MSK trauma Flashcards
Control of arterial bleed
Move down this ladder:
- Apply direct pressure to the vessel
- Apply pressure dressing using a stack of gauze
- Apply manual pressure to the proximal vessel
- Consider tourniquet
Tourniquet application technique
Tighten enough to stop bleeding: needs to stop arterial pressure as occluding only venous can cause haemorrhage and result in swollen, cyanotic extremity
Pressures up to what level may required to stop bleeding in upper and lower limbs
Upper limb could be as high as 250mmHg
Lower limb could be as high as 400mmHg
Timing of tourniquet
if time to operative management is longer than 1 hr, a single attempt at deflating the tourniquet may be considered to reduce ischaemic time
Indication for arteriography in a bleeding patient
Only if resuscitated and stable haemodynamically
Use of vascular clamps in control of bleeding
Not advised unless it is a clear superficial vessel
Treatment of an open fracture associated with haemorrhaging wound
One person to apply pressure to wound whilst you reduce it under traction
Candidates for replantation
Patients with isolated upper limb extremity in traumatic amputations
How to transport a traumatically amputated extremity
Wash with hartmans
Wrap in moist sterile gauze
Wrap in moist towel
place in plastic bag in insulated cooling box, with crushed ice
Ix for rhabodmyolysis
Myoglobin in urine
Raised CK
Role of splinting in control of haemorrhage
Helps as keeps structures stable, allowing haematoma formation which would stop bleeding
Anterior shoulder dislocation appearance
Squared off shoulder
Posterior shoulder dislocation
Locked in internal rotation
Posterior elbow dislocation appearance
Olecranon prominent posteriorly
Anterior hip dislocation appearance
Extended
Abducted
Externally rotated
Posterior hip dislocation appearance
Flexed
Adducted
Internally rotated
Anteroposterior knee dislocation
Loss of normal contour
Extended
Subtalar dislocation appearance
laterally displaced calcaneus
Lateral ankle dislocation appearance
Externally rotated prominent medial maelleolus
In what scenario would you not get an x-ray before treating a dislocation
vascular compromise
or
impending skin breakage
Management of open wounds
Remove gross contamination
Cover with a moist sterile dressing
Apply immobilisation
Abx + tetanus
Management of a dislocated joint in presence of an associated arterial injury
Gentle attempts at reducing may be done
Otherwise must splint the dislocation and obtain emergency consultation
Compartment syndrome definition
Increased pressure within musculofascial compartments causes ischaemia
Compartment syndrome latest sign
Absence of palpable pulse
What intracompartmental pressure could be harmful
Tissue pressure of greater than 30 mmHg suggests reduced capillary blood flow
Treatment of compartment syndrome
fasciotomy
Treatment of lacerations
Debridement and closure
If extends below fascial level, may require operative intervention
Management of contusions
If seen early:
limit function
apply cold packs
Morel-Lavallee lesion injury mechanism
Soft-tissue avulsion, shearing the skin from the deep fascia, allowing for significant accumulation of blood in the resulting cavity
Risk factors for tetanus
Wounds >6hrs old
Contused or abraded
>1cm deep
Burns/cold
contaminated
Denervated or ischaemic
Site of injury to ulnar nerve
Elbow
Site of injury to median nerve
Wrist fracture
Site of injury to anterior interosseous nerve
Supracondylar fracture of humerus (children)
Site of injury to the musculocutaneous nerve
Anterior shoulder dislocation
Site of injury to radial nerve
Distal humeral shaft
Anterior shoulder dislocation
Site of injury to axillary nerve
Anterior shoulder dislocation
Proximal humerus fracture
Site of injury to femoral nerve
Pubic ramus fracture
Site of injury to obturator nerve
Obturator ring fracture
Site of injury to posterior tibial nerve
Knee dislocation
Site of injury to suprficial peroneal nerve
Fibular neck fracture
Knee dislocation
Site of injury to deep peroneal nerve
Fibular neck fracture
Compartment syndrome
Site of injury to sciatic nerve
Posterior hip dislocation
Site of injury to superior gluteal nerve
acetabular fracture
Site of injury to inferior gluteal nerve
acetabular fracture
