ISE Trauma 5 (trauma to extremities) Flashcards

1
Q

most commonly injured vessels in trauma to the extremities

A

femoral and popliteal vessels

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2
Q

hard signs of extremity vascular trauma

A

absent or diminished distal pulses
obvious arterial bleeding
large expanding or pulsatile hematoma

audible bruit
palpable bruit
distal ischemia
-pain
-pallor
-paralysis
-paresthesias
-coolness

prsence of any hard sign, consult vascular surgery immediately

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3
Q

soft signs of extremity vascular trauma

A

small, stable hematoma
injury to anatomically related nerve
proximity of injury to major vascular structures

unexplained hypotension
history of hemorrhage
complex fracture

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4
Q

remarks on ABI

A

ABI <0.9, do CT angiography

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5
Q

4 types of fractures associated with low-energy gunshots

A
  1. drill-hole track pattern
  2. unicortical fractures
  3. comminuted fractures
  4. distal spiral fracture
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6
Q

most common fracture associated with low-energy gunshots

A

drill-hole wound track pattern
most common in
distal femur
pelvis
proximal humerus

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7
Q

unicorticacl fractures

A

appear in metaphyses of long bones

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8
Q

comminuted fractures

A

diaphyseal bone

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9
Q

distal spiral fracture

A

femur

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10
Q

remarks on ultrasound in extremity trauma

A

doppler:
normal triphasic arterial flow in both the dorsalis pedis artery and posterior tibial artery had a sensitivity and specificity of 100% in ruling out arterial lesions in lower-limb penetrating trauma

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11
Q

most important component of wound management in extremity trauma

A

irrigation with saline or tap water (500-1000mL) at high pressures (15-20 pounds per square inch)

antiseptic solution does not decrease infection rate and may actually be harmful

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12
Q

when is delayed closure of wound indicated

A

delay of 72-96 hours

“BCD”
retained foreign Bodies
Contamination
major tissue Destruction

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13
Q

remarks on bullet in extremities

A

a bullet generally should not be removed unless the bullet has potential to migrate into surrounding vital structures or if it is in the joint capsule

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14
Q

disposition in penetrating extremity trauma

A

hard signs —> immediiate surgical consult

all other patients with penetrating extremity trauma: a minimum of 24hours is reasonable

return precaution:
-increasing pain
-numbness
-weakness
-redness
-pus discharge

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