Musculoskeletal in the ER Flashcards
Most common Musculoskeletal symptom in the ER
Pain
Most common joints seen in order
AWKHSE
Most common ankle injury
Lateral INVERSION
Treatment of ankle sprain
PRICE…protection, rest, ice, compression, elevation
The vast majority of ankle fractures are what type?
Malleolar
Complications of ankle fractures
joint space disruptions, dsilocation, soft tissue necrosis, nerve damage, arterial damage
Dislocation pressuring skin needs what?
REDUCTION ASAP. (reduction= putting it back in place) to avoid necrosis of the overlying skin.
Loss of arterial blood supply is what
SURGICAL EMERGENCY
Most common type of wrist injury
fracture of radius, or ulna, or carpal bones, due to fall on outstretched hands
Most common fracture of the wrist=
Colles fracture at the distal radial metaphysis
Usually a proximal and dorsal displacement, creating a “dinner fork deformity”
70% of ppl with an ACL tear report what
Hearing an audible pop at the time of injury. Very good clue.
Most ligamentous injuries of the knee present with>
hemarthoses (blood in the joint)
75% of hemarthroses are caused by?
Disruption of the ACL
Hip fractures are twice as common in women and one-third more common in whites
yes
90% of hip fractures in the elderly are associated with simple fall from standing position. What is the reason of the fall in most cases?
Femoral neck breaks
What is teh sign that a hip fracture is displaced?
The leg is shortened and rotated externally
What is the most severe risk for hip fracture
DVT in the leg
Only 1% of pts with back pain have sciatica, but 95% of ppl with back pain due to disk herniation have sciatica
true
Cauda equina syndrome is
compression of the cauda equina causing some low back pain, leg weakness, bladder dysfunction, saddle anesthesia, fecal incontinence, sexual dysfunction
Incomplete cauda equina syndrome is
altered urinary sensation, loss of desire to void, poor urinary stream. must strain to micturate
Complete cauda equina syndrome
painles urinary retention, overflow incontinence, inability to pass urine
Signs of cauda equina syndrome
bladder distension, decreased anal tone, absent ankle, knee reflex, saddle anethsia, BILATERAL Sciatica
All pts with Cauda Equina syndrome have
500 ml urinary retention
Opioid pain relievers account for more overdose deaths than heroin and cocaine combined
truth
NEcrotizing fascitis usually spreads how?
along muscle fascia due to relatively poor blood supply
What is the definition of necrotizing facitis?
rare, acute, progressive destruction of muscle fascia and overlying subcutaneous fat
Histologic manifestations of necrotizing fasciitis?
coagulative necrosis+ acute inflammation + nuclear dust+ hemorrhage
Skin color changes from red to purple to?
blue grey
Most common site of necrotizing fasciitis
legs
After the legs, the next most common site of necrotizing fasciitis is?
Perineum
Subcutaneous gas is characteristic of what type of necrotizing fasciitis?
Type 1 (aerobes+ anaerobes= polymicrobial)
Compartment syndrome
Occurs when increased pressure within a compartment compromises the circulation within that space.
Compartment syndrome often follows?
Trauma. Long bone fractures in the leg or forearm
Symptoms of compartment syndrome
Pain out of proportion to injury, deep ache or burning, parasthesias
Signs of compartment syndrome?
Pain with passive stretch of muscles in the affected compartment.
Tense compartment with a firm wood-like feeling
Diminished sensation
Muscle Weakness
Normal compartment pressure is
0-8 mmHg
Pain in a compartment develops when pressure hits
20-30 mmHg
Capillary blood flow through that compartent becomes compromised when?
tissue pressure increases to within 25 mmHg of mean arterial pressure
A perfusion pressure of less than 30mmHg =
do something
What is clostridial myonecrosis
Gas gangrene
Clostridial myonecrosis is:
a life threatening muscle infection from a contiguous area of trauma or hematogenous muscle seeding from GI tract
2 major forms of clostridial myonecrosis are?
traumatic and spontaneous
Traumatic clostridial myonecrosis is most commonly caused by
C. Perfringens
Spontaneous clostridial myonecrosis most commonly caused by
C. Septicum
C. Perfringens virulence factors
Alpha Hemolytic toxin: causes platelett aggregation and also is a negative ionotrope (inhibits cardiac pumping). The alpha toxin causes rapid decline in muscle blood flow and ischemic necrosis due to the formation of occlusive intravascular masses of activated pateletts
ALSO, the alpha toxin is the reason neutrophils can’t get into the infected tissue, Alpha toxin makes them bind to the endothelium.
Theta toxin:
What is rhabdomyolysis
A condition of muscle necrosis and release of intracellular muscle constituents into the circulation.
Classic rhabdo triad?
muscle pain, weakness, dark urine
Symptoms of rhabdo outside of the triad
- pain is typically in shoulders and thighs, lower back and calves
- Reddish brown urine in half of cases
- Remember that many cases are asymptomatic
- muscle swelling with rehydration
- muscle tenderness may be present
- muscle weakness can occurr
- many patients have no signs of rhabdo
Top 3 causes of rhabdo
trauma
Exertion
Miscellaneous- toxins, infections, meds
The hallmark lab finding of Rhabdo is
elevation in serum muscle enzymes, particularly creatine kinase which is usually five times the upper limit of normal
Myoglobinuria presents in 50-75 % of cases
It is positive for blood on urine dipstick but without red blood cells on microscopic urine exam
What can myoglobin do to the kidneys?
Can clog the renal tubules leading to acute renal failure
Treatment for compartment syndrome
Fasciotomy
