ER and Musculoskeletal Flashcards
What is the most common symptoms?
Pain then swelling
What are the joints that are commonly injured from most to least common?
- ankle
- wrist
- knee
- hip
- shoulder
- elbow
What is the most common ankle injury?
- lateral sprain due to inversion - treat w/ PRICE
2. Fracture - unimalleolar fracture - the complication of arterial disruption is a surgical emergency
What is the most common wrist injury?
Colle’s fracture - distal radial metaphysis w/ proximal/dorsal displacement = dinnerfork deformity
What is common w/ knee injury?
- ACL ( pop)
- MCL
3/ ACL + MCL
- most ligament injuries present w/ hemarthroses
Hip Frature
- old white women
- weakening of bone w/ age, femoral neck fractures
- sudden onset of hip pain, inability to bear weight
- leg shortened and externally rotated if fracture is displaced
RISK – DVT in legs
Back pain - most common cause
85% idiopathic
What is lumbar intervertebral disc herniation?
- middle aged, recurring episodes of low back pain
2. 95% of pts w/ this that present w/ back pain have sciatic
What is sciatica?
- pain +/- sensorimotor symptoms
- lower back, buttock, legs - commonly single dermatome, numbness and tingling
- straight leg test and cross leg test
What is cauda equina?
low back pain, sciatica, leg weakness, bladder dysfuntion, saddle hypo or ananesthesia, fecal incontinences, sexual dysfuntions
What are signs for cauda equina?
bladder distention, decreased anal tone, absent knee/ankle/bulbocavernous reflexes, bilateral sciatica —> NEUROSURGICAL emergency
Drug seekers predictors
- know meds by name
- multiple visits for same CC
- suspicious Hx
- symptoms out of proportion to PE
What is necrotizing fascitis?
rare, acute progressive destructive infxn of muscle fascia and overling sub Q fat. the muscle is usually spared b/w infxn travels along the fascia.
What are signs of NF?
erythema, swelling, warm, shiny, exquistely tender, pain out of proportion
What are the different types of NF?
- polymicrobial – subQ gas seen
2. GAS
What are risk factors for NF?
DM, vascular dz, trauma, surgery, etc
What is the micro path for NF?
- coagulative necrosis
- acute inflammation (PMN and fibrin exudate)
- aggregated of bacteria maybe
- nuclear dust, hemorrhage
What is the progressive of NF
- over 3-7 days, skin changes from red to purple to purple w/ blue-grey patches.
- w/in 1st three days- skin breaks down w/ Bullae
- advanced infxn has fever, tachy, hypotension, malaise, myalgia, anorexia, diarrhea
- SURGICAL and broad spectrum Abx
What is compartment syndrome
- increase pressure w/ in compartment compromises circulation w/in that space
- usually due to trauma ( LONG BONE FRACTUREA) or chronic in athletes presenting w/ insidious pain
- RX = Fasciotomy
What are the symptoms for compartment syndrome?
pain out of prop, persistent deep ache/burning pain, parasthesias
What are the sigsn for compartment syndrome?
pain w/ passive stretch of muscles, tense compartment w/ firm “wood-like” feeling, decreased sensation, muscle weakness
What is the normal pressure and what happens to the pressures in compartment syndrome
- normal is 0-8 mm Hg
- pain develops at 20-30 mm hG
- capillary blood flow compromised w/ pressure increases to 25mm Hg of MAP
- ischemia when pressure reaches diastolic pressre
What is the pathogensis of compartment syndrome?
- arterivenous/interstitial pressure gradient theory
- pre-req : fascial enclosure that prevents adequate expansion of tissue volume to compensate for increase in fluid
- inadequate venous drainage = tissue edema + IS pressure increases; venous outflow decreases and venous pressure increases
- arterioles collapse and blood is shunted away from comparment tissues
What is the confirmatory diagnostic test for compartment syndrome?
perfusion pressure less than 30 mm Hg
What is clostridial myonecrosis?
necrotizing muscle infxn from trauma or blood muscle seeding from GI tract
Difference b/w traumatic and spontaneous CM?
- traumatic - C. Perfringes; 20% mortality
2. spontaneous - C septicum - 67-100% mortality
What are the VF for C. perfingens?
- alpha toxin (hemolytic toxin w/ PL and sphinogomyelinase) - platelet aggretation and adherence of PMN to endothelium; negative inotrop so inhibits cardia pump function
- omega toxin = PFO
What is the pathophysiology of CM?
- trauma introduces spores/bugs into deep tissue and it impairs blood supply producing an anerobic envirnoment that has acidic pH and a low oxidation-reduction
- necrosis progresses w/in 24-36 hours
- alpha toxin - potent rapid irreversible decline in muscle blood flow and ischemic necrosis due to formation of occlusive intravascular masses of activated platelets, leukocytes, and fibrin
- perfusion deficits expand anerobic environment
- platelet GP inhibitos may play a role in maintaining tissue blood flow
What does the skin look like in CM?
pale then bronzed over, purple/red discoloration, tense/tender, Bullae form (distended w/ hemolyzed blood), gas palpable
what do you see in histo for CM?
lack of acute inflammatory cells
Rx for CM
surgical debridement, Abx (clinda and penicillin)
What is rhabdomyolysis?
- muscle necrosis w/ muscle pain, weakeness, and dark urine
- causes can be trauma, exertion, of misc
- increased in serum CK
- myoglobinuria - no RBCs, can causes renal failure by clogging tubules
