General trauma Flashcards
What is the “golden hour” in trauma?
Survival is better if resuscitation etc is delivered within the first hour of arriving in hospital e.g. stabilised, imaging done, management plan made
What is the difference between the initial primary survey and secondary surgvey in ATLS?
initial primary survey = ABCDE
Secondary survey = survey to look for other injuries than ones that require immediate treatment (CT helpful)
What are the 2 types of bone healing and what are the differences between them?
Primary and secondary bone healing
Primary = where there is a minimal gap (hairline fractures or fractures united by screws and plates) - bridge the gap with new bone from osteoblasts
Secondary = gap at the fracture site, callus forms and remodelling occurs due to an inflammatory response
What are the 4 steps in secondary bone healing?
Step 1: inflammation - macrophages and osteoclasts remove debris and resorb the bone ends
Step 2: soft callus formation (2-3 weeks)
Step 3: Hard callus formation (6-12 weeks)
Step 4: remodelling
What is a transverse fracture and explain mechanism of injury?
break right through a bone due to a bending force
What is an oblique fracture and explain mechanism of injury?
break right through a bone due to a shearing force (deceleration/fall from height)
What is a spiral fracture and mechanism of injury?
spiral fracture through the bone, due to rotational forces
What is a segmental fracture?
When a bone is fractured in 2 separate places
What is a comminuted fracture?
Bone fractured into 3+ segments - usually a high energy injury
What is the difference between translation, angulation and rotation in terms of describing a displaced fracture?
translation = distal fracture can be DISPLACED anteriorly or posteriorly or TRANSLATED medially or laterally Angulation = describes the direction that the distal fragment points towards Rotation = rotation of the distal fragment relative to the proximal fragment
Give 4 early local complications of fractures?
Compartment syndrome
Vascular injury/ischaemia
Nerve injury/compression
Skin necrosis
Give 4 early systemic complications of fractures?
Hypovoleamia
Shock
Fat embolism
Death
Give 4 late local complications of fractures?
Infection
Non-union
Mal-union
Volkmann’s isachaemic contracture
What is the main late systemic complication of fractures?
Pulmonary embolism
What is compartment syndrome?
Serious complication of fractures and surgical emergency - raised pressure within a compartment in a limb due to bleeding or muscle swelling after trauma which leads to compression of vasculature and nerves
Why is there severe pain in compartment syndrome?
Rising pressure causes congestion in the muscle which leads to secondary ischaemia and arterial blood cant reach the muscle - combination leads to severe pain
What are the key clinical signs of compartment syndrome?
Increased pain on passive stretching of the muscles involved
Severe pain that wouldn’t be expected in the clinical context
Management of compartment syndrome?
Immediately remove all casts and bandages
Fasciotomy (slipping of the fascia)
What would happen if compartment syndrome was left untreated?
Ischaemic muscle would would necrose, resulting in Volkmann’s contracture
Which artery is at risk in knee dislocations?
Popliteal artery
Which artery is at risk in supracondylar fractures (especially in children)?
Brachial artery
Which artery is at risk in an anterior shoulder dislocation?
Axillary artery
What is given initially in open fractures to help prevent infection?
IV broad spectrum antibiotics (usually flucloxacillin)
What surgical procedure must be done in open fractures?
Debridement
