EM Trauma 5 (trauma to extremities)

Question 1

most commonly injured vessels in trauma to the extremities

Answer 1

femoral and popliteal vessels

Question 2

hard signs of extremity vascular trauma

Answer 2

obvious arterial bleeding
large expanding or pulsatile hematoma

audible bruit
palpable bruit

absent or diminished distal pulses
distal ischemia
-pain
-pallor
-paralysis
-paresthesias
-coolness

prsence of any hard sign, consult vascular surgery immediately

Question 3

soft signs of extremity vascular trauma

Answer 3

small, stable hematoma
complex fracture

injury to anatomically related nerve
proximity of injury to major vascular structures

unexplained hypotension
history of hemorrhage

Question 4

remarks on ABI

Answer 4

ABI <0.9, do CT angiography

Question 5

4 types of fractures associated with low-energy gunshots

Answer 5

1. drill-hole track pattern
2. unicortical fractures
3. comminuted fractures
4. distal spiral fracture

Question 6

most common fracture associated with low-energy gunshots

Answer 6

drill-hole wound track pattern
most common in
distal femur
pelvis
proximal humerus

Question 7

unicorticacl fractures

Answer 7

appear in metaphyses of long bones

mu

Question 8

comminuted fractures

Answer 8

diaphyseal bone

dc

Question 9

distal spiral fracture

Answer 9

femur

Question 10

remarks on ultrasound in extremity trauma

Answer 10

doppler:
normal triphasic arterial flow in both the dorsalis pedis artery and posterior tibial artery had a sensitivity and specificity of 100% in ruling out arterial lesions in lower-limb penetrating trauma

Question 11

most important component of wound management in extremity trauma

Answer 11

irrigation with saline or tap water (500-1000mL) at high pressures (15-20 pounds per square inch)

antiseptic solution does not decrease infection rate and may actually be harmful

Question 12

when is delayed closure of wound indicated

Answer 12

delay of 72-96 hours

“BCD”
retained foreign Bodies
Contamination
major tissue Destruction

Question 13

remarks on bullet in extremities

Answer 13

a bullet generally should not be removed unless the bullet has potential to migrate into surrounding vital structures or if it is in the joint capsule

Question 14

disposition in penetrating extremity trauma

Answer 14

hard signs —> immediiate surgical consult

all other patients with penetrating extremity trauma: a minimum of 24hours is reasonable

return precaution:
-increasing pain
-numbness
-weakness
-redness
-pus discharge