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CV487 > Class 12: Fractures, inflammation/immunity & burns > Flashcards

Class 12: Fractures, inflammation/immunity & burns Flashcards

1
Q

In infants, fractures are…

A

Rare

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2
Q

The highest incidence of fractures is in blanks and blank

A

Young males (15-24) and old people (>65)

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3
Q

Etiology of fractures

A

-Direct blow, crushing force & torsion
-Cancer, osteoporosis & Cushing’s syndrome

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4
Q

Classification of fractures

A

-Name of the bone, location of injury, orientation of the fracture & condition of the overlying tissues

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5
Q

Location of injury in fractures includes

A

Metaphysial, diaphysial and epiphyseal

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6
Q

Orientation of fracture includes the…

A

Type

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7
Q

Condition of the overlying tissues in a fracture includes..

A

Open or closed

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8
Q

Fracture identification sentence

A

A (orientation) (fragmentation) fracture of the (side) (location) of the (bone)

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9
Q

Example of a fracture identification sentence

A

A (transvere) (segmental) fracture of the (medial) (diaphysis) of the (tibia)

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10
Q

Closed fracture

A

Skin is intact

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11
Q

Complete fracture

A

The bone is separated in 2 pieces

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12
Q

Depressed fracture

A

Bone fragments are driven inward

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13
Q

Impacted fracture

A

A part of the fractured bone is driven into another bone

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14
Q

Oblique fracture

A

The fracture line runs at an angle across the axis of the bone

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15
Q

Pathological fracture

A

The fracture results from weakening of the bone structure by pathological processes such as neoplasia

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16
Q

Transverse fracture

A

The bone is fractured straight across

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17
Q

Comminuted fracture

A

The bone is splinted or crushed, creating numerous fragments

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18
Q

Compression fracture

A

A fractured bone is compressed by another bone

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19
Q

Greenstick fracture

A

One side of the bone is broken and the other is bent; common in children

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20
Q

Incomplete fracture

A

The fracture line does not extend through the full transverse width of the bone

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21
Q

Open fracture

A

The skin is not intact, bone is exposed and infection/soft tissue injury are common

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22
Q

Spiral fracture

A

The break partially encircles the bone

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23
Q

A broken bone can…

A

Cause damage to the surrounding tissue, periosteum and blood vessels in the cortex and marrow

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24
Q

Bone tissue destruction…

A

Triggers an inflammatory response

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25
Q

Procallus formation

A

A bony callus formation that is part of bone remodeling

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26
Q

Fracture healing time (neonates to later childhood)

A

-Neonatal period; 2-3 weeks
-Early childhood; 4 weeks
-Later childhood; 6-8 weeks

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27
Q

Fracture healing time (adolescence to adults)

A

-Adolescence; 8-12 weeks
-Adults vary depending on risk factors

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28
Q

Clinical manifestations of fractures

A

-Often numbness up to 20 minutes following injury
-Unnatural alignment, swelling, muscle spasms, tenderness, pain, impaired sensation, loss of function, discolouration, bleeding and crepitus

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29
Q

5 P’s to assess in fractures

A

-Pain & point of tenderness
-Pulse distal to the fracture site
-Pallor
-Paresthesia: Sensation distal to the fracture site
-Paralysis: Movement distal to the fracture site

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30
Q

Assessing injured limb: CSM

A

-C: Circulation
-S: Sensation
-M: Motion

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31
Q

Positive local factors influencing bone healing

A

Immobilization, timely reduction, application of ice and electrical stimulation

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32
Q

Positive systemic factors influencing bone healing

A

-Adequate amounts of growth hormone, vitamin D and Ca+
-Adequate blood supply, younger age and moderate activity level prior to injury

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33
Q

Negative local factors influencing bone healing

A

Delayed reduction, open fracture (increased risk for infection) and presence of foreign body at the fracture site

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34
Q

Negative systemic factors influencing systemic factors

A

Immunocompromised, decreased circulation (DM & PVD), malnutrition, osteoporosis and advanced age

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35
Q

Complications of fracture

A

Avascular necrosis, compartment syndrome, fat embolism, infection and osteomyelitis, PE, nerve compression, delay union/nonunion and skin breakdown

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36
Q

Fat emboli subjective data

A

-Dyspnea & chest pain
-Confusion, aLOC, numbness, feeling faint, DM & obesity

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37
Q

Fat emboli objective data

A

-Cyanosis, chest petechiae, pallor & cold extremeties
-Pupillary changes, buccal cavity, conjunctiva and soft palate
-Muscle twitching, shock & vomiting

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38
Q

Nerve compression subjective data

A

Discomfort, pain, referred pain, burning, tingling, “stinging sensation”, numbness, aSensation & inability to distinguish touch

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39
Q

Nerve compression objective data

A

Diminished movement & reflexes, weakness, paralysis, irritability, colour changes r/t impaired circulation

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40
Q

Avascular necrosis subjective data

A

Tenderness & pain, especially on passive motion

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41
Q

Avascular necrosis objective data

A

Edema, swelling, bleeding from wound, decreased colour, temperature & mobility

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42
Q

Delayedunion/nonunion subjective data

A

Pain

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43
Q

Delayed union/nonunion objective data

A

Lack of callus formation on x-ray & poor alignment

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44
Q

Skin breakdown subjective data

A

Pain

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45
Q

Skin breakdown objective data

A

-Elevated temp & HR, erythema, edema-cast edges, exposed distal portion of limb within cast and hyperactive reflexes
-Draining and foul odour from break in skin; crepitus

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46
Q

Compartment syndrome subjective data

A

Severe, unrelenting pain, unrelieved by narcotics and associated with passive stretching of muscle and paresthesias

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47
Q

Compartment syndrome objective data

A

Edema, paralysis, decreased/absent peripheral pulses, poor cap refill, and limb temp change

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48
Q

Innate & adaptive immunity are..

A

The 2 main defence systems

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49
Q

Innate immunity

A

-1st line of defence
-Natural or native immunity
-Inflammation (2nd Line of Defense); biochemical and cellular mechanisms

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50
Q

Adaptive immunity

A

-3rd line of defence
-Slower but more specific process

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51
Q

Innate & adaptive immunity are blank

A

Separate but also interdependent

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52
Q

Innate immunity is..

A

Non specific & always prepared to act quick

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53
Q

First line of defence

A

Physical (ie. skin)

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54
Q

Common bacteria we encounter

A

-Staph. aureus
-MRSA, streptococci, VRE & STI

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55
Q

Second line of defense

A

-Inflammation: First response to injury, quick & non specific

56
Q

Inflammation vascular response

A

Vasodilation, increased permeability, and WBC adhere to vessel walls

57
Q

Inflammation plasma protein systems

A

Complement system, clotting system & kinin system

58
Q

Second line of defence: Cell components + leukocytes (1)

A

-Granulocytes (neutrophils): Band cells/immature neutrophils, eosinophil, basophil (histamine), and mast cells (released during inflammation & healing)

59
Q

Second line of defence: Cell components + leukocytes (2)

A

Agranulocytes (monocytes & macrophages): Precursors of macrophages, slower than neutrophils, and better suited for long term defence

60
Q

Second line of defence: Cell components + leukocytes (3)

A

B&T cells

61
Q

Acute inflammation symptoms + local

A

Swelling, pain, heat & redness

62
Q

Early/mild inflammation + local

A

Serous exudate

63
Q

Severe inflammation + local

A

Fibrinous & purulent exudate

64
Q

Fever + systemic signs

A

-Normal temperature 36-37
-Leukocytes and macrophage; pyrogen
-Pyrogen “fire”
-Mild-moderate vs high fever (39.4-41.1)

65
Q

Leukocytosis + systemic signs

A

-Increase in circulating WBC

66
Q

Inflammation with wounds

A

-Normal response of living tissue to injury
-Starts- Tissue damage (but NOT destroyed)
-Until healing starts

67
Q

Infection & wounds

A

Maggots, cleaning MRSA infection and group A streptococcus

68
Q

Burns

A

A traumatic injury to the skin or other organic tissue primarily caused by thermal or other acute exposures

69
Q

Types of burns

A

Thermal, cold, electrical, radiation (sunburn), chemical and inhalation (flash burns from fire & steam, hot smoke & CO)

70
Q

Most common type of burn in children is…

A

From a scald injury (thermal)

71
Q

The most common type of burn in adults is…

A

From a flame

72
Q

Males are blank..

A

Twice as likely to be burn victims than females

73
Q

Childrens skin is…

A

Thinner & burns 4x more quickly & deeply than adult skin

74
Q

Children’s rapid physical growth means ..

A

They also scar more easily

75
Q

Superficial burn

A

-1st degree, involing only the epidermis, no blisters
-Painful, dry, red, and blanch with pressure
-Commonly seen with sunburns

76
Q

Partial thickness burns

A

-2nd degree involving the epidermis & dermis
-Superficial or deep, caused by prolonged exposure (>10 seconds) to intense heat

77
Q

Characteristics of partial thickness burns

A

Blister, moist, serous, edema, pink or red mottling, blanching and very painful

78
Q

Full thickness burns

A

-3rd degree extending through all layers of dermis & SC tissue

79
Q

Characteristics of full thickness burns

A

Waxy white to leathery gray to charred & black, dry, inelastic, does not blanch, no vesicles or blister formation

80
Q

Fourth degree burns

A

Potentially life threatening burns extending through the skin into underlying tissues & fascia, muscle and/or bone

81
Q

Severity of the burn is determined by…

A

-Location, pt age, causative agent, contact duration, presence of respiratory involvement and pt general health

82
Q

Minor burn

A

3rd degree appear on <2% of the TBSA, 2nd degree burns appear on <10% of a child’s TBSA

83
Q

Moderate burn

A

3rd degree burns appear on 2-10% of TBSA regardless of the body size, 2nd degree burns appear on 10-20% of a child’s TBSA

84
Q

Major burn

A

20% of TBSA in most adults are major burns, 2nd degree burns covering >20% of a child’s TBSA

85
Q

Burn assessment tools

A

-Pt palmer surface, lund-browder chart and rule of nines
-These assessments are used to estimate the % of TBSA involved in a burn injury

86
Q

Pt palmer surface (hand chart)

A

-The hand chart is a practical method to determine the extent of a burn, since the palm of the human hand comprises 1% of BSA. Use the patients own hand when using this assessment tool. It can be used to accurately measure the extent of burns that have occurred over many different areas of the body.
-From finger tips to wrist

87
Q

Rule of nines, look at picture online

A

Divides the body surface into areas of equal 9% or multiples of 9% of TBSA. This chart is used for adult patients only as BSA proportions do not follow this 9% configuration for children less than 14 years of age

88
Q

Factors influencing a positive outcome in burns

A

Multidisciplinary team involved, airway, rehydration, depth and extent of burns, nutrition, pain control, activity, psychological impact on patient and family

89
Q

Airway + burns

A

-The first priority of burn care is airway maintenance
-If there is evidence of respiratory involvement, 100% oxygen is administered and blood gas values are drawn including carbon monoxide levels
-If the child is displaying signs of respiratory distress, intubation is performed

90
Q

The following suggest inhalation of noxious agents or respiratory burns

A

-Thermal injuries to the face, nares, and upper torso
-A hx of injury in an enclosed space
-An examination of the oral and nasal membranes that reveals edema or blisters
-Evidence of trauma to the upper respiratory passage

91
Q

CO poisoning

A

-Colorless, odorless and tasteless gas that has an affinity for hemoglobin 200 x greater than that of oxygen
-Oxygen molecules are displaced and carbon monoxide reversibly binds to hemoglobin to form carboxyhemoglobin (tissue hypoxia)

92
Q

Mild CO poisoning

A

-1-10 is normal and 11-20% is mild
-Headache, flushing, aVisual acuity, aCerebral functioning and slight breathlessness

93
Q

Moderate CO poisoning

A

-21-40%
-Headache, N/V, drowsiness, tinnitus, vertigo, confusion & stupor, pale to reddish-purple skin, decreased BP, increased & irregular HR

94
Q

Severe CO poisoning

A

-41-60%
-Coma & seizures

95
Q

Fatal CO poisoning (61-80)

A

Death

96
Q

Infection control + burns

A

-Hand & forearm washing is the best
-Large burns may require iso

97
Q

Infection control + burns cont’d

A

-Chief danger is wound infection, generalized sepsis and bacterial pneumonia
-Ongoing assessment is crucial

98
Q

Assessments in burn pts

A

-ABC
-Signs of shock (hypovolemic and septic), increased temperature
-Intake (both IV and PO), U/O (minimum 1-2 cc/kg/hr), pain control, wound & dressing assessments and psychosocial support

99
Q

Burn size is…

A

Essential to guide therapy

100
Q

The most accurate assessment of TBSA burn in children & adults is the…

A

Lund-Browder chart

101
Q

3rd line of defence

A

-Adaptive immunity
-Slower than innate
-Antigen: Substance capable of stimulating antibodies

102
Q

3 benefits of adaptive immunity

A

-Specific: Engages a particular target
-Systemic: Not restricted to a local site
-Memory: It remembers

103
Q

Adaptive defence system

A

-Humoral: B lymphocytes
-Cell mediated: T lymphocytes

104
Q

Lymph nodes

A

B & T lymphocytes act as surveillance, lymph nodes are widespread

105
Q

Adaptive immunity: Humoral immunity

A

-Humoral: Virus free in the fluids of our bodies
-Plasma cells secrete antibodies (immunoglobulin) that binds to antigens
-Memory cell that prevents future re-exposures

106
Q

Adaptive immunity: Humoral immunity steps

A

-Bone marrow; B lymphocytes; memory cells & plasma cells
-Plasma cells; antibodies

107
Q

Humoral immunity

A

-Antibody circulates in the blood and binds to antigens on infectious agents
-Either directly inactivates the microorganism or activates the inflammatory mediators
-Antibodies are primarily responsible for protection

108
Q

Adaptive immunity: Cell-mediated immunity T lymphocytes

A

-Helper: Activates B cells, cytotoxic T cells, NK cells & macrophages
-Cytotoxic (killer): Cell lysis
-Suppressors Th: Expressed as CD4 & T regulatory cells

109
Q

Adaptive immunity: Cell-mediated immunity

A

-Cellular: Virus infected cells
-T cells activate lymphocytes & macrophages
-Memory produced

110
Q

Adaptive immunity: Cell-mediated immunity steps

A

Bone marrow; T lymphocyte; helper T cell, suppressor T cell, cytotoxic T cell and memory cells

111
Q

Active & passive immunity

A

-Adaptive immunity can be either
-Active (active acquired) immunity is produced after either natural exposure to an antigen or after immunization
-Passive (acquired) immunity occurs when preformed antibodies or T lymphocytes are transferred from donor to recipient

112
Q

To recognize & respond

A

-Antigen is a molecule that reacts with antibodies or antigen receptors on B and T cells
-Most antigens are immunogenic
-Must be recognized by and bound to an antibody

113
Q

To recognize & respond cont’d

A

-Antibodies are aka immunoglobulins
-There are 5 molecular classes of immunoglobulins

114
Q

5 molecular classes of immunoglobulins

A

-GAMED
-IgG, IgA, IgM, IgE & IgD

115
Q

IgG

A

Most abundant & crosses the placenta

116
Q

IgA

A

Found in the blood & body secretions

117
Q

IgM

A

Biggest size & first to respond in a primary response

118
Q

IgE

A

Least concentrated but specific to allergic responses & in the defense against parasitic infections

119
Q

IgD

A

Found in low concentrations with limited knowledge of function

120
Q

Live/attenuated

A

Measles, mumps, rubella (MMR), varicella (chicken pox), zosters (shingles), influenza (nasal spray), rotavirus and yellow fever

121
Q

Inactivated/killed

A

Polio (IPV), hepatitis A and rabies

122
Q

Toxoid (inactivated toxin)

A

Diphtheria, tetanus (DTaP)

123
Q

Subunit/conjugate

A

Hepatitis B, influenza (injection), haemophilus influenza type B (Hib), pertussis (DTaP), pneumococcal & meningococcal & HPV

124
Q

Early & late signs in fractures

A

-Early: Numbness & tingling
-Late: Cyanosis

125
Q

Pain is not always….

A

Congruent with the injury

126
Q

Avascular necrosis

A

Fracture interrupts blood supplu to the bone leading to bone death

127
Q

Fat embolism

A

Only occurs in larger limbs (ie. Femur) and will develop 48-72hr after the injury

128
Q

PE in fractures occurs as a result of…

A

Fat emboli

129
Q

Compartment syndrome timeline

A

-Early symptom is numbness & tingling
-4-6 hours after compartment syndrome develops, it is irreversible

130
Q

The kinin system..

A

Responds to pain

131
Q

Inflammation steps

A

-1. Protect tissue
-2. Limits inflammatory response to a specific area
-3. Interacts with adaptive immune response
-4. Starts the healing process

132
Q

Agranulocytes live…

A

Longer than granulocytes in acidic environments

133
Q

Pt palmer surface burn assessment tool pros & cons

A

It is the most innacurate but easiest way to measure burns in children

134
Q

Hourly U/O is used to determine…

A

Fluid resuscitation in burn pts

135
Q

IgM & IgG are…

A

Most common

136
Q

IgM is the first to…

A

respond when getting a vaccine and turns into IgG antibodies

137
Q

Immunocompromised people cannot get…

A

Live vaccines

CV487 (15 decks)

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