Emergency Medicine Flashcards
What is a salter-harris fracture?
A growth plate fracture
What is a compound fracture?
A fracture in which the skin is broken, and bone is exposed to air
What is a stable fracture?
A fracture in which sections of the bone remain in alignment with the fracture
What is a Colle’s fracture?
A fracture of the distal radius, causes a dinner fork deformity
Usually resulting from a fall onto outstretched hand
What is a key sign of a scaphoid fracture?
Tenderness in the anatomical snuffbox
What are the main cancers that metastasise to bones?
PoRTaBLE:
Prostate
Renal
Thyroid
Breast
Lung
Why do pelvic ring fractures carry a high risk of shock and possible death?
Cause significant intraabdominal bleeding, either due to vascular injury or bleeding from the cancellous bone
Which type of fracture is described using the Webber classification?
Ankle fractures of the lateral malleolus/distal fibula
Describe the Webber classification of ankle fractures:
Lateral malleous/distal fibula fracture…
A - below the ankle joint
B - at the level of the ankle joint
C - above the ankle joint
B = fibrous join between tibia and fibula partially torn
C = fibrous join completely disrupted
How do you investigate a possible fracture?
X-ray from two views
May need a CT if XR is inconclusive
What is the first principle of treating a fracture?
Achieve mechanical alignment by either:
- Closed reduction by manual manipulation of the limb
- Open reduction in surgery
Don’t forget pain management!
What is the second principle of treating a fracture?
Stabilise to allow healing by:
- external cast
- plates and screws
- intramedullary wires or nails
- K wires
Don’t forget pain management!
5 possible early complications of a fracture:
- Fat embolism
- VTE due to immobility
- Haemorrhage → shock and death
- Compartment syndrome
- Damage to local structures e.g. tendons, nerves
8 longer term complications of a fracture:
- Delayed union
- Malunion
- Non-union
- Avascular necrosis
- Stiffness, instability, chronic pain
- Arthritis
- Contractures
- Infection
What is fat embolism syndrome?
When a long bone is fractured, it can release fat globules into circulation.
These globules obstruct blood vessels and trigger a systemic inflammatory response.
This can lead to multiple organ failure.
Mortality rate is ~10%.
What criteria is used to diagnose fat embolism syndrome?
Give 3 major and 4 minor criteria:
Gurd’s criteria.
Major:
- Petechial rash
- Respiratory distress
- Cerebral involvement
Minor:
- Tachycardia
- Thrombocytopenia
- Fever
- Jaundice
What is acute compartment syndrome?
Pressure within a fascial compartment is elevated, cutting off blood flow to the contents of the compartment.
Orthopaedic emergency.
Presentation of compartment syndrome: (5)
P - pain disproportionate to injury, not relieved by analgesia, made worse by stretching the muscles passively
P - paraesthesia
P - pressure (high)
P - pale
P - paralysis (a late and worrying sign)
Mx of compartment syndrome:
Measure compartment pressure with a needle manometer
Elevate limb to heart level, remove dressings/bandages, maintain good BP
Emergency fasciotomy
Name two non-shockable rhythms:
How do you manage a cardiac arrest with a non-shockable rhythm?
Pulseless electrical activity (PEA) and asystole
Continous compressions and ventilation
Give 1 mg adrenaline IV
Repeat every 3-5 mins
Re-check rhythm every 2 mins
Reversible causes of cardiac arrest (8)
4Hs and 4Ts
Hypoxia
Hypovolaemia
Hypercalcaemia, hyperkalaemia, hypokalaemia, hypoglycaemia (and other metabolic disorders(
Hypothermia
Tension pneumothorax
Tamponade
Thromboembolism
Toxins
Definition of hypothermia:
Core temperature <35
Mx of hypothermia:
Aim for 0.5 degree increase in temp per hour using warm IV fluids, warm oxygen and blankets
(Rapid increase can cause vasodilation and shock, only allow rapid increase in cardiac arrest)
Definition of status epilepticus:
Seizure lasting >5 minutes OR ≥ seizures within a 5 minutes period
Tx of status epilepticus:
IV lorazepam, repeat after 10 mins
Not working? IV phenytoin and prepare to possibly intubate
A patient in cardiac arrest with a shockable rhythm (VF/pulseless VT) has had 3 shocks, what IV drugs should be given? (2)
1mg adrenaline after the third shock - repeat every 3-5 mins whilst continuing ALS
300 mg amiodarone after the third shock - repeat dose of 150 mg after 5 shocks
