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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
Management of long bone fracture
``` Assessment (open/closed, NV status, comp syndrome, skin) Analgesia (IV morphine) Splint/immobilise xray/MRI Reduce ```
26
Early local complications of fractures
Compartment syndrome Vascular trauma with ischaemia Nerve compression/injury Skin necrosis
27
Early systemic complications of fractures
``` Hypovolaemia ARDS Fat embolism Shock AKI SIRS MOF ```
28
Late local complications of fractures
``` Stiffness Loss of function Chronic regional pain syndrome Non-union Post-traumatic OA DVT ```
29
Late systemic complications of fractures
PE
30
Compartment syndrome
Surgical emergency Bleeding and inflammation = increased pressure = ischaemia Severe pain and paraesthesia Loss of pulses, tender
31
Treatment of compartment syndrome
Remove tight bandaging | Fasciotomy
32
Neurapraxia
Temporary nerve conduction defect due to compression or stretch Resolves in 28 days
33
Axonotmesis
Axons distal to point of injury die (Wallerian degeneration) due to sustained compression/stretch Axons regenerate at 1mm/day Variable recovery
34
Neurotmesis
Complete transection of a nerve | Surgical repair
35
Nerve injury in Colles fracture
Median nerve - CTS
36
Nerve injury in anterior shoulder dislocation
Axillary nerve palsy
37
Nerve injury in humeral shaft fracture
Radial nerve palsy (spiral groove)
38
Nerve injury in humeral supracondylar fracture
Median nerve palsy
39
Nerve injury in posterior hip dislocation
Sciatic nerve palsy
40
Nerve injury in bumper injury to lateral knee
Common peroneal nerve palsy
41
Symptoms of fracture causing excess pressure on skin
Tenting of skin Blanching = reduce as emergency to avoid necrosis
42
Degloving of the skin
Shearing force on skin = avulsion away from BVs | No blanching, numbness
43
Fracture blisters
Inflammatory exudates lift epidermis of skin
44
Symptoms and signs of fracture healing
Resolution of pain and function Absence of tenderness No oedema Resolution of movement at fracture site
45
Slowest healing bone in the body
Tibia, 16 weeks
46
Delayed union
Fracture hasn't healed in expected time | Can be due to infection
47
Hypertrophic non union
Instability and excessive motion = plate
48
Atrophic non union
Rigid fixation, lack of blood supply, chronic disease = remove fibrous tissue, bone graft, external fixation
49
Areas prone to poor healing
``` Scaphoid Distal clavicle Intra-articular Jones fracture of 5th metatarsal Subtrochanteric femur fracture ```
50
DVT
Pelvic or LL fractures and immobility LMWH prophylaxis Tx: duplex scanning and anticoagulation
51
Fracture disease
Stiffness and weakness due to fracture | Tx: time and physio
52
AVN
Femoral neck, scaphoid, talus
53
Complex regional pain syndrome
Burning/throbbing, sensitive to light touch, swelling, stiffness, pain Heightened pain response after injury
54
Treatment of CRPS
``` Analgesia Amitryptalline Gabapentin (anti convulsant) Steroids TENS Physio Nerve block ```
55
Treatment of mangled extremity/open fracture
``` Flucloxacillin (gram pos) Gentamicin (coliforms, gram neg) Metronidazole (anaerobes) Sterile dressing Splint Debride, graft ```
56
Unstable fractures may produce:
haematoma (bacteria grow)
57
Treatment of dislocation
``` Reduce ASAP (closed manipulation, sedation, analgesia) ORIF if delayed ```
58
Treatment of soft tissue injuries
RICE | Surgical repair
59
Symptoms of septic arthritis
Sudden onset severe pain in one joint | Red, hot, swollen, worse on movement
60
Causes of septic arthritis
``` Staph aureus Strep Haem influenzae (kids) Neiserria gonorrhoeae (young adults) E. coli (elderly, IVDU) ```
61
Treatment of septic arthritis
Aspirate BEFORE antibiotics | Washout and antibiotics

MSK (10 decks)

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