Week 3 - Geraldine Lewis 1 Flashcards
What does ATS stand for? What is it used for?
- Australasian Trauma Scale
- Used to help ED physicians rank patients in order of who they are going to treat
What are ATS scores based on?
Pain score Airway Breathing Circulation Disability
What are examples of a score of 1 on ATS?
Unresponsive, cardiac arrest, severe shock, severe behavioural disorder with immediate threat of danger violence
What are some examples of scores of 2 on ATS?
Acute stroke, severe stridor, major multi-trauma
What is compartmental syndrome?
Localised swelling of soft tissue enclosed by fascia that cuts off expansion - this can lead to a block in blood supply, which can cause irreversible ischaemic injury if pressure if not released
What are the eight bones of the wrist?
Scaphoid Lunate Triquetral Pisiform Trapezium Trapezius Capitate Hamate
Where do you look on a wrist exam?
On flexor and extensor side, as well as medial and lateral sides.
Assess for radial and ulnar deviation
Where do you palpate on a wrist exam?
- Palpate along distal radius, then into the snuff box. Continue down 1st metacarpal and onto the thumb.
- Then check 2nd, 3rd, 4th and 5th metacarpals for any pain.
- Move to ulnar side, feel around the ulnar styloid, and carry up the distal ulnar
- Feel across carpal bones
Assess for pain around phalangeal joints
How do you assess for mobility in a wrist exam
- adduction/abduction of the fingers
- opposition of the thumb, thumb to little finger, thumb to index finger, flexion and extension of the thumb
What are the special tests in a wrist exam?
Collateral ligament assessment
How would you assess for integrity of radial collateral ligament of the wrist?
See if passive ulnar deviation causes pain
How would you assess strength in the wrist/hand?
Ask patient to keep fist closed while you try to open in
As patient to flex, extend and deviate the wrist - actively, and against resistance
What do you need for good fracture healing?
Immobilization Absence of infection Adequate vascular supply Good general health for healing Precise anatomical reduction Minimal necrosis
What does ‘reduction’ of a fracture mean?
That you’re manipulating it back into a normal position. Can be closed or open – open means surgery and tools are used
Describe Bier’s block for a closed reduction
- 1% lidocaine (no epinephrine), 1:1 with saline.
- Intravenous catheter inserted
- Complete isolation of area being blocked, two tourniquets are used - both arterial, both taped in place
Pressure cuff also used, pressure taken up to about 300 systolic
Reduction performed
Deflate tourniquet after at least 20 minutes to avoid bolus into systemic circulation
Remove catheter