Injured Lower Extremity Flashcards
Level 1 trauma
Complete care
Surgery residency
Required volume
Surgeons on duty 24 hrs per day
Level 2 trauma
Initial care
Surgeons out of house but readily available
Level 3 trauma
Immediate care
Prearranged transfer
Prompt availability of surgeon
Rural/Community hospital
Level 4 and 5 trauma
Advanced trauma life support
Trauma trained nurse immediately available and physician available upon patient arrival
Glasgow Coma Scale
8 or lower is severe, coma
9-12 is moderate
13-15 is minor
Understand revised trauma score
scale is ranged from 0-4 and added together based on Glasgow, Systolic BP, and RR
What does the RTS help you do?
Directs triage and evaluates patient outcomes
-Less than 4 requires treatment at trauma center
Primary Survey includes?
ABCDE
-Life threatening injuries are identified and addressed until the patient is stable
ABCDE includes?
Airway Breathing Circulation Disability Exposure/Environmental Control
Secondary survey includes?
Complete head to toe eval w/ definitive diagnosis and treatment
Repeat vitals
Extensive testing
Tertiary survey includes?
Repeat head to toe w/ reevaluation w/ labs and studies
Comprehensive review of medical records
Repetition of the surveys and review
Changes are evaluated and treated
HPI
Local injury as well as associated injuries
Scoring system used to determine risk for amputation
Mangled Extremity Score
-Greater than 7 is high risk
How are the specificity and sensitivity for amputation of the MES?
GOOD specificity
POOR sensitivity
What are MES scores used for>
Help guide decision but NOT used in isolation
When do you consider limb salvage?
Intact Tibial n. Reconstruct vascular supply Moderate tissue injury/loss Moderate bone loss Functional foot/ankle Younger patient
Tetanus vaccine
Vaccine produces immune response that takes several months
Tetanus Immunoglobulin
Produces immediate but temporary protection
When to give Tdap
Adults who have never received Tdap
More than ten years since the last
More than 5 years since the last
IV Antibiotics are based on…?
Severity Timing Contamination Co-morbidities Contra-indications
What classification is used to determine antibiotics for open fractures?
Gustilo and Anderson
Explain gross debridement/wash out
Performed after patient is stabilized
Remove all debris and foreign material
Decrease bacterial burden
Explain initial stabilization/reduction
After the patient is stabilized Address neurovasculature Decrease trauma to soft tissue Prevent 2nd hit **Damage control
First hit
Trauma activates SIRS
Soft tissue and bone
Second Hit
Surgery in the early phase accelerates SIRS
Increased local soft tissue damage
Lag period
Surgery just past the peak of SIRS
Surgery may overwhelm soft tissues already damaged
