Emergency Medicine

Question 1

What is a salter-harris fracture?

Answer 1

A growth plate fracture

Question 2

What is a compound fracture?

Answer 2

A fracture in which the skin is broken, and bone is exposed to air

Question 3

What is a stable fracture?

Answer 3

A fracture in which sections of the bone remain in alignment with the fracture

Question 4

What is a Colle’s fracture?

Answer 4

A fracture of the distal radius, causes a dinner fork deformity

Usually resulting from a fall onto outstretched hand

Question 5

What is a key sign of a scaphoid fracture?

Answer 5

Tenderness in the anatomical snuffbox

Question 6

What are the main cancers that metastasise to bones?

Answer 6

PoRTaBLE:
Prostate
Renal
Thyroid
Breast
Lung

Question 7

Why do pelvic ring fractures carry a high risk of shock and possible death?

Answer 7

Cause significant intraabdominal bleeding, either due to vascular injury or bleeding from the cancellous bone

Question 8

Which type of fracture is described using the Webber classification?

Answer 8

Ankle fractures of the lateral malleolus/distal fibula

Question 9

Describe the Webber classification of ankle fractures:

Answer 9

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

Question 10

How do you investigate a possible fracture?

Answer 10

X-ray from two views
May need a CT if XR is inconclusive

Question 11

What is the first principle of treating a fracture?

Answer 11

Achieve mechanical alignment by either:
- Closed reduction by manual manipulation of the limb
- Open reduction in surgery

Don’t forget pain management!

Question 12

What is the second principle of treating a fracture?

Answer 12

Stabilise to allow healing by:
- external cast
- plates and screws
- intramedullary wires or nails
- K wires

Don’t forget pain management!

Question 13

5 possible early complications of a fracture:

Answer 13

1. Fat embolism
2. VTE due to immobility
3. Haemorrhage → shock and death
4. Compartment syndrome
5. Damage to local structures e.g. tendons, nerves

Question 14

8 longer term complications of a fracture:

Answer 14

1. Delayed union
2. Malunion
3. Non-union
4. Avascular necrosis
5. Stiffness, instability, chronic pain
6. Arthritis
7. Contractures
8. Infection

Question 15

What is fat embolism syndrome?

Answer 15

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%.

Question 16

What criteria is used to diagnose fat embolism syndrome?
Give 3 major and 4 minor criteria:

Answer 16

Gurd’s criteria.
Major:
- Petechial rash
- Respiratory distress
- Cerebral involvement
Minor:
- Tachycardia
- Thrombocytopenia
- Fever
- Jaundice

Question 17

What is acute compartment syndrome?

Answer 17

Pressure within a fascial compartment is elevated, cutting off blood flow to the contents of the compartment.
Orthopaedic emergency.

Question 18

Presentation of compartment syndrome: (5)

Answer 18

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)

Question 19

Mx of compartment syndrome:

Answer 19

Measure compartment pressure with a needle manometer
Elevate limb to heart level, remove dressings/bandages, maintain good BP
Emergency fasciotomy

Question 20

Name two non-shockable rhythms:
How do you manage a cardiac arrest with a non-shockable rhythm?

Answer 20

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

Question 21

Reversible causes of cardiac arrest (8)

Answer 21

4Hs and 4Ts
Hypoxia
Hypovolaemia
Hypercalcaemia, hyperkalaemia, hypokalaemia, hypoglycaemia (and other metabolic disorders(
Hypothermia
Tension pneumothorax
Tamponade
Thromboembolism
Toxins

Question 22

Definition of hypothermia:

Answer 22

Core temperature <35

Question 23

Mx of hypothermia:

Answer 23

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)

Question 24

Definition of status epilepticus:

Answer 24

Seizure lasting >5 minutes OR ≥ seizures within a 5 minutes period

Question 25

Tx of status epilepticus:

Answer 25

IV lorazepam, repeat after 10 mins
Not working? IV phenytoin and prepare to possibly intubate

Question 26

A patient in cardiac arrest with a shockable rhythm (VF/pulseless VT) has had 3 shocks, what IV drugs should be given? (2)

Answer 26

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