ATLS- MSK injuries Flashcards
Why should an ED doc not worry about completely reducing an open fracture back into the skin?
Will require surgical debridement
How do anterior and posterior shoulder dislocations classically appear?
Anterior = Squared off Posterior = Locked in internal rotation
How do posterior elbow dislocations appear?
Olecranon prominent posteriorly
How do anterior and posterior hip dislocations appear on exam?
Anterior = flexed, abducted and externally rotated Posterior = Flexed adducted and internally rotated
When is the only time an x-ray is not indicated prior to reduction of a broken bone?
In the presence of vascular compromise or impending skin breakdown
What are the two major extremity injuries that are potentially life threatening?
Major arterial hemorrhage
crush syndrome
What are the stabilizing measures used to stop hemorrhage?
Tourniquet use and direct pressure
What is the recommended rate of urinary output to prevent renal failure with rhabdo?
100 mL/hr
Should you ever explore an open wound?
No
True or false: if a fracture and a wound exist on the same limb, it is considered an open wound until proven otherwise
True
What is the only way to determine if a wound is an open fracture?
Surgically explore it in the OR
What two antimicrobial interventions should all patients with open wounds receive?
Abx and tetatnus
How long can muscle tolerate a lack of arterial flow for?
6 hours
How many attempts should be made at relocating a dislocated joint when arterial insufficiency is present?
Once. If unsuccessful, then splint and emergently call a surgeon
Is a patient with multiple injuries who requires intensive resuscitation and emergency surgery a candidate for replantation?
No
What is the appropriate way to save an amputated finger?
Wrap with isotonic solution in sterile gauze and PCN, and put in ice, but do not freeze
When in the course of disease does the lack of a pulse present itself with compartment syndrome?
Late
Tissues pressures greater than how many mmHg suggest compartment syndrome?
30-45 mmHg
What is the role of compartment pressures in the diagnosis of compartment syndrome?
Aid, but it is a clinical diagnosis
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?
30-60 minutes
How can you test motor and sensory function for the following nerve: ulnar
What injury is this usually compromised in?
Index and little finger abduction
Sensation to little finger
elbow injury
How can you test motor and sensory function for the following nerve: distal median nerve
What injury is this usually compromised in?
Thenar contraction with opposition
index finger sensation
Wrist fracture or dislocation
How can you test motor and sensory function for the following nerve: median/anterior interosseous n
What injury is this usually compromised in?
Index tip flexion
No sensation
Supracondylar fracture of humerus
How can you test motor and sensory function for the following nerve: musculocutaneous
What injury is this usually compromised in?
Elbow flexion
Radial forearm sensation
Anterior shoulder dislocation
How can you test motor and sensory function for the following nerve: radial
What injury is this usually compromised in?
Thumb, finger metacarpophalangeal extension
First dorsal web space sensation
Distal humeral shaft fracture/anterior shoulder dislocation
How can you test motor and sensory function for the following nerve: axillary
What injury is this usually compromised in?
Deltoid motor function
Lateral shoulder sensation
Anterior shoulder dislocation
If a laceration extends below what level does it require surgical debridement?
Fasical level
What is the general management of joint injuries?
Immobilize the joint and reassess the vascular and neuro status. Call the surgeon
True or false: Imaging and immobilization follow the rule of above and below the site of injury
True
How are femur fractures without lower leg fractures handled?
Traction splint
How should the knee be positioned to be immobilized?
In about 10 degrees of flexion
How should the hand be position to be immobilized?
in anatomic functional position, with wrist slightly dorsiflexed and fingers gently flexed at 45 degrees at the MCP
How should the wrist and forearm be positioned to be immobilized?
flat
How should the elbow be positioned to be immobilized?
flexion
What is the best way to ensure that you do not miss an injury?
Frequent reassessment and thorough secondary survey
How can you test motor and sensory function for the following nerve: femoral nerve
What injury is this usually compromised in?
Knee extension
Anterior knee sensation
Pubic rami fractures
How can you test motor and sensory function for the following nerve: obturator
What injury is this usually compromised in?
Hip adduction
Medial thigh sensation
Obturator ring fractures
How can you test motor and sensory function for the following nerve: Posterior tibial
What injury is this usually compromised in?
toe flexion
Sole of foot sensation
knee dislocation
How can you test motor and sensory function for the following nerve: superficial peroneal
What injury is this usually compromised in?
Ankle eversion
Lateral dorsum of the foot sensation
Fibular neck fracture/knee dislocation
How can you test motor and sensory function for the following nerve: Deep peroneal
What injury is this usually compromised in?
Ankle/toe dorsiflexion
Dorsal first to second web space sensation
fibular neck fractures
How can you test motor and sensory function for the following nerve: sciatic nerve
What injury is this usually compromised in?
Plantar dorsiflexion
Foot sensation
Posterior hip dislocation
How can you test motor and sensory function for the following nerve: superior gluteal nerve
What injury is this usually compromised in?
Hip abduction
Upper buttocks
acetabular fractures
How can you test motor and sensory function for the following nerve: inferior gluteal
What injury is this usually compromised in?
Gluteus maximus hip extension
Lower buttocks sensation
acetabular fx
