MSK in acute trauma

Question 1

What are the critical components of initial evaluation of a trauma patient?

Answer 1

airway, breathing, circulation

Question 2

_____ is defined as inadequate perfusion and oxygen delivery to body tissues

Answer 2

shock

Question 3

Shock results in anaerobic metabolism, production of _______, and metabolic acidosis

Answer 3

lactic acid

Question 4

Describe the five major bodily sites of blood loss that can contribute to hemorrhagic shock

Answer 4

external loss
chest cavity
abdomen
retroperitoneal- esp pelvic fracture
extremities

Question 5

Describe the four classes of hemorrhage

Answer 5

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 (

Question 6

Describe the four classes of hemorrhage

Answer 6

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 (

Question 7

What kinds of MSK trauma can cause or contribute to hemorrhagic shock?

Answer 7

brisk bleeding of open fracture
closed femur fracture with hematoma
unstable pelvic fracture with retroperitoneal bleeding
amputation

Question 8

How does the pain from fractures contribute to hemodynamic instability?

Answer 8

Pain can stimulate catecholamine release, causing further hemodynamic instability, and contribute to inflammatory response caused by injury

Question 9

What are the key priorities in MSK trauma?

Answer 9

Reverse ischemia
Stop hemorrhage
Wound care
Reduce dislocation
Splint / align fractures
Long bone stabilization

Question 10

What groups of patients should not be treated with early total care?

Answer 10

pulmonary or head injuries

Question 11

Distinguish between the appropriate patient groups for early total care vs damage control orthopedics

Answer 11

• 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

Question 12

Damage control orthopedics can help avoid a _________ phenomenon of hypotension, coagulopathy, and hypoxia in surgery

Answer 12

second hit

Question 13

Describe complications of muscle injury, ex in crush injury

Answer 13

• 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

Question 14

Describe complications of muscle injury, ex in crush injury

Answer 14

• 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

Question 15

Describe the treatment approach to acute muscle injury

Answer 15

• aggressive IV fluids to avoid hypovolemia and kidney failure
• urine alkalinization to avoid myoglobin precipitation in the kidney
• surgical removal of necrotic tissue

Question 16

Describe the treatment approach to acute muscle injury

Answer 16

• aggressive IV fluids to avoid hypovolemia and kidney failure
• urine alkalinization to avoid myoglobin precipitation in the kidney
• surgical removal of necrotic tissue

Question 17

What is compartment syndrome?

Answer 17

Elevated pressure inside nonexpendable compartments that is severe enough to lead to muscle death, decreased capillary perfusion, ischemia, nerve death

Question 18

What exam findings suggest compartment syndrome?

Answer 18

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

Question 19

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

Answer 19

30 mm Hg

if compartment pressure is within 30mm Hg of diastolic pressure, it is a concern

Question 20

How is compartment syndrome treated?

Answer 20

loosen bandages/ surgical decompression by fasciotomy

Question 21

Irreversible damage to muscle and nerves can occur in as little as ______ hours in compartment syndrome

Answer 21

4-6 hours

Question 22

_______ is a major added concern with open fractures

Answer 22

infection

prevent sepsis with timely debridement and antibiotics

Question 23

What host factors increase the risk of sepsis with open fractures?

Answer 23

smoking, debilitation

Question 24

Open fractures of the ____ are most common because of its relatively subcutaneous location

Answer 24

tibia