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Emergency Medicine > MSK Complaints > Flashcards

MSK Complaints Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

which 2 situations are considered an orthopedic emergency?

A

open fracture
neurovascular injury

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2
Q

what are the 2 most common etiologies of open fractures and neurovascular injuries?

A

subluxation
dislocation

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3
Q

how should xrays be done?

A

xray joint above and below the injury

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4
Q

what should be done if a patient is suspicious for a fracture but there isn’t a visible fracture on the 1st day of injury? (2)

A

splint as if fractured
f/u for another xray in 7-10 days

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5
Q

what S/S are highly suspicious for an extremity fracture? (3)

A

point tenderness
pain w/ PROM
pain w/ tuning fork test

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6
Q

what is the first thing to check if a patient has an extremity fracture?

A

neurovascular status

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7
Q

what should be done for an extremity fracture to immobilize the injured bone/joint and prevent pressure-related skin breakdown?

A

splint with plenty of padding

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8
Q

what should be done for an extremity fracture if we attempt to reduce angulation, shorten, or displace the fracture while splinting?

A

repeat xray in splint + document

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9
Q

what is the Salter Harris Fracture?

A

Straight through growth plate
Above growth plate
Lower than growth plate
Through everything
Ram/compression of growth plate

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10
Q

when should all patients with an extremity fracture follow up with ortho?

A

within 2-3 days of fracture

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11
Q

what can lead to a loss of full hand function in hand burns? (2)

A

healing process + scar tissue tightening

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12
Q

what should we instruct the patient to do to expose possible tendon injuries of the hand?

A

fully flex and extend digits

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13
Q

what type of injuries of the hands must always be repaired?

A

tendon injuries

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14
Q

what kind of injury of the hand leads to dissection along planes of least resistance; the neurovascular bundles and facial planes?

A

high pressure injuries

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15
Q

what is the treatment for a hand high pressure injury caused by air or water? (3)

A

tetanus
antibiotics
immobilization

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16
Q

what is the treatment for a hand high pressure injury caused by things other than air or water? (4)

A

tetanus
antibiotics
immobilization
immediate debridement

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17
Q

what is the treatment for a hand infection? (4)

A

drain pus
immobilize + elevate in position of function
antibiotics
admit for observation + ortho f/u

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18
Q

a closed space infection of the flexor tendon sheath that is considered an orthopedic emergency

A

flexor tenosynovitis

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19
Q

a patient presents with fusiform swelling, finger is held in slight flexion, they have pain with passive extension and pain w/ palpation. Dx?

A

flexor tenosynovitis

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20
Q

what is the treatment for flexor tenosynovitis? (2)

A

IV antibiotics w/ elevation
emergency ortho consult

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21
Q

a patient presents with back pain. what can indicate an infection (red flag)? (3)

A

fever
immune compromise
IV drug use

22
Q

a patient presents with back pain. what can indicate a fracture (red flag)?

A

recent trauma

23
Q

a patient presents with back pain. what can indicate cauda equina or central cord compression (red flag)? (5)

A

numbness of LE

saddle paresthesias

LE weakness/foot drop

bowel/bladder incontinence / retention

hyporeflexia

24
Q

a patient presents with back pain. what can indicate an aortic dissection/aneurysm (red flag)? (3)

A

abdominal pain
pulsating mass
upper back pain w/ neuro deficit

25
Q

a fast spreading, gas producing infection

A

necrotizing fasciitis

26
Q

what should be done if we suspect a patient has necrotizing fasciitis?
(3)

A

outline cellulitis
palpate for crepitus + severe TTP
Xray / CT

27
Q

what is the most common treatment for necrotizing fasciitis?

A

amputation

28
Q

what is the treatment for an open fracture? (3)

A

cefazolin (1st gen)
+ gram (-) antibiotic
tetanus
schedule surgery

29
Q

which antibiotic should be used for a large open fracture/wound?

A

gentamicin (aminoglycoside)

30
Q

in a joint infection that is associated with an injury, how can you check if the joint capsule is compromised?

A

injecting sterile saline/methylene blue into capsule = no resistance

31
Q

what is the treatment for a joint infection? (2)

A

surgery + culture/arthrocentesis
IV antibiotics

32
Q

a patient presents with a fever, erythematous joint that is warm, swollen, and has effusion. There is + pain with all ROMA and axial load, and the patient has an elevated WBC count. Dx?

A

joint infection

33
Q

what must all erythematous, warm, painful joints have before an infection is ruled out?

A

arthrocentesis

34
Q

what are the synovial results that indicate septic arthritis? (3)

A

looks purulent
leukocytes > 50K
+ gram stain/culture

35
Q

what can compartment syndrome lead to?

A

necrosis

36
Q

where is compartment syndrome most common?

A

lower extremities

37
Q

what should be suspected in all crush injuries, fractures, and soft tissue injuries with severe pain?

A

compartment syndrome

38
Q

a patient presents with pain out of proportion, pain with passive stretch of muscle, paresthesia, pallor, poikilothermia, and pulselessness. Dx?

A

compartment syndrome

39
Q

what diagnostic can be used for compartment syndrome?

A

direct compartment pressure testing

40
Q

compartment syndrome treatment?

A

fasciotomy

41
Q

management for laceration? (3)

A

tetanus if > 5yrs
clean with antiseptic
closure

42
Q

what are 3 definitive closure options for a laceration? 2 temporary options?

A

glue
staples
suture

suture
gauze/occlusive dressing

43
Q

what are 3 abrasion considerations?

A

stop the bleeding
assess depth and area
assess cosmetic impact of wound

44
Q

management for abrasion? (2)

A

tetanus if > 5 yrs
clean with antiseptic

45
Q

what is the treatment for an abrasion wound? (2)

A

antibiotic ointment
iodoform bandage

46
Q

what may severe abrasions of palms and over joints require? why?

A

physical therapy
avoid contractures + maintain ROM

47
Q

a patient presents with an animal bite and the animal was found. what is done?

A

animal services holds animal and monitors for disease

48
Q

what is the treatment for all bites? (3)

A

clean with antiseptic
tetanus
amoxicillin-clavulanate (augmentin)

48
Q

a patient presents with an animal bite but the animal cannot be found. what is done? (3)

A

1st rabies dose in ED
rabies immunoglobulin in ED
2nd - 4th rabies dose in local clinic

49
Q

in a case of bite, what are the only 2 places to do closure d/t high vascularity and cosmesis?

A

face
scalp

Emergency Medicine (12 decks)

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