MSK - Trauma Flashcards
What are the four most common locations for haemorrhage in an A&E patient assessment?
- Chest
- Abdomen
- Pelvis
- Fractured long bones
What 3 imaging scans are common as part of an ATLS assessment?
- CXR
- PXR
- FAST scan - check for internal bleeding
What is a pathological fracture?
A fracture through an abnormal bone
- e.g. a fracture through the bone of a patient with: osteoporosis; primary or secondary tumours; infection; medications
PCA (Patient controlled analgesia) is the practice of patient’s self administering small IV bolus doses of IV opiods. This is most effective when the button is pressed at the onset of symptoms and not at peak pain (as less drug is required and blood levels of opiod remain below threshold for adverse effects).
Which opiods are most commonly used for PCA?
- Morphine
- Pethidine
- Fentanyl (may be preferred in pts with renal failure as it is a shorter acting opiod and thus accumulation in pts system is less likely - pt will press button less frequently)
Which of the following are true about morphine?
- It is subject to extensive first-pass metabolism
- Its primary actions of therapeutic value are analgesia and sedation
- It works predominantly through its action on Kappa-receptors
- Is more potent than buprenorphine
- Is broken down in the liver through conjugation with glucuronic acid
1, 2 and 5
- It is subject to extensive first-pass metabolism
- Its primary actions of therapeutic value are analgesia and sedation
- Is broken down in the liver through conjugation with glucuronic acid
Post reduction and stabilisation of tibial fracture, the pts limb is tense with mottling of toes and severe pain on passive stretch.
What could be the cause?
Compartment Syndrome
- Pain that isn’t responding to analgesia should make you think compartment syndrome
Describe Compartment Syndrome
Compartment Syndrome is when the pressure within a fascial compartment exceeds the perfusion pressure of the vascular system within the compartment, causing ischaemia of the tissues within the compartment.
What are the 2 main fractures associated with compartment syndrome?
- Supracondylar fracture
- Tibial shaft fracture
What steps do you take when you suspect a patient has compartment syndrome?
- History
- Examine the neurovascular status of the limb for signs of compartment syndrome
- Review analgesia
- Release any dressings/casts which may be causing external compression
- Position limb at level of the heart
- If patient doesn’t respond to analgesia –> contact senior as emergency fasciotomy may be needed
What time period defines ‘delayed union’ i.e. failure of a fracture to reach bony union?
Failure at 6 months post injury = delayed union
What protocol / steps might you following when
describing a fracture on x-ray?
- Site of fracture (which bone and which part of the bone)
- Type of fracture (Transverse, oblique, spiral)
- Simple or comminuted
- Displaced or not
- Angulated or not
- Is the bone of normal consistency or not (e.g. osteoporosis causing pathological fracture)
Describe this X-ray
This is an AP of the right humerus. There is a simple transverse fracture of the midshaft of the right humerus, which is displaced medially and angulated by 40 degrees medially. There are no signs of pathological fracture.
Describe this X-ray
This is an AP and lateral x-ray of the left tibia and fibula. There is a comminuted spiral fracture of the midshaft of the tibia and fibula. It is completely displaced laterally and anteriorly with no angulation. There are no signs of a pathological fracture.
Describe this X-ray
This is a transverse fracture of the midshaft of the left collar bone. It is displaced but not angulated and has occurred through normal bone.
What do the following descriptions of nerve injuries mean?
- Neuropraxia
- Axonotmesis
- Neurotmesis
- Neuropraxia = reversible conduction block due to mild injury to nerve (compression / ischaemia)
- Axonotmesis = disruption to the myelin sheath and the axon but endoneurium still intact
- Neurotmesis = complete nerve division and disruption of the endoneurium
The common peroneal nerve splits into superficial and deep branches - what does each supply?
- Superficial = motor for lateral compartment of lower leg
- Deep = motor for anterior compartment of lower leg
Common peroneal also = sensation over lateral lower leg + dorsum of foot (majority)
What are the WHO (1992) definitions of osteopenia and osteoporosis?
- Osteopenia = Bone mineral density that lies 1 standard deviation or more below the average value for a young healthy person of the same race and sex as the patient
- Osteoporosis = Bone mineral density that lies 2.5 standard deviation or more below the average value for a young healthy person of the same race and sex as the patient
What is the most accurate clinical sign of Compartment Syndrome?
Pain in suspected region is exacerbated by passive stretch
Which area of the body and which compartment are most likely to be affected by compartment syndrome?
Anterior compartment of the lower leg
If a diagnosis of compartment syndrome is made in the lower leg, what is the first course of action?
Immediate fasciotomy of all 4 compartments of the lower leg
- Anterior
- Lateral
- Deep posterior
- Superficial posterior