12 - lacerations, 13 - Trauma Flashcards
4 stages of wound healing? What happens in last 2 stages ?
Haemostasis. Inflammation. Proliferation.
Maturation
Proliferation: growth of new tissue. Angiogenesis, collagen deposition, granulation tissue, wound contraction.
Maturation: Collagen remodelled. Unnecessary cells apoptose and are removed by the lymph nodes.
Types of wound?
Incisions: clean neat edged cut Lacerations: deep irregular tear Abrasions: graze where the epidermis is scraped off Punctures: self-explanatory GSW: look for exit wound
Wound Mx…
Moist or dry?
Abx?
Eg of wound healing impairment?
moist - but could help breed infection if unclean
Abx not usually needed unless risk of infection
Clean with aseptic technique
Diabetes, malnutrition, vascular insufficiency, being old as shit
Mx of animal / human bites
Encourage bleeding and irrigate with warm water.
PRN step one pain relief
Close wounds not at risk of infection.
Give tetanus prophylaxis if required (five doses).
Abx: 7d co-amox. Met+doxy if allergic.
Assess blood born illness and rabies risk
organism causing tetanus ?
Sx/?
Mx?
Clostridium tetani
Causes mild spasms which progress leading to tetany. Opisthotonos, risus sardonicus, drooling, arrhythmia, incontinence, breathing difficulty
PEP with toxoid or Ig.
Abx is met.
Diazepam for the muscle spasms.
More severe cases require respiratory support, Mg SO4
RUSTY NAILS
Necrotising fasciitis mx
: gent, clindamycin, penicillin G, vanc and surgical debridement.
Trauma ABCDE
Catastrophic haemorrhage Airway + C-spine Breathing (be aware of basal skull #) Circulation Disability Exposure Reassess constantly.
Stages of fracture healing
Reactive: Normal inflammatory process with haematoma and granulation formation.
Reparative: periosteum replicates and reform hyaline cartilage then osteoblasts as woven bone which is replaced by lamellar bone
Remodelling: trabecular lamellar bone is replaced with compact bone. This takes years.
Mx of foreign bodies in eye?
What drug do you use to asses for abrasions?
Bandage both eyes to prevent movement.
Anaesthetise eye and swab with cotton to remove object unless it is too large.
Use fluorescein to check for abrasions. If present, provide chloramphenicol drops.
Refer to ophthalmology.
What to do in major trauma if can’t maintain airway?
Mx of open pneumothoraces?
Haemorrhages?
Drug for bleeding?
ABCDE. rapid sequence induction if pt cannot maintain airway.
FAST scan or CXR if history indicates it.
Occlude open pneumothoraces.
Decompress if shocked.
Apply pressure to haemorrhages. Tourniquet if fails on limbs.
Iv tranexamic acid unless more than 3 hours post injury.
Establish venous access.
Replace lost blood restrictively. Use crystalloids if blood products unavailable.
Call surgeons.
CT if stable.
Iv morphine for pain control, if no access use nasal diamorphine/ketamine.
Document everything.
Mx of uncomplicated fractures
WHO pain ladder. Immobilise and splint Ottawa rules for X-rays Stablise, set, plaster if needed Refer to ortho.
What are the ottawa rules for x-rays of ankle ?
Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
An inability to bear weight both immediately and in the emergency department for four steps
Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
Bone tenderness at the navicular bone (for foot injuries), OR
An inability to bear weight both immediately and in the emergency department for four steps.
Ottawa rules for x ray of knee
Age 55 years or older
Tenderness at head of fibula
Isolated tenderness of patella
Inability to flex to 90°
Inability to bear weight both immediately and in the emergency department (4 steps)
What is compartment syndrome?
stages?
Mx?
Muscles bounded off into compartments by fascial planes.
Pressure in these compartments due to bleeding or inflammation can damage tissue.
Pain -> Parasthesia -> Paralysis -> Pulsesless
Be aware with pain (excruciating on movement)+ lump
Needs to be relieved via surgery (fasciotomy)
Salter harris fracture in kids has a mneumonic to remember increasing severity . what is it?
Gets worse as you go down
I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
II – A = Above. The fracture lies above the physis, or Away from the joint.
III – L = Lower. The fracture is below the physis in the epiphysis.
IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
V – R = Rammed (crushed). The physis has been crushed.
