MSK in Trauma Flashcards
What are the ABCD of initial evaluation?
airway, breathing, circulation, disability
Define shock.
inadequate delivery of oxygen to the cells caused by transition from aerobic to aerobic metabolism often de to acute blood loss
Which areas of the body are most dangerous for blood loss?
external, extremities (easy to see but bleeds freely), internal femur bleed can be extensive
chest, abdomen pelvis: obscured, plenty of high flow vessels
Define the 4 classes of shock, specifically when would you expect to see changes in pulse and systolic BP?
class I 40% blood loss
What are the goals of shock resuscitation?
organ perfusion
restoration of tissue oxygenation
reversal of oxygen debt, tissue acidosis and aerobic metabolism
Major hemorrhage is associated with these types of injury to the extremities.
open fractures
closed fracture of the femur or tibia
major dislocation or amputation
pelvic fracture (**bleed into the retroperitoneal space)
What are orthopedic priorities in addressing a trauma injury?
reverse ischemia, stop hemorrhage
wound care
reduce dislocation, splint/align fractures, stabilization of long bones
What are orthopedic priorities in addressing a trauma injury?
reverse ischemia, stop hemorrhage
wound care
reduce dislocation, splint/align fractures, stabilization of long bones
What are the benefits of early open reduction and internal fixation?
increase in mobility which decreases DVT, PE, atelectasis, decubitus ulcers
decrease pain and narcotic use
decrease inflammatory response/cytokine
What are the benefits of early open reduction and internal fixation?
increase in mobility which decreases DVT, PE, atelectasis, decubitus ulcers
decrease pain and narcotic use
decrease inflammatory response/cytokine
What are some the detrimental consequences of early ORIF?
worsening pulmonary and head injury due to tissue hypoxia esp. with linger state of shock (lactic acidosis)
in these cases damage control orthopedics is practice, doing small stabilizing surgeries before returning for definitive treatment
How are current trauma patients treated?
stable, well resuscitated patients get early total care
borderline and unstable patients get damage control until stable to avoid early second hit phenomenon (hypotension, coagulopathy, hypoxia
How are current trauma patients treated?
stable, well resuscitated patients get early total care
borderline and unstable patients get damage control until stable to avoid early second hit phenomenon (hypotension, coagulopathy, hypoxia
What are the lab consequences of acute muscle injury? How do you treat?
acute muscle death leads to increased myoglobin, increased K+ and decreased Ca++ which can lead to renal failure or cardiac arrest
increase hydration, alkalinize urine and remove dead muscle
Define compartment syndrome.
a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space
