MSK, MVA, Trauma Flashcards

1
Q

Define dislocation

A

Injury or disability caused when normal position of a joint or other part of the body is disturbed

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2
Q

What do most dislocations require prior to realigning?

A

Some degree of anesthesia/analgesia

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3
Q

Options for analgesia/anesthesia prior to reducing a dislocation

A
  • Local anesthetic
  • Nerve block
  • Parenteral analgesics
  • Conscious sedation
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4
Q

What makes a joint more difficult to relocate and why?

A

The longer a joint has been dislocated, more difficult to relocate due to muscle spasm

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5
Q

What should always be performed post-reduction of a dislocation?

A

X-ray and neurovascular check

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6
Q

MC dislocations of the mandible

A

Anterior and bilateral

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7
Q

Etiologies of mandible dislocation

A
  • Trauma
  • Yawning
  • Hypermobility syndrome
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8
Q

Imaging for mandible dislocation

A

Panorex or mandible

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9
Q

Method of mandible reduction

A
  • Conscious sedation for most
  • Wrap thumbs with gauze
  • Intraoral pressure down and back
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10
Q

FU care for mandible reduction

A
  • Soft diet for 2 wks

- Oral surgery if nerve deficit present

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11
Q

How is a shoulder MC dislocated?

A

98% of time - humeral head displaced anterior to glenoid and inferior to coracoid

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12
Q

How does a shoulder dislocation MC present?

A

“Squared off” shoulder

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13
Q

Imaging finding of dislocated shoulder

A

Look for ball on tee

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14
Q

FU care of shoulder relocation

A

Immobilizer for 1-4 wks then PT

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15
Q

Methods of shoulder relocation

A
  • Traction-countertraction
  • Stimson
  • Milch
  • Kocher
  • Scapular manipulation
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16
Q

MC type of elbow dislocation?

A

Posterior

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17
Q

What are elbow dislocations frequently associated with?

A

Fractures

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18
Q

Etiology of elbow dislocation

A

FOOSH

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19
Q

Methods of elbow relocation

A
  • Sedation necessary

- Distal traction or interlocking hands

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20
Q

FU care of elbow relocation

A
  • Splint in 90 degrees, sling

- ROM in 1-2 wks

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21
Q

What is a nursemaid’s elbow?

A
  • Radial head subluxation

- Annular ligament displaces into radiocapitellar articulation

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22
Q

Who is MC affected by nursemaid’s elbow?

A

Girls, 6 mo-3 yo

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23
Q

Methods of nursemaid’s elbow relocation

A
  • Hyperpronation w/elbow at 90 degrees

- Supination then flexion (less successful)

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24
Q

FU care of nursemaid’s elbow relocation

A
  • Full use should return quickly

- Avoid pulling/twisting mechanisms

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25
Q

What is a Colles fracture?

A

Distal radius metaphysis fracture w/dorsal angulation

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26
Q

What presents as a “dinner fork” appearance?

A

Colles fracture

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27
Q

Colles fracture clinical presentation

A

“Dinner fork” appearance

28
Q

Methods of Colles fracture reduction

A
  • Hematoma block and/or sedation
  • Inline traction, push distal radius volarly
  • Reduction indicated if over 20 degrees angulated
29
Q

FU care of Colles fracture

A
  • Volar splint, sling

- Ortho FU

30
Q

What is a “reverse Colles”?

A

Smith fracture - volar angulation of distal radius fracture

31
Q

What is a Smith fracture?

A
  • “Reverse Colles”

- Volar angulation of distal radius fracture

32
Q

What presents as a “garden spade” deformity?

A

Smith fracture

33
Q

Clinical presentation of Smith fracture

A

Garden spade deformity

34
Q

Etiology of Smith fracture

A

Fall on flexed hand, usually backwards

35
Q

Method of Smith fracture

A

Same as Colles but pressure volar to dorsal

36
Q

Key to diagnose Smith fracture?

A

Lateral wrist x-ray

37
Q

Which joint is MC dislocated in finger?

A

PIP

38
Q

Methods of finger reduction

A
  • Digital block
  • Traction
  • Hyperextension if dorsal
  • Hyper flexion if volar
39
Q

FU care of finger reduction

A

Aluminum splint 1-2 wks

40
Q

MC type of hip dislocation

A

Posterior 80-90%

Anterior 10%

41
Q

Methods of hip reduction

A
  • Allis
  • Stimson
  • Captain Morgan
  • Whistler
42
Q

Potential complications of hip dislocation

A
  • Avascular necrosis

- Sciatic nerve injury

43
Q

MC type of knee dislocation?

A

Posterior

44
Q

FU care of knee reduction

A
  • Knee immobilizer

- Post-reduction arteriography to r/o popliteal injury

45
Q

Etiology of patella dislocation

A

Twisting injury while knee extended (males MC)

46
Q

Method of patella reduction

A
  • Usually quick, no sedation needed

- Extend leg while applying valgus force

47
Q

FU care of patella reduction

A
  • Immobilizer, crutches
  • Ortho referral
  • Quads strengthening exercises
48
Q

MC source of generalized trauma evaluation in the ED?

A

MVAs

49
Q

Goals of trauma management?

A
  1. Rapidly identify life threatening injuries
  2. Initiate adequate supportive therapy
  3. Efficiently organize either definitive therapy OR transfer to a facility that provides definitive therapy
50
Q

Primary trauma survey?

A
Airway w/C-spine control
Breathing
Circulation 
Disability (neuro)
Exposure and Environmental control
51
Q

What is a good sign that the airway is intact?

A

Effective verbal communication

52
Q

What signs usually indicate airway involvement in trauma situations?

A

Stridor or dysphonia

53
Q

When should a pt be intubated?

A

GCS 8 or lower

54
Q

What should be placed after intubation?

A

NG tube

55
Q

How to recognize shock?

A
  • AMS
  • Cyanosis or ashen gray
  • Thready pulse, hypotension
56
Q

Describe exposure and environmental control in trauma situation

A
  • Expose everything for thorough evaluation (blood from urethral meatus? back?)
  • After, COVER pt to maintain warm environment
  • Warm IV fluids if indicated
57
Q

What is the secondary survey?

A

Assessment for life threatening injuries

58
Q

What are the NEXUS criteria?

A

National Emergency X-ray Utilization Study (criteria to determine if C spine imaging is needed)

59
Q

When is cervical spine imaging necessary?

A

NEXUS (If any of the following present:)

  • Midline C spine tenderness to palpation
  • Altered LOC
  • Focal neuro deficits
  • Intoxication
  • Painful, distracting injury(s)
60
Q

Seashore sign is:

A

NORMAL (pleural sliding, negative PTX)

61
Q

Barcode sign is:

A

ABNORMAL (positive PTX)

62
Q

How do GSWs injure the body?

A
  1. Penetration crushes and destroys tissue in its path creating a permanent cavity
  2. Imparts a shock wave that radiates outward from this path
63
Q

Which GSW wound is usually bigger?

A

Exit wound is usually bigger than entry

64
Q

GSWs to the head need:

A

Intubation and CT scan

65
Q

Unstable GSW pt w/possible thoracic/abd involvement needs:

A

Emergent exploratory laparotomy (once potential lung injury is addressed)