BOAST Key points Flashcards
What key things should be done in ED for an open fracture?
Arterial vs PNI?
Abx within 1 hour
Tetanus up to date
Gross contamination removed
Photos
Saline soaked swab + Occlusive dressing
Plastics
Which open fractures should go immediately to theatre?
Contaminated- agricultural, sewage, aquatic
Ischaemia
12 hours for high energy
24 hours for low energy
When should definitive soft tissue coverage and stabilisation occur?
Within 72 hours
How should you manage arterial injuries associated with fractures in ED?
Control major haemorrhage- direct pressure/tourniquet
Reduce/realign
Assess
If CT scan should have CTA without repositioning
Involve vascular/plastics
How quickly should revascularisation occur in an arterial injury and how?
Within 4 hours
DIrect closure attempted first
If fails for shunting and skeletal stabilisation.
Then for interposition grafting rather than bypass grafting
What else should you consent for with arterial injury in a fracture?
Fasciotomies and amputation
What simple things can you do to improve nerve symptoms post op?
Loosen bandages, split plaster, reposition limb (relax nerve)
How do you control the bleeding in pelvic trauma?
Pelvic binder
TXA
Major haemorrhage protocol
Packing if venous
Embolisation if Arterial
How to reduce a pelvic fracture?
Pelvic binder
Traction for vertical sheer fractures
If pelvic binder goes on what must you get?
Binder off xray!!!
When should you take pelvic binder off?
Within 24 hours- under monitoring of haemodynamic stability
ASper local protocols
Post binder xrays!!!
Important examination points for all pelvic trauma?
Open fracture finding
External genitalia, PV/PR, Blood at meatus- catheterise if scrotal swelling
Talk through the urological injury algorithm for pelvic fractures
Single attempt at catheterisation allowed- 16ch
Look for blood at external meatus
If blood stained urine for retrograde cystogram
If frank blood/cannot be passed for retrograde urethrogram
Involve urology
Suprapubic catheter for urethral injury
If there is a bladder/urethral injurywhich medication needs to be started?
As an open fracture- with antiobiotics
If stable distal radius fracture what management should they have?
Consider for early mobilisation and a removable support
What radiological parameters should be assessed in distal radius fractures?
Intra-articular step, dorsal angulation, ulnar variance/radial shortening
+ reflect on patient needs
What to do if for surgical management and distal radius fracture can be reduced closed?
Consider K-wire fixation
Timeperiod to fix intra and extra-articular distal radius fractures?
72 hours for intra
1 week for extra
What other assessments should you consider for a patient with a distal radius fracture?
Bone health
Falls assessment
What points in a history of an ankle fracture should you consider?
Peripheral neuropathy
Diabetes
Mobility impairement
PVD
Osteoporosis
Renal disease
Smoking
Alcohol excess`
What to do with stabl ankle fractures and ones with uncertain stability?
Stable- let weight bear in a cast
?weight bearing xrays at one week in fracture clinic
What ankle fractures are unstable?
Bimalleolar fractures
Trimal
Posterior mal >25%
Pilon
Medial malleolus fracture + talar shift
Weber B/C + talar shift
What to consider with a patient with a suspected SCI?
Full in line spinal immobilisation
Blocks + collar
4 person log rolling
Nurse flat
I+V if resp failure
Cardiovascular support if Neurogenic shock
Catheterise +NGT
MRI post CT scan
For a metastatic bone tumour when to do a sarcoma referral?
CT TAP?
Within 72 hours
Within 24 hous
Where should bone biopsies occur for a sarcoma?
At the sarcoma centre
What should happen prior to prophylactic fixation of MBD?
MDT decision about neoadjuvant treatment
How to tell if tumour is more likely to be a primary bone tumour?
Bony destruction/formation, periosteal involvement, soft tissue swelling
Important investigations in children with acute MSK infections?
Obs- septic?
Bloods- WCC, CRP, ESR, Blood cultures
Imaging- xrays
MRI (within 48 hours) + USS (concurrently)
What is the first line management of Septic A?
Osteomyelitis, pyomyositis, or discitis?
Osteomyleitis with abscess formation?
Surgical Drainage
ABx
Surgical drainage
What else should be examined in a child with suspected MSK infection?
Spine, all other systems, extremities
How long should MSK infections in children be followed up for?
Minimum 12 months
When is a DAIR indicated?
Acute PJI in a well fixed and functioning implant
When should 1/2 stage revision be considered?
MDT decision- If sinus, loose implant, weird infections, immunocompromised patients, chronic infection, when pre op bacteria/sensitivities obtained, failed single stage
What to do re sampling in a DAIR?
5 samples for MCS
2 for histo if uncertain re diagnosis/chronic infections
No abx until sampling
Spiel for assessment of MSK infections in Kids?
Joint care
Full exam including spine
Exclude other sources
Blood cultures
Xrays
MRI +/- USS
Spiel for management of MSK INfections in Kids?
If septic then BCs then IV Abx
If stable delay Abx till deep tissue samples (5 MCS, 2 Histo)
Surgery if abscess/septic A
Involve Micro
Consider PICC
F/U for 12 months minimum
