MSK, MVA, Trauma Flashcards
Define dislocation
Injury or disability caused when normal position of a joint or other part of the body is disturbed
What do most dislocations require prior to realigning?
Some degree of anesthesia/analgesia
Options for analgesia/anesthesia prior to reducing a dislocation
- Local anesthetic
- Nerve block
- Parenteral analgesics
- Conscious sedation
What makes a joint more difficult to relocate and why?
The longer a joint has been dislocated, more difficult to relocate due to muscle spasm
What should always be performed post-reduction of a dislocation?
X-ray and neurovascular check
MC dislocations of the mandible
Anterior and bilateral
Etiologies of mandible dislocation
- Trauma
- Yawning
- Hypermobility syndrome
Imaging for mandible dislocation
Panorex or mandible
Method of mandible reduction
- Conscious sedation for most
- Wrap thumbs with gauze
- Intraoral pressure down and back
FU care for mandible reduction
- Soft diet for 2 wks
- Oral surgery if nerve deficit present
How is a shoulder MC dislocated?
98% of time - humeral head displaced anterior to glenoid and inferior to coracoid
How does a shoulder dislocation MC present?
“Squared off” shoulder
Imaging finding of dislocated shoulder
Look for ball on tee
FU care of shoulder relocation
Immobilizer for 1-4 wks then PT
Methods of shoulder relocation
- Traction-countertraction
- Stimson
- Milch
- Kocher
- Scapular manipulation
MC type of elbow dislocation?
Posterior
What are elbow dislocations frequently associated with?
Fractures
Etiology of elbow dislocation
FOOSH
Methods of elbow relocation
- Sedation necessary
- Distal traction or interlocking hands
FU care of elbow relocation
- Splint in 90 degrees, sling
- ROM in 1-2 wks
What is a nursemaid’s elbow?
- Radial head subluxation
- Annular ligament displaces into radiocapitellar articulation
Who is MC affected by nursemaid’s elbow?
Girls, 6 mo-3 yo
Methods of nursemaid’s elbow relocation
- Hyperpronation w/elbow at 90 degrees
- Supination then flexion (less successful)
FU care of nursemaid’s elbow relocation
- Full use should return quickly
- Avoid pulling/twisting mechanisms
What is a Colles fracture?
Distal radius metaphysis fracture w/dorsal angulation
What presents as a “dinner fork” appearance?
Colles fracture
Colles fracture clinical presentation
“Dinner fork” appearance
Methods of Colles fracture reduction
- Hematoma block and/or sedation
- Inline traction, push distal radius volarly
- Reduction indicated if over 20 degrees angulated
FU care of Colles fracture
- Volar splint, sling
- Ortho FU
What is a “reverse Colles”?
Smith fracture - volar angulation of distal radius fracture
What is a Smith fracture?
- “Reverse Colles”
- Volar angulation of distal radius fracture
What presents as a “garden spade” deformity?
Smith fracture
Clinical presentation of Smith fracture
Garden spade deformity
Etiology of Smith fracture
Fall on flexed hand, usually backwards
Method of Smith fracture
Same as Colles but pressure volar to dorsal
Key to diagnose Smith fracture?
Lateral wrist x-ray
Which joint is MC dislocated in finger?
PIP
Methods of finger reduction
- Digital block
- Traction
- Hyperextension if dorsal
- Hyper flexion if volar
FU care of finger reduction
Aluminum splint 1-2 wks
MC type of hip dislocation
Posterior 80-90%
Anterior 10%
Methods of hip reduction
- Allis
- Stimson
- Captain Morgan
- Whistler
Potential complications of hip dislocation
- Avascular necrosis
- Sciatic nerve injury
MC type of knee dislocation?
Posterior
FU care of knee reduction
- Knee immobilizer
- Post-reduction arteriography to r/o popliteal injury
Etiology of patella dislocation
Twisting injury while knee extended (males MC)
Method of patella reduction
- Usually quick, no sedation needed
- Extend leg while applying valgus force
FU care of patella reduction
- Immobilizer, crutches
- Ortho referral
- Quads strengthening exercises
MC source of generalized trauma evaluation in the ED?
MVAs
Goals of trauma management?
- Rapidly identify life threatening injuries
- Initiate adequate supportive therapy
- Efficiently organize either definitive therapy OR transfer to a facility that provides definitive therapy
Primary trauma survey?
Airway w/C-spine control Breathing Circulation Disability (neuro) Exposure and Environmental control
What is a good sign that the airway is intact?
Effective verbal communication
What signs usually indicate airway involvement in trauma situations?
Stridor or dysphonia
When should a pt be intubated?
GCS 8 or lower
What should be placed after intubation?
NG tube
How to recognize shock?
- AMS
- Cyanosis or ashen gray
- Thready pulse, hypotension
Describe exposure and environmental control in trauma situation
- Expose everything for thorough evaluation (blood from urethral meatus? back?)
- After, COVER pt to maintain warm environment
- Warm IV fluids if indicated
What is the secondary survey?
Assessment for life threatening injuries
What are the NEXUS criteria?
National Emergency X-ray Utilization Study (criteria to determine if C spine imaging is needed)
When is cervical spine imaging necessary?
NEXUS (If any of the following present:)
- Midline C spine tenderness to palpation
- Altered LOC
- Focal neuro deficits
- Intoxication
- Painful, distracting injury(s)
Seashore sign is:
NORMAL (pleural sliding, negative PTX)
Barcode sign is:
ABNORMAL (positive PTX)
How do GSWs injure the body?
- Penetration crushes and destroys tissue in its path creating a permanent cavity
- Imparts a shock wave that radiates outward from this path
Which GSW wound is usually bigger?
Exit wound is usually bigger than entry
GSWs to the head need:
Intubation and CT scan
Unstable GSW pt w/possible thoracic/abd involvement needs:
Emergent exploratory laparotomy (once potential lung injury is addressed)
