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Flashcards in Trauma & orthopaedics Deck (31)
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1

Where can a catastrophic haemorrhage be?

floor, chest, abdomen, pelvis, long bones

2

5 ways to stop bleeding

Tourniquet
Lift it up
Pelvic binding
Interventional radiology (intravascular coagulation)
Packing

3

What is cerebral perfusion pressure?

MAP - intracranial pressure

4

Most important blood test in trauma?

Group and save!

5

Which fractures need fixation?

Open
Neurovascular damage
Displaced (loss of function, arthritis)
Unstable (non union, DVT/PE)

6

3 classifications of fracture and subcategories

Traumatic #
• Direct: e.g. assault, metal bar
• Indirect: e.g. fall on an outstretched hand → clavicle #
• Avulsion

Stress #
• Bone fatigue due to repetitive strain e.g. foot #s in marathon runners

Pathological #
• Normal forces but diseased bone
• Local: tumours
• General: osteoporosis, Cushing’s, Paget’s

7

6 parts of describing a fracture

1. Demographics
• Pt. details
• Date radiograph taken
• Orientation and content of image
2. Pattern
• Transverse
• Oblique
• Spiral
• Multifragmentary
3. Anatomical Location
4. Intra- / extra-articular
• Crush
• Greenstick
• Avulsion
• Dislocation or subluxation
5. Deformity (distal relative to proximal)
• Translation
• Angulation or tilt
• Rotation
• Impaction (→shortening)
6. Soft Tissues
• Open or closed
• Neurovascular status
• Compartment syndrome

8

What do you need before describing a fracture?

Pt details
Radiographs at right angles
At least 2 views
Need images of join above and below #

9

What are the 4 R's of fracture management?

Resuscitation
Reduction
Restriction
Rehabilitation

10

What is involved in resuscitation (1st R of fracture management)

• Trauma care (ABCDE, 1º survey, C-spine)
• Neurovascular status and dislocations
• Consider reduction and splinting before imaging (reduce bleeding, pain and risk of neurovascular injury)
• X-ray once stable
• Open fractures need: analgesia, wound swab, irrigation, dressing, alignment, anti-tetanus and antibiotics
• Gas gangrene is most dangerous complication of open fracture: debridement and clindamycin + benpen

11

What is involved in reduction (2nd R of fracture management)

• All displaced fractures should be reduced, alignment is more important than opposition
• Manipulation/closed reduction (under local/regional/general anaesthetic, traction to disimpact, manipulation to align)
• Traction (not usually used)
• Open reduction and internal fixation (accurate but risks of surgery, used in open and intra-articular #s or if conservative management fails)

12

What is involved in restriction (3rd R of fracture management)

• Fixation to decreases strain and lead to bone formation
• Slings, elastic supports
• Plaster of paris (full cast only after 48hrs due to risk of compartment syndrome)
• Functional bracing (only bone shaft supported, free to move joints)
• Continuous traction
• External fixation (pins & wires connected to external frame, allows wound access and decreases infection risk)
• Internal fixation (pins, plates, screws, IM nails, perfects anatomical alignment, increases stability and aids early mobilisation)

13

What is involved in rehabilitation (4th R of fracture management)

• Mobilisation to keep muscle and bone mass up, decreases joint stiffness
• Maximise mobility of uninjured limbs
• Quick return to function, less chronic morbidity
• Physiotherapy
• OT (splints, mobility aids, home modification)
• Social services (meals on wheels, home help)

14

What are the types of complication you would list for fractures?

General
Specific
Early
Late

15

Give 5 general complications of fractures

• Haemorrhage
• Pain
• Muscle damage (rhabdomyolysis)
• Anaesthesia (teeth damage, aspiration, anaphylaxis)
• Prolonged bed rest (UTI, pneumonia, pressure sores, DVT, PE, reduced bone mineral density

16

Give 2 specific complications after fractures

Neurovascular damage
Visceral damage

17

Give 3 early complications after a fracture

• Compartment syndrome
• Infection
• Fat embolism

18

Describe pathophysiology of compartment syndrome

Oedema after #
Pressure can’t be released due to fascia
Decreases venous drainage
If compartment pressure>capillary pressure= ischaemia
Pain on passive muscle stretching
Warm erythema
Weak/absent peripheral pulses

19

Name 6 late complications after a fracture

• Problems with union of bone (ischaemia, infection, interposition of tissue between fragments, malignancy, malnutrition)
• Avascular necrosis (eg femoral head, scaphoid. Soft and deformed bone)
• Growth disturbance (crush injury may injure physis and lead to growth arrest)
• Post traumatic osteoarthritis
• Pain (complex regional pain syndrome affecting neighbouring area, sensory and abnormal blood flow)
• Myositis ossificans (bone tissue formed within muscle after trauma, restricted painful movement, can be excised)

20

Define a burn

An injury to the body tissues as a result of extremes of energy

21

What are the 6 functions of skin

1) Sensory Organ
2) Endocrine
3) Thermoregulatory
4) Immune Response
5) Barrier to fluid loss
6) Social

22

Name 6 types of burn

• Heat (dry flame, sunstroke, wet scalds)
• Electrical
• Chemical
• Radiation
• Mechanical (friction)
• Cold

23

What are burns associated with?

(Mad Bad Glad Sad)
• Carelessness
• Accidents
• Epilepsy/stroke/psychiatric problems
• Alcohol/substance misuse
• Extremes of age

24

Pathophysiology of burns

• Hypovolaemic shock (tissue damage-> inflammatory mediators-> leaking vessels-> vascular resistance
• Capillary leakage mediators (histamine, prostaglandins, oxygen free radicals)
• Vasoconstriction and burn extensions (thromboxane, catecholamines)
• Multisystem shock and reduced cardiac output
• Blood cells lost in urine

25

What are the zones of a burn?

Central->peripheral
Zone of coagulation
Zone of stasis
Zone of inflammation

26

Survival rates of people with >50% burns is ____
Why has survival rates improved?

• 75% patient with 50% burns or more survive
• Improved resus, inhalation injury care & surgical techniques

27

How do you assess severity of burns?

• BSA (rule of nines, hand=1%, Lund&Browder chart) These don’t include erythema.
• Depth of burn (erythema, partial thickness, full thickness)

28

Differences between partial and full thickness burn

• Partial thickness (blistered, painful, tissue paper appearance, wet, swelling, fluid loss)
• Full thickness (painless, thick and leathery, no blisters, dry, dark red/brown, no blanching, swelling in limbs)

29

Management of burns

• ABCDE (intubate? Escharotomy if full thickness? Fasciotomy if compartment syndrome)
• Remove heat source and cool for 10mins minumum
• Fluid resuscitation if>15% BSA in adults of >10% BSA in children
• Monitor urine output (1ml/kg/hr), replace lost sodium
• 4ml/kg/% burn in 1st 24 hrs (half in 8 hrs, remainder in 16hrs)
• More fluid if myoglobinuria, electrical injuries, skeletal trauma
• Add maintenance in children
• Pain relief
• Non adherent dressings (cling film?)

30

How are chemical burns treated?

• Dilution is the solution to pollution
• Mustard gas-> treat with dilute hydrochloric acid
• Caustic soda-> Treat with 1% acetic acid