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A1 > ATLS- MSK injuries > Flashcards

ATLS- MSK injuries Flashcards

1
Q

Why should an ED doc not worry about completely reducing an open fracture back into the skin?

A

Will require surgical debridement

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2
Q

How do anterior and posterior shoulder dislocations classically appear?

A 
Anterior = Squared off
Posterior = Locked in internal rotation
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3
Q

How do posterior elbow dislocations appear?

A

Olecranon prominent posteriorly

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4
Q

How do anterior and posterior hip dislocations appear on exam?

A 
Anterior = flexed, abducted and externally rotated
Posterior = Flexed adducted and internally rotated
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5
Q

When is the only time an x-ray is not indicated prior to reduction of a broken bone?

A

In the presence of vascular compromise or impending skin breakdown

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6
Q

What are the two major extremity injuries that are potentially life threatening?

A

Major arterial hemorrhage

crush syndrome

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7
Q

What are the stabilizing measures used to stop hemorrhage?

A

Tourniquet use and direct pressure

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8
Q

What is the recommended rate of urinary output to prevent renal failure with rhabdo?

A

100 mL/hr

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9
Q

Should you ever explore an open wound?

A

No

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10
Q

True or false: if a fracture and a wound exist on the same limb, it is considered an open wound until proven otherwise

A

True

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11
Q

What is the only way to determine if a wound is an open fracture?

A

Surgically explore it in the OR

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12
Q

What two antimicrobial interventions should all patients with open wounds receive?

A

Abx and tetatnus

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13
Q

How long can muscle tolerate a lack of arterial flow for?

A

6 hours

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14
Q

How many attempts should be made at relocating a dislocated joint when arterial insufficiency is present?

A

Once. If unsuccessful, then splint and emergently call a surgeon

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15
Q

Is a patient with multiple injuries who requires intensive resuscitation and emergency surgery a candidate for replantation?

A

No

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16
Q

What is the appropriate way to save an amputated finger?

A

Wrap with isotonic solution in sterile gauze and PCN, and put in ice, but do not freeze

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17
Q

When in the course of disease does the lack of a pulse present itself with compartment syndrome?

A

Late

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18
Q

Tissues pressures greater than how many mmHg suggest compartment syndrome?

A

30-45 mmHg

19
Q

What is the role of compartment pressures in the diagnosis of compartment syndrome?

A

Aid, but it is a clinical diagnosis

20
Q

If compartment syndrome is suspected, and all of the occlusive dressings are removed, how much time does the pressure have to fall before an emergent fasciotomy is needed?

A

30-60 minutes

21
Q

How can you test motor and sensory function for the following nerve: ulnar

What injury is this usually compromised in?

A

Index and little finger abduction
Sensation to little finger

elbow injury

22
Q

How can you test motor and sensory function for the following nerve: distal median nerve

What injury is this usually compromised in?

A

Thenar contraction with opposition
index finger sensation

Wrist fracture or dislocation

23
Q

How can you test motor and sensory function for the following nerve: median/anterior interosseous n

What injury is this usually compromised in?

A

Index tip flexion
No sensation

Supracondylar fracture of humerus

24
Q

How can you test motor and sensory function for the following nerve: musculocutaneous

What injury is this usually compromised in?

A

Elbow flexion
Radial forearm sensation

Anterior shoulder dislocation

25
Q

How can you test motor and sensory function for the following nerve: radial

What injury is this usually compromised in?

A

Thumb, finger metacarpophalangeal extension
First dorsal web space sensation

Distal humeral shaft fracture/anterior shoulder dislocation

26
Q

How can you test motor and sensory function for the following nerve: axillary

What injury is this usually compromised in?

A

Deltoid motor function
Lateral shoulder sensation

Anterior shoulder dislocation

27
Q

If a laceration extends below what level does it require surgical debridement?

A

Fasical level

28
Q

What is the general management of joint injuries?

A

Immobilize the joint and reassess the vascular and neuro status. Call the surgeon

29
Q

True or false: Imaging and immobilization follow the rule of above and below the site of injury

A

True

30
Q

How are femur fractures without lower leg fractures handled?

A

Traction splint

31
Q

How should the knee be positioned to be immobilized?

A

In about 10 degrees of flexion

32
Q

How should the hand be position to be immobilized?

A

in anatomic functional position, with wrist slightly dorsiflexed and fingers gently flexed at 45 degrees at the MCP

33
Q

How should the wrist and forearm be positioned to be immobilized?

A

flat

34
Q

How should the elbow be positioned to be immobilized?

A

flexion

35
Q

What is the best way to ensure that you do not miss an injury?

A

Frequent reassessment and thorough secondary survey

36
Q

How can you test motor and sensory function for the following nerve: femoral nerve

What injury is this usually compromised in?

A

Knee extension
Anterior knee sensation

Pubic rami fractures

37
Q

How can you test motor and sensory function for the following nerve: obturator

What injury is this usually compromised in?

A

Hip adduction
Medial thigh sensation

Obturator ring fractures

38
Q

How can you test motor and sensory function for the following nerve: Posterior tibial

What injury is this usually compromised in?

A

toe flexion
Sole of foot sensation

knee dislocation

39
Q

How can you test motor and sensory function for the following nerve: superficial peroneal

What injury is this usually compromised in?

A

Ankle eversion
Lateral dorsum of the foot sensation

Fibular neck fracture/knee dislocation

40
Q

How can you test motor and sensory function for the following nerve: Deep peroneal

What injury is this usually compromised in?

A

Ankle/toe dorsiflexion
Dorsal first to second web space sensation

fibular neck fractures

41
Q

How can you test motor and sensory function for the following nerve: sciatic nerve

What injury is this usually compromised in?

A

Plantar dorsiflexion
Foot sensation

Posterior hip dislocation

42
Q

How can you test motor and sensory function for the following nerve: superior gluteal nerve

What injury is this usually compromised in?

A

Hip abduction
Upper buttocks

acetabular fractures

43
Q

How can you test motor and sensory function for the following nerve: inferior gluteal

What injury is this usually compromised in?

A

Gluteus maximus hip extension
Lower buttocks sensation

acetabular fx

A1 (32 decks)

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