MSK trauma Flashcards
Blood loss in
Pelvic #
Femoral #
Tibial #
Pelvis and Femoral up to 2l
Tibial shaft up to 1.5l
how to stabilise fracture
Open fracture - clean, apply moist sterile dressing and place in splint. IV Abx + IVI
Neurovascular examination before and after splint
Do not apply traction splint on ipsilateral femur and tibial #
Life threatening injuries of extremities
- Pelvic or Femoral #
- Fat embolism from open fractures
- Crush injury - acute renal failure from myoglobin release
- Compartment syndrome
Major Arterial Haemorrhage approach
- Manual pressure on injury
- Pressure dressing
- Manual pressure on arterial proximal to injury
- Tourniquet
- If fracture - apply pressure, another realign and splint fracture
- Reduce joint dislocation
- Arteriography if stable, + Surgical consult/Transfer to surgeons
MSK examination
Neurovascular
Skin
Skeletal and ligament
- Palpate pulses - dopper if hypotensive and thus can’t find
- CRT
- Ankle/brachial pressure index
- Joint instability
- Skin integrity, tenderness
What abx to treat open fractures
First gen cephalosporins in ALL open #
Target time for revascularisation of arterial injury
6h
Signs of vascular compromise or neurological deficit after splint/cast/dressing
Remove and release
Reexamine
Signs of compartment syndrome
Pain disproportionate to stimuli (early sign)
Tense swelling
Pain on passive stretch of muscle
Parasthesia (late)
Pulseless (late)
Paralysis (late)
More likely in glutes, thigh, calves, forearms, hand and feet
Crushing and degloving injury complications
Crushing injury can have devascularisation and muscle necrosis, soft tissue avulsion from deep fascia leaves room for haematoma, skin may necrose over few days.
Crushing and degloving injury management
MOI, Palpate extremity, drainage and debridement, tetanus immunisation
Missed injury associated with femoral fracture
Femoral neck fracture
Ligamentous knee injury
Posterior hip dislocation
Image joint above and below!
Missed injury associated with elbow fracture/dislocation
knee dislocation
Brachial artery injury
Median, ulnar, radial nerve injury
Popliteal artery and nerve injury
Missed injury associated with clavicular/scapular/shoulder # or dislocation
Major thoracic injury - pulmonary contusion, rib #
Scapulothoracic dissociation
