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Emergency Med Final > Foot & Ankle Emergencies > Flashcards

Foot & Ankle Emergencies Flashcards

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1
Q

what constitutes a foot & ankle emergency?

A

soft tissue infxn w/ gas
open fx
closed injury w/ elevated compartment pressures & vascular compromise
fxs/dislocations involving th eankle calcaneus, talus and Lisfranc’s joint

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2
Q

triage

A

ABCs
primary & secondary survey
isolated foot & ankle injury
time from injury

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3
Q

do this before calling surgery

A

NPO
tetanus prophylaxis
Abx
IVF hydration

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4
Q

Labs

A

CBC
CMP
sed rate & crp (very helpful)
lactate

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5
Q

imaging

A 
plain films 
CT
ULS
MRI
*choose the best one, don't have to do all
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6
Q

infxn?

A 
febrile, WBC elevated?
to wht level is infxn (toes, foot, ankle or above)
soft tissue involvement (gas?)
necrosis (necrotizing fasciitis?)
sepsis
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7
Q

fractures

A

open vs closed
dislocation, extrusion of bone outside of body
polytrauma

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8
Q

soft tissue compromise (needs to be taken care of first)

A

open fx w/ contamination
compartment syndrome
crush injuries (worst)
tendon rupture

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9
Q

open fx

A

all open fx are considered contaminated wounds

require IMMEDIATE tx

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10
Q

Type I open fx

A

clean wound
less than 1 cm long
no crushing component
internal to external injiury

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11
Q

Type II open fx

A

moderate contamination
more than 1 cm long, less than 5 cm
minimal comminution
outside to inside injury

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12
Q

Type III open fx (A-C)

A

contaminated wound
extensive soft tissue damage
severe comminution
neurovascualr injury

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13
Q

what’s broken

A

ankle
rearfoot
midfoot
forefoot

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14
Q

ankle fx

A

very common

Ottowa rules- tells us if we should order x-rays

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15
Q

Ottowa Rules

A

reasons to order plain film x-rays

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16
Q

tib-fib fxs

A 
significant displacement
uni, bi, or trimalleolar
skin compromise (fx blister)
vascular compromise (pulseless?)
edema (can turn into fx blisters)
inability to ambulate
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17
Q

radiographs for tib-fib fx

A

order 3 views:
ankle
2 views of foot

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18
Q

if there is a wide mortise, order what?

A

high tib-fib plain film looking for Maisonneuve fx

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19
Q

if high energy ankle fx, get what if you suspect an intra-articular injury?

A

CT scan w/ 3D recon

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20
Q

do i try to reduce?

A

yes
distract, increase, reduce the fx
get conscious sedation, muscle relaxants on board

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21
Q

how to treat minimally displaced fx

A

posterior splint and jones compression dressing: 1 layer of web roll+coban+web roll+coban….3 layers- then put on posterior cast

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22
Q

ORIF

A

open reduction internal fixation

definitive tx for many fx’s

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23
Q

calcaneal fx

A 
Mondors sign
edema
open component
vascular compromise
outcome is always bad/ usually from high energy from height
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24
Q

Mondors sign

A

pt w/ calcaneal fx

immense amount of ecchymosis in arch

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25
Q

radiographs for calcaneal fx

A 
3 views of both feet
calcaneal axial 
consider spine films if mechanism consistent
Bohler's Angle 
Angle of Gissane's
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26
Q

Bohler’s Angle

A

decreased in calcaneal fx

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27
Q

Angle of Gissane’s

A

increased in calcaneal fx

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28
Q

always get this in calcaneal fx

A

CT with 3D recon

29
Q

10% of calcaneal fx’s lead to what?

A

compartment syndrome

30
Q

compartment syndrome

A

soft tissue injury

elevated intracompartmental pressures from bleeding into that compartment

31
Q

the 5 P’s of compartment syndrome

A 
pain (severe)
pulselessness
pallor
paresthesias
pain w/ passive stretch
32
Q

how to dx compartment syndrome

A

check pressure
if > 30 mmHg= compartment syndrome
immediate fasciotomy in OR
needs to be opened & pressure needs to be released

33
Q

if compartment syndrome untreated

A

rhabdomyolysis & permanent nerve damage

34
Q

ORIF vs CAST in calcaneal fx

A

nondisplaced, minimal fx—> cast will work
ORIF for severe
posterior splint + jones compression

35
Q

talus fx

A 
open or extruded
acute fx (emergency)
polytrauma
soft tissue envelope
*always a bad fx
36
Q

tenous blood supply & very high chance of AVN?

A

talus fx

37
Q

talus fx mech

A

high energy impact of tibia into talus; crush component

38
Q

radiographs for talus fx

A

3 vies of ankle & 3 of foot

39
Q

classification of talus fx (Hawkings classification)

A

I- through neck
II-thru neck & subtalar
III-displaced frx of talar neck w/ dislocation of body of talus from both subtalar joint and the ankle joint
IV-subtalar, tibiotalar, and talonavicular joint subluxation or dislocation
usually immediately to OR in acute setting!!

40
Q

Lisfranc fx/ dislocations

A

deformity
vascular compromise
open compartment

41
Q

mech of Lisfranc fx/ dislocation

A

high energy forced dors/plantarflexion injuries across Lisfranc’s joint

42
Q

radiographs for Lisfranc fx/ dislocation

A

3 vies of foot & include medial oblique

*CT scan if in doubt

43
Q

subtle Lisfranc fx

A

problematic
easily missed in EM setting
can cause problems in future

44
Q

toe fx’s

A

most distal toe fx if nondisplaced & extra-articular, do well w/ modified wt bearing & buddy splinting

45
Q

infection

A

chronic vs acute
fulminant?
gangrene wet vs dry
*these are red flags

46
Q

infxn & co-morbidities

A

DM
PVD
immune compromise

47
Q

acute setting infxn mngt

A

NPO
labs- CBC, CMP, HgA1c, lactate, others PRN
admission
ermergent OR visit

48
Q

exam findings of nasty infected foot

A

odor
crepitus
obvious tissue necrosis

49
Q

radiographs in infxn

A

3 views of foot & ankle

look for gas in tissue

50
Q

soft tissue injury

A 
tendon rupture (achilles, posterior tibial, extensor hallacis longus)
crush injury (failure rate is high)
ankle sprains
51
Q

Achilles tendon rupture

A

weekend warrior

felt “pop” in achilles while playing basketball, felt like someone hit them w/ baseball bat

52
Q

physical sign of Achilles tendon rupture

A

palpable dell in tendon approx 2-3 cm proximal to insertion

53
Q

imaging for Achilles TR

A

MRI or ULS

54
Q

Thompson-Dougherty test

A

pathognomic for Achilles rupture

55
Q

tx for Achilles TR

A

cast

end-to-end repair

56
Q

ankle sprain grading system

A

I,II,III
based on level of ligamentous injury
often lateral ligaments

57
Q

ankle sprain grades I, II, III

A

I-mild stretch
II-partial tear
III-full tear

58
Q

S/sx of ankle sprain

A 
ecchymosis
edema
guarding
fx?
ambulatory
59
Q

radiographs for ankle sprain

A

3 views of ankle- always bilateral views

consider stress views to locate specific injuries to specific ligamnets

60
Q

+ anterior drawer & talar tilt

A

ATFL ligament & C… usually injured

61
Q

MRI is best imaging modality for?

A

ligaments

62
Q

tx for ankle sprain

A

RICE
PT
gradual return to activity

63
Q

if peristent after 2-5 wks, consider OCD of talus or other occult fx of the foot

A

DIAL a PIMP

64
Q

DIAL a PIMP

A

dorsiflexion-inversion pain- anterolateral lesion

plantarflexion-inversion pain-posterior medial lesion

65
Q

Crush injuries

A 
open fx's
soft tissue deficit
amputation
vascular compromise
compartment syndrome
*these are red flags! call
66
Q

how to tx crush injury in acute setting

A 
soft tissue deficit coerage
immediate stabilization of fxs
debridement of devitalized tissue
appropriate Abx
tetanus prophylaxis
67
Q

crush are usually?

A

Gustillo IIIc injuries

require different types of surgeons

68
Q

while waiting on consult

A

cover wounds
hemostatsis
medically stabilize
assess for polytrauma

Emergency Med Final (9 decks)

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