MSK Injuries II Flashcards

1
Q

High risk injuries r/t compartment syndrome include?

A

Forearm & tibial fx’s
Immobilized injuries in constrictive dressings/casts
Severe crush injuries
Localized, prolonged external pressure
Increased capillary permeability from reperfusion of ischemic muscle
Burns
Excessive exercise

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2
Q

Compartment S/Sx’s include?

A

Swollen, tense extremity
4P’s - 1st symptoms occur with nerve compression
1. Paresthesia - w/n 30 min can have numbness & tingling
2. Pain - out of proportion to injury
3. Pallor - cyanosis early, pallor late
4. Pulseless - unreliable & late sign
Hypoesthesia (late sign)
Paresis (late sign)

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3
Q

Compartment syndrome management includes

A

Release constrictive dressings & monitor for 30-60 min
Fasciotomy for pressure > 35mmHg
Untreated muscle death & amputation

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4
Q

Crush Injury Complications Hyperkalemia
ECG?
Progressive increase in what? leads to what?
How high can K+ rise to an hour after extrication?

A

Elevated K+ & peaked T waves, prolonged PR & QRS intervals
QRS widens to V dysrhythmias
7 or higher

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5
Q

Hyperkalemia management includes?
Stabilize myocardium with what?
Shift K into cells with what?
Promote K excretion with what?

A

CaGluconate 10ml 10% solution; CaChloride 5ml 10% solution
NaHCO3 1mEq/kg; Albuterol 5mg/3ml inhalation; Regular insulin 10u IV with 1amp D50W
Lasix 20-40mg IV; Kayexalate 25-50gm po/pr; Lokelma 10gm po TID

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6
Q

Crush injury complications Hypocalcemia
Depostion of Ca+2 salts where?
Cell membrane injury leads to?
Ca+2 influx overloads what?
Usually doesn’t require what?

A

in necrotic muscle & binds w/ phosphate
Na/K pump malfunction & cant pump out Ca+2
mitochondria to further reduce ATP production
repletion & will correct as fluid shifts occur post injury

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7
Q

Rhabdomyolysis
Multiple causes include?

A

final common pathway resulting in muscle injury & necrosis is direct myocyte injury or energy supply failure in muscle cell

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8
Q

Rhabdomyolysis
Normally Na/K pump & Na/Ca exchanger on what? maintain what?

A

sarcoplasmic membrane
low IC sarcoplasmic Na, Ca & high K concentration in resting muscle

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9
Q

Rhabdomyolysis
Muscle contraction is active prosses in using ATP; excess Ca influx into sarcoplasm results in what?
Any insult that disrupts ATP, ion channels, & plasma membrane results in what?

A

actin myosin linkage.
loss of IC electrolyte equilibrium

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10
Q

Be suspicious of Rhabdo in patients with?

A

traumatic injuries
Multiple orthopedic injuries
Crush injury to any part of body
laying on limb for long period of time - patient found down
Lengthy surgery
brown urine

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11
Q

Rhabdo Diagnosis
Classic triad?
S/Sx?
Electrolyte abnormalities include?
Elevated what?

A

brown urine, muscle pain & weakness
Hypovolemia, shock
increased K, Low Ca, acidemia upon reperfusion
Creatinine

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12
Q

Rhabdo: CK levels how high above normal with risk factors or symptoms?
Check serial what?
Should peak when? then decrease how much/day?
If not decreasing after 2-3 days, suspect what?

A

5-10x’s, > 5000 correlated with AKI
CK levels q6-12 hrs
w/n 24hrs; 30%/day
further injury or compartment syndrome

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13
Q

Rhabdo stats
5-35% of pts develop what?
8-15% of what is caused by Rhabdo in US?
Mortality rate for those that develop this complication is what?

A

AKI
AKI
3-50%

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14
Q

Rhabdo management
what is the cornerstone of treatment?
IV access?
Urine output goal of what by using what?
urine alkalization to keep pH > what?
Monitor/manage what?
Use what to encourage UO?

A

hydration with isotonic crystalloid
Large bore
IVF for UO goal of > 100ml/hr
6.5
electrolyte abnormalities
mannitol or lasix

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15
Q

Abdominal Compartment Syndrome (ACS)
Organ dysfunction due to what?
definition of this problem?
ACS occurs if sustained IAP > what? & what other qualifier?

A

Intra-abdominal HTN
sustained or repeated pathological elevation of intrabdominal pressure (IAP) of 12 mmHg or more

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16
Q

Abdominal Compartment Syndrome
Grade I =
Grade II =
Grade III =
Grade IV =

A

IAP 12-15
16-20
21-25
>/= 25

17
Q

Abdominal Compartment Syndrome Categories/Causes?
Primary or acute?
Secondary?
Chronic?

A

Intra-abdominal pathology is directly responsible
when no visible intra-abdominal injury is present but injuries otuside abdomen cause fluid accumulation
presence of cirrhosis & ascites or related disease states, often in later stages of disease

18
Q

ACS causes
Primary

A

blunt/penetrating trauma
liver transplant
ruptured AAA
RP hemorrhage
bowel obstruction
post-op tension
bleeding pelvic fx

19
Q

ACS causes
secondary

A

severe intra-abd infection
large volume resuscitation
ascites
pancreatitis
ileus
sepsis
burns
morbid obesity
pregnancy

20
Q

ACS System by system
Renal IAP of >/= what associated w/ what?
Pulm: IAP pushes diaphragm up; how much IAP is dispersed across diaphragm affecting what?

A

15mmHg associated w/ renal impairment
~50; respiration/ventilation (decreased VT, hypercarbia, acidosis, compression atelectasis)

21
Q

ACS System by system
CV: IAP compresses what? resulting in what?
Fictitiously elevated what?
CO affected by waht?

A

heart & major vessels; tamponade-like picture
CVP & PAWP
decreased preload, contractility, & increased pulmonary vascular resistance

22
Q

ACS System by System
CNS: IAP can impair what?

A

drainage of CNS d/t increased intrathoracic pressure

23
Q

ACS S/Sx?

A

Increased abdominal girth
difficulty breathing
decreased UOP (unresponsive to IVF/pressor)
Syncope
Melena
N/V
High peak/plateau pressures, difficulty ventilating

24
Q

ACS Workup includes

A

CMP
CBC
amylase/lipase
coag studies
cardiac markers
Lactate
ABG
CT scan
Bladder pressure if >/= 2 risk factors
Lift Foley tubing

25
Q

ACS diagnosis
Transducer Or manometer via?
sustained IAP > what? & what other qualifier?
Abdominal perfusion pressure = what?
Goal APP?

A

Foley
20mmHg & new organ dysfunction
MAP - IAP
> 60mmHg

26
Q

ACS management includes?

A

Judicious use of IVF
Diuretics
General Surgery
Decompression for IAP > 25mmHg
early closure
pressors or inotropes if IVF do not increase APP
Goal: IAP < 15 mmHg, APP> 60 mmHg, Prevent ACS