MSK in acute trauma Flashcards
What are the critical components of initial evaluation of a trauma patient?
airway, breathing, circulation
_____ is defined as inadequate perfusion and oxygen delivery to body tissues
shock
Shock results in anaerobic metabolism, production of _______, and metabolic acidosis
lactic acid
Describe the five major bodily sites of blood loss that can contribute to hemorrhagic shock
external loss chest cavity abdomen retroperitoneal- esp pelvic fracture extremities
Describe the four classes of hemorrhage
Class 1 hemorrhage is caused when less than 15 % of the circulating blood volume is lost. BP/pulse not affected.
Class 2 hemorrhage is defined as losing between 15-30% of blood volume. BPnormal, pulse is elevated (100-120 beats per minute).
Class 3 hemorrhage is defined by loss of 30-40% of blood volume, elevated HR and decrease in BP.
Class 4 hemorrhage is seen when >40% of blood volume is lost. Profound changes in pulse (>130 beats per minute) and systolic blood pressure (
Describe the four classes of hemorrhage
Class 1 hemorrhage is caused when less than 15 % of the circulating blood volume is lost. BP/pulse not affected.
Class 2 hemorrhage is defined as losing between 15-30% of blood volume. BPnormal, pulse is elevated (100-120 beats per minute).
Class 3 hemorrhage is defined by loss of 30-40% of blood volume, elevated HR and decrease in BP.
Class 4 hemorrhage is seen when >40% of blood volume is lost. Profound changes in pulse (>130 beats per minute) and systolic blood pressure (
What kinds of MSK trauma can cause or contribute to hemorrhagic shock?
brisk bleeding of open fracture
closed femur fracture with hematoma
unstable pelvic fracture with retroperitoneal bleeding
amputation
How does the pain from fractures contribute to hemodynamic instability?
Pain can stimulate catecholamine release, causing further hemodynamic instability, and contribute to inflammatory response caused by injury
What are the key priorities in MSK trauma?
Reverse ischemia Stop hemorrhage Wound care Reduce dislocation Splint / align fractures Long bone stabilization
What groups of patients should not be treated with early total care?
pulmonary or head injuries
Distinguish between the appropriate patient groups for early total care vs damage control orthopedics
- early total care for stabilized patients with no shock- resolution of metabolic acidosis, good vitals, urine output
- damage control ortho for patients with lingering acid-base disturbance, etc; patients with head or pulmonary injury
Damage control orthopedics can help avoid a _________ phenomenon of hypotension, coagulopathy, and hypoxia in surgery
second hit
Describe complications of muscle injury, ex in crush injury
- release of myoglobin
- increase in K
- decrease in Ca due to absorption by injured cells
- acute renal failure (myoglobin is toxic)
- cardiac arrhythmia from K/ Ca changes
- hypovolemic shock
Describe complications of muscle injury, ex in crush injury
- release of myoglobin
- increase in K
- decrease in Ca due to absorption by injured cells
- acute renal failure (myoglobin is toxic)
- cardiac arrhythmia from K/ Ca changes
- hypovolemic shock
Describe the treatment approach to acute muscle injury
- aggressive IV fluids to avoid hypovolemia and kidney failure
- urine alkalinization to avoid myoglobin precipitation in the kidney
- surgical removal of necrotic tissue
Describe the treatment approach to acute muscle injury
- aggressive IV fluids to avoid hypovolemia and kidney failure
- urine alkalinization to avoid myoglobin precipitation in the kidney
- surgical removal of necrotic tissue
What is compartment syndrome?
Elevated pressure inside nonexpendable compartments that is severe enough to lead to muscle death, decreased capillary perfusion, ischemia, nerve death
What exam findings suggest compartment syndrome?
tense swollen limb
pain out of proportion to exam
pain with passive stretch of muscles in the affected compartment
numbness in nerves within the affected compartment
pallor, pulselessness as late signs
It is thought that as long as the difference between the compartment pressure reading and the diastolic blood pressure is greater than ____ mm Hg, perfusion of the tissues in the compartment should be adequate
30 mm Hg
if compartment pressure is within 30mm Hg of diastolic pressure, it is a concern
How is compartment syndrome treated?
loosen bandages/ surgical decompression by fasciotomy
Irreversible damage to muscle and nerves can occur in as little as ______ hours in compartment syndrome
4-6 hours
_______ is a major added concern with open fractures
infection
prevent sepsis with timely debridement and antibiotics
What host factors increase the risk of sepsis with open fractures?
smoking, debilitation
Open fractures of the ____ are most common because of its relatively subcutaneous location
tibia
