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
What are clinical signs of compartment syndrome?
pain (out of proportion with perceived injury), swelling, sensory or paralysis
late consequences include
How much time do you have for tissue survival in compartment syndrome?
after 6mo variable damage to muscle
after 8mo you have irreversible changes in nerve conduction
if the compartment is within 30 mm of diastolic blood pressure it is of concern
Name the 3 compartment of the lower leg and the nerve that they contain.
anterior: deep peroneal nerve
lateral: superficial perennial nerve
posterior: tibial nerve
Name the 3 compartment of the lower leg and the nerve that they contain.
anterior: deep peroneal nerve - plantar flexion, skin between first two toes
lateral: superficial perennial nerve- plantar flexion and eversion; shin and top of foot
posterior: tibial nerve- flexion of big toe- heel sensory
Name the 3 compartment of the lower leg and the nerve that they contain.
anterior: deep peroneal nerve - plantar flexion, skin between first two toes
lateral: superficial perennial nerve- plantar flexion and eversion; shin and top of foot
posterior: tibial nerve- flexion of big toe- heel sensory
How is compartment syndrome treated?
decrease pressure on tissue (loosen cast, bandage, open the fascia surgically)
increase perfusion by reversing shock
How is compartment syndrome treated?
decrease pressure on tissue (loosen cast, bandage, open the fascia surgically)
increase perfusion by reversing shock
What is the standard treatment of open fractures?
cover wound, wound debridement (including removal of dead tissue and liberal irrigation)
time matters, start antibiotics, prevent sepsis
*sepsis increases with host factors like smoking or otherwise debilitated host
