Chapter 8 - MSK Trauma

Question 1

What is a risk of massive/ dramatic MSK injuries

Answer 1

there is a risk that it will distract the clinician from more urgent resuscitation priorities

Question 2

How to we reduce the risk of not identifying fractures and soft tissue injuries

Answer 2

we perform continued reevaluation

Question 3

name some potentially life threatening extremity injuries

Answer 3

major aerial haemorrhage, bilateral femoral fracture, crush syndrome

Question 4

how can we immediately reduce bleeding from long bone fractures

Answer 4

splinting

Question 5

what must we document when we apply a tourniquet

Answer 5

the time of application

Question 6

do we consider the use of arteriography

Answer 6

only in resuscitated patients, otherwise they go for urgent operation

Question 7

who would we consider not to be a candidate for implantation

Answer 7

a patient with multiple injuries who requires extensive resuscitation and/or emergency surgery

Question 8

what is crush syndrome

Answer 8

traumatic rhabdomylasis. myoglobin release that causes renal failure

Question 9

what is a sign of rhabdo

Answer 9

dark amber urine that tests positive for haemoglobin.

Question 10

what do we do with exposed bone when applying traction

Answer 10

we pull the exposed bone back into the wound

Question 11

what are signs and symptoms of compartment syndrome

Answer 11

history of crush injury
pain greater than expected or out of proportion
pain on passive stretch of the affected muscle
tense swelling of the compartment
paraesthesia or altered sensation distal the the compartment

Question 12

how do we manage suspected compartment syndrome

Answer 12

immediate surgical consult
release all constrictive dressings, casts, splints
fasciotomy

Question 13

how is haemorrhage best controlled

Answer 13

with direct pressure

Question 14

how can splinting significantly decrease bleeding

Answer 14

by reducing motion and enhancing tamponade effect of muscle and fascia

Question 15

how do we manage open haemorrhaging wound

Answer 15

one person realigns and splints the wound whilst another applies pressure to the open wound

Question 16

When is replantation of an amputated limb possible

Answer 16

when patients have an isolated extremity injury. Patients who have multiple injuries requiring intensive resuscitation or emergency surgery are not candidates for replantation

Question 17

what do we do with the amputated part

Answer 17

wash it in isotonic solution e.g. Ringers lactate / Hartmanns, and wrap in moist sterile gauze, then moist sterile towel, then put in plastic bag. Transport with the patient in a cooling chest with crushed ice.

Question 18

what do patients with bilateral femur fractures have increased risk of over unilateral fractures

Answer 18

death, significant blood loss, severe assoc injuries, pulmonary complications, MOF.

Question 19

Who should we transfer early to a major trauma centre

Answer 19

patients with vascular injury and concomitant fracture to trauma centre with vascular and orthopaedic surgical capabilities. Bilateral femur fractures benefit from early transfer to trauma centres

Question 20

what is crush syndrome

Answer 20

traumatic rhabdomyolysis which can cause acute renal failure and shock

Question 21

what are adjuncts to the primary surely of MSK trauma

Answer 21

fracture reduction and xray