Injured Lower Extremity

Question 1

Level 1 trauma

Answer 1

Complete care
Surgery residency
Required volume
Surgeons on duty 24 hrs per day

Question 2

Level 2 trauma

Answer 2

Initial care

Surgeons out of house but readily available

Question 3

Level 3 trauma

Answer 3

Immediate care
Prearranged transfer
Prompt availability of surgeon
Rural/Community hospital

Question 4

Level 4 and 5 trauma

Answer 4

Advanced trauma life support

Trauma trained nurse immediately available and physician available upon patient arrival

Question 5

Glasgow Coma Scale

Answer 5

8 or lower is severe, coma
9-12 is moderate
13-15 is minor

Question 6

Understand revised trauma score

Answer 6

scale is ranged from 0-4 and added together based on Glasgow, Systolic BP, and RR

Question 7

What does the RTS help you do?

Answer 7

Directs triage and evaluates patient outcomes

-Less than 4 requires treatment at trauma center

Question 8

Primary Survey includes?

Answer 8

ABCDE

-Life threatening injuries are identified and addressed until the patient is stable

Question 9

ABCDE includes?

Answer 9

Airway
Breathing
Circulation
Disability
Exposure/Environmental Control

Question 10

Secondary survey includes?

Answer 10

Complete head to toe eval w/ definitive diagnosis and treatment
Repeat vitals
Extensive testing

Question 11

Tertiary survey includes?

Answer 11

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

Question 12

HPI

Answer 12

Local injury as well as associated injuries

Question 13

Scoring system used to determine risk for amputation

Answer 13

Mangled Extremity Score

-Greater than 7 is high risk

Question 14

How are the specificity and sensitivity for amputation of the MES?

Answer 14

GOOD specificity

POOR sensitivity

Question 15

What are MES scores used for>

Answer 15

Help guide decision but NOT used in isolation

Question 16

When do you consider limb salvage?

Answer 16

Intact Tibial n.
Reconstruct vascular supply
Moderate tissue injury/loss
Moderate bone loss
Functional foot/ankle
Younger patient

Question 17

Tetanus vaccine

Answer 17

Vaccine produces immune response that takes several months

Question 18

Tetanus Immunoglobulin

Answer 18

Produces immediate but temporary protection

Question 19

When to give Tdap

Answer 19

Adults who have never received Tdap
More than ten years since the last
More than 5 years since the last

Question 20

IV Antibiotics are based on…?

Answer 20

Severity
Timing
Contamination
Co-morbidities
Contra-indications

Question 21

What classification is used to determine antibiotics for open fractures?

Answer 21

Gustilo and Anderson

Question 22

Explain gross debridement/wash out

Answer 22

Performed after patient is stabilized
Remove all debris and foreign material
Decrease bacterial burden

Question 23

Explain initial stabilization/reduction

Answer 23

After the patient is stabilized
Address neurovasculature
Decrease trauma to soft tissue
Prevent 2nd hit
**Damage control

Question 24

First hit

Answer 24

Trauma activates SIRS

Soft tissue and bone

Question 25

Second Hit

Answer 25

Surgery in the early phase accelerates SIRS

Increased local soft tissue damage

Question 26

Lag period

Answer 26

Surgery just past the peak of SIRS

Surgery may overwhelm soft tissues already damaged