Signs of basal skull fracture
Vomiting >1 episode

Question 4

How is massive transfusion defined?

Answer 4

Over 10 units of pRBC in 24 hours or 4 units in 1 hour.

Or

1 blood volume replacement in 24 hours, or 50% blood vol in 4hrs

Question 5

What is a Morel-Lavallee lesion?

Answer 5

Uncommon shearing injuries that result in the separation of skin and subcutaneous tissue from underlying fascia with resultant haemolymphatic and serotic fluid accumulation.
They are usually painless and managed conservatively with compression.

Question 6

What are the red flags for CES? (7)

Answer 6

1. Bilateral sciatica
2. Severe or progressive bilateral neuro deficit of the legs.
3. New bladder dysfunction
4. New onset sexual dysfunction
5. New bowel dysfunction
6. Saddle anaesthesia or genital/perianal
7. Reduced anal tone

Question 7

Spinal fracture red flags (4)

Answer 7

1. Acute severe central spinal pain relieved on lying down
2. Hx of trauma (can be minor if steroids of osteoporosis)
3. Palpated structural deformity of spine
4. Point tenderness of vertebral body

Question 8

Back pain Cancer red flags (7)

Answer 8

1. Age >50
2. Thoracic pain
3. Gradual onset or no improvement over 4-6 weeks of rx.
4. Severe unremitting pain
5. Localised spinal tenderness
6. Unexplained at loss
7. Hx of cancer - breast, lung, prostate, renal, thyroid, GI

Question 9

What is the most common cause of CES and at what level?

Answer 9

Disc herniation at L4/5

Question 10

What are the st of grade III haemorrhagic shock?

Answer 10

30-40% blood vol loss (1500-2000mls)
HR>120bpm
BP down
CR 3-4s
Pulse pressure reduced ++
RR 30-40
Urine output 5-10mls/hr
Anxious and confused

Question 11

How do you calculate a Battle score?

Answer 11

1pt per every decade after 10 (so this is 4pts)
3pts per rib fracture (15pts)
5pts if chronic lung disease (5pts)
4pts pre-injury anti-coag use (0pts)
2pts per 5% decrease starting at 94% (2pts)

Question 12

What constitutes a tetanus prone wound? (5)

Answer 12

• Puncture injuries from a contaminated environment
• Wounds containing foreign bodies
• Compound fractures
• Wounds or burns with sepsis
• Certain animal bites/scratches

Question 13

What makes a wound high risk for tetanus?

Answer 13

Any of the tetanus prone factors plus:
- heavy contamination
- wounds/burns with extensive devitalised tissue
- wounds/burns requiring surgical intervention that is delayed over 6 hours.

Question 14

What are the high risk factors that mandate immediate CT neck in trauma?

Answer 14

> 65yrs
Paraesthesia in an extremity
Dangerous MOI (fall>1m/6stairs, high speed rtc rollover or ejection, quad bike, bicycle struck or collision)

Question 15

What are the low risk factors in neck trauma that allow safe assessment of movement/rotation to 45 degrees L & R? (You only need one)

Answer 15

Simple shunt
Sitting position in ED
Ambulatory at any time
Delayed onset neck pain
Absence of midline tenderness

Question 16

When do you perform a CT neck in head injury patients?

Answer 16

GCS 12 or less on IA
Intubation
Definitive Dx required urgently
Clinical suspicion and other body areas being scanned

Alert and stable and suspicion with any of:
- 65+
- dangerous MOI (inc axial load + usual)
- focal peripheral neuro
- paraesthesia in limb