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MSK > General Trauma > Flashcards

General Trauma Flashcards

1
Q

What GCS score implies loss of airway control?

A

8 or less

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2
Q

How do you control airway?

A

Head tilt chin lift/jaw thrust
Endotracheal tube
Cricothyroidotomy

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3
Q

Minimum accepted UO

A

30ml/hour

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4
Q

When do you CT in trauma?

A

Signs of significant head injury (LOC for 5 mins, vomiting, amnesia, severe headache, fracture, GCS less than 12 at any time or less than 15 for 2 hours after injury)

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5
Q

When can c spine be cleared?

A

After primary surgery if patient is conscious, copoerative, not confused and no pain/neuro deficits

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6
Q

Investigations for trauma

A

Fluids, UO, NG tube
ABGs
FBC, UandEs, group and save or crossmatch
CT, US

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7
Q

SIRS

A 
Amplification of inflamm cascades in response to trauma
Temp less than 36 or over 38
HR over 90
RR over 20
WCC over 10,000 or less than 4000
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8
Q

ARDS

A

Due to hypoperfusion/sirs/aspiration

Need positive pressure ventilation

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9
Q

Damage control orthopaedics

A

Skeletal stabilisation to prevent deterioration

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10
Q

Primary bone healing

A

Minimal fracture gap
New bone from Obs
Hairline fractures/compression screws

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11
Q

Secondary bone healing

A

Gap needs to be filled
Inflammatory response = haematoma = resorption = granulation tissue = callus
Woven to lamellar bone

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12
Q

Soft and hard callus

A

Soft: Chrondroblasts form cartilage
Hard: Obs lay down bone matrix (type I collagen)

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13
Q

What impairs fracture healing?

A

Smoking

Vascular disease/chronic disease/malnutrition

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14
Q

Transverse fractures

A

Bending force
One side fails in compression the other in tension
May angulate

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15
Q

Oblique fractures

A 
Shearing force (fall from height/deceleration)
May shorten/angulate
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16
Q

Spiral fractures

A

Torsional force

May angulate

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17
Q

Comminuted fractures

A

3 or more fragments

High energy injury

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18
Q

Segmental fractures

A

Fractured in 2 places = very unstable

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19
Q

Displacement

A

Degree of translation of distal fragement

Anteriorly/posteriorly/medially/laterally displaced

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20
Q

Off ended fracture

A

100% displacement

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21
Q

Angulation

A

Direction distal part points

Medial/lateral/anterior/posterior angulation

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22
Q

Clinical signs of a fracture

A

Tenderness
Swelling
Deformity
Crepitus

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23
Q

How to assess a fracture

A

Open/closed
Neurovacular status
Compartment syndrome
State of the skin

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24
Q

Tomogram

A

Moving xray

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25
Q

Management of long bone fracture

A 
Assessment (open/closed, NV status, comp syndrome, skin)
Analgesia (IV morphine)
Splint/immobilise
xray/MRI
Reduce
26
Q

Early local complications of fractures

A

Compartment syndrome
Vascular trauma with ischaemia
Nerve compression/injury
Skin necrosis

27
Q

Early systemic complications of fractures

A 
Hypovolaemia
ARDS
Fat embolism
Shock
AKI
SIRS
MOF
28
Q

Late local complications of fractures

A 
Stiffness
Loss of function
Chronic regional pain syndrome
Non-union
Post-traumatic OA
DVT
29
Q

Late systemic complications of fractures

A

PE

30
Q

Compartment syndrome

A

Surgical emergency
Bleeding and inflammation = increased pressure = ischaemia
Severe pain and paraesthesia
Loss of pulses, tender

31
Q

Treatment of compartment syndrome

A

Remove tight bandaging

Fasciotomy

32
Q

Neurapraxia

A

Temporary nerve conduction defect due to compression or stretch
Resolves in 28 days

33
Q

Axonotmesis

A

Axons distal to point of injury die (Wallerian degeneration) due to sustained compression/stretch
Axons regenerate at 1mm/day
Variable recovery

34
Q

Neurotmesis

A

Complete transection of a nerve

Surgical repair

35
Q

Nerve injury in Colles fracture

A

Median nerve - CTS

36
Q

Nerve injury in anterior shoulder dislocation

A

Axillary nerve palsy

37
Q

Nerve injury in humeral shaft fracture

A

Radial nerve palsy (spiral groove)

38
Q

Nerve injury in humeral supracondylar fracture

A

Median nerve palsy

39
Q

Nerve injury in posterior hip dislocation

A

Sciatic nerve palsy

40
Q

Nerve injury in bumper injury to lateral knee

A

Common peroneal nerve palsy

41
Q

Symptoms of fracture causing excess pressure on skin

A

Tenting of skin
Blanching
= reduce as emergency to avoid necrosis

42
Q

Degloving of the skin

A

Shearing force on skin = avulsion away from BVs

No blanching, numbness

43
Q

Fracture blisters

A

Inflammatory exudates lift epidermis of skin

44
Q

Symptoms and signs of fracture healing

A

Resolution of pain and function
Absence of tenderness
No oedema
Resolution of movement at fracture site

45
Q

Slowest healing bone in the body

A

Tibia, 16 weeks

46
Q

Delayed union

A

Fracture hasn’t healed in expected time

Can be due to infection

47
Q

Hypertrophic non union

A

Instability and excessive motion = plate

48
Q

Atrophic non union

A

Rigid fixation, lack of blood supply, chronic disease = remove fibrous tissue, bone graft, external fixation

49
Q

Areas prone to poor healing

A 
Scaphoid
Distal clavicle
Intra-articular
Jones fracture of 5th metatarsal
Subtrochanteric femur fracture
50
Q

DVT

A

Pelvic or LL fractures and immobility
LMWH prophylaxis
Tx: duplex scanning and anticoagulation

51
Q

Fracture disease

A

Stiffness and weakness due to fracture

Tx: time and physio

52
Q

AVN

A

Femoral neck, scaphoid, talus

53
Q

Complex regional pain syndrome

A

Burning/throbbing, sensitive to light touch, swelling, stiffness, pain
Heightened pain response after injury

54
Q

Treatment of CRPS

A 
Analgesia
Amitryptalline
Gabapentin (anti convulsant)
Steroids
TENS
Physio
Nerve block
55
Q

Treatment of mangled extremity/open fracture

A 
Flucloxacillin (gram pos)
Gentamicin (coliforms, gram neg)
Metronidazole (anaerobes)
Sterile dressing
Splint
Debride, graft
56
Q

Unstable fractures may produce:

A

haematoma (bacteria grow)

57
Q

Treatment of dislocation

A 
Reduce ASAP (closed manipulation, sedation, analgesia)
ORIF if delayed
58
Q

Treatment of soft tissue injuries

A

RICE

Surgical repair

59
Q

Symptoms of septic arthritis

A

Sudden onset severe pain in one joint

Red, hot, swollen, worse on movement

60
Q

Causes of septic arthritis

A 
Staph aureus
Strep
Haem influenzae (kids)
Neiserria gonorrhoeae (young adults)
E. coli (elderly, IVDU)
61
Q

Treatment of septic arthritis

A

Aspirate BEFORE antibiotics

Washout and antibiotics

MSK (10 decks)

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