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Pre-Hospital > Fractures > Flashcards

Fractures Flashcards

1
Q

How would you assess a suspected musculoskeletal fracture?

A
  • Mechanism of injury assessment
  • Focussed history
  • Patient position
  • Assess degree of pain
  • Look/Feel/Move examination
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2
Q

What are important things to cover when feeling a suspected fracture?

A
  • Warmth
  • Sensation
  • Neurovascular compromise
  • CRT of affected limb
  • Pain assessment
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3
Q

What immediate management would you consider for someone with a fracture?

A
  • Stop any external haemorrhage
  • Immobilise the affected area
  • Give adequate analgesia
  • Pelvic or long bone - IV access
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4
Q

What are the beneficial effects of splintage and immobilisation of a fracture?

A
  • Reduces pain by reducing fracture mobility
  • Reduces blood loss by anatomical alignment of bleeding bones and preveneting clot disruption
  • Restores neurovascular function
  • Reduces risk of fat embolism
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5
Q

When should you splint a fracture?

A

A limb needs immobilising because due to pain or to try to reduce neurovascular injury

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6
Q

What should you always do once you have immobilised a fracture?

A

Reassess neurovascular status before and after anything is done to the affected limb

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7
Q

What are relative contraindications to splinting a fracture?

A
  • Open fractures
  • Compartment syndrome
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8
Q

What are different types of splints that can be used to splint a fracture?

A
  • Box splint
  • Vacuum splint
  • Traction splint
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9
Q

What are the main aims of a traction splint?

A

Reduce pain and restores normal alignment of the fractured bone

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10
Q

When does traction on a long bone fracture reduce blood loss?

A

Traction pulls thigh back to cylindrical shape rather than spherical shape created by muscle spasm. This leaves less space for blood to pool into as volume of a cylinder is less than the volume of a sphere

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11
Q

What is a simple and easy way you can traction and splint a lower limb?

A

Tie it to the other limb

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12
Q

What is a simple way to alleviate pain in upper limb fractures?

A

Simple triangular sling

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13
Q

How much blood can be lost in a closed femoral fracture?

A

1000-1500 mls

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14
Q

How much blood can be lost in a closed tibial fracture?

A

500-1000 mls

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15
Q

What is an open fracture?

A

Fracture which communicates with the environemnt

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16
Q

How soon after someone has sustained an open fracture should the receive prophylactic antibiotics?

A

1 hour

17
Q

How would you manage an open fractures in a pre-hospital setting?

A
  • Irrigate
  • Dress
  • Splint
  • Transport to definitive care
  • Photograph injury if possible
18
Q

When should pelvic fractures be suspected?

A

High energy impacts

19
Q

What is the most important diagnostic tool for assessing pelvic fractures?

A

Mechanism of injury

20
Q

Why are pelvic fractures such a bleeding risk?

A

There are numerous bleeding sources - bones, venous/arterial plexuses. This, combined with the fact that disruption of the pelvic ring can prevent natural tamponade, means that people can lose vast amounts of blood

21
Q

What points should you consider before examining somone for a pelvic fracture?

A
  • What is the MOI?
  • Was high energy impact involved?
  • Is patient alert?
  • Can the patient feel pain in that area (groin, pelvic area, lower back, hips?)
22
Q

How would you approach examining someone for a pelvic fracture?

A
  1. Any obvious deformity of pelvis or legs?
  2. Leg length discrepancy?
  3. Bruising/wounds/swelling over bony prominences/perineum/pubis
  4. Scrotal swelling?
  5. Visible bleeding?
  6. Bleeding from rectum/vagina/urethra
23
Q

How would you manage a ssuspected pelvic fracture?

A

Early/Rapid reduction and immobilisation - can be lifesaving

24
Q

What are the benefits of pelvic reduction?

A
  • Arrests bleeding and closes communication with retroperitoneal space
  • Minimises movement of pelvic bones, reducing pain and preventing further damage
25
Q

What are important points to consider when applying a pelvic binder?

A
  • Minimal movement
  • Apply directly to skin
  • Applied before extrication/transfer
  • Early application
26
Q

Where should a pelvic binder be positioned?

A

At the level of the greater trochanter

27
Q

When should a pelvic binder be removed?

A
  • When radiography reveals no fractures
  • When a more definitive stabilisation technnique is available
28
Q

What things can be used when trying to improvise a pelvic binder?

A
  • Belts
  • Bed sheets
  • Jackets
  • Adapting a kendrick splint

Pre-Hospital (15 decks)

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