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Trauma Course > Musculoskeletal Trauma > Flashcards

Musculoskeletal Trauma Flashcards

1
Q

Do injuries to the musculoskeletal system present in blunt trauma or penetrating trauma?

A

Blunt trauma

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2
Q

What are you assessing when assessing the limb that has a musculoskeletal trauma?

A

Colour and perfusion
Wound
Deformity
Swelling
Discolouration
Bruising

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3
Q

What does swelling over the region of a major muscle group suggest?

A

Crush injury with impending compartment syndrome

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4
Q

What does a pale or white distal extremity suggest?

A

A lack of arterial inflow

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5
Q

What does swelling or ecchymosis in or around a joint and/or over the subcutaneous surface of a bone suggest?

A

Musculoskeletal injury

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6
Q

What do wound over a bony prominence suggest?

A

Open fracture

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7
Q

Why is palpation of the extremity important when assessing limbs?

A

It helps determine sensation and to identify areas of tenderness

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8
Q

What does a loss of sensation to touch or pain to a limb indicate?

A

A spinal or peripheral nerve injury

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9
Q

What does pain, swelling and deformity over a boney prominence indicate?

A

A possible underlying fracture

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10
Q

What is indicative of a ligamentous rupture?

A

Abnormal motion of the joint

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11
Q

What is extremely important following musculoskeletal trauma?

A

Palpation of distal pulses and assessment of capillary refil

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12
Q

What can be used if hypotension limits the assessment of distal pulses?

A

A Doppler

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13
Q

What might penetrating extremity trauma result in?

A

Arterial vascular injury

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14
Q

Apart from penetrating extremity injury, what else could disrupt arterial blood flow?

A

Blunt trauma resulting in an extremity fracture or joint dislocation in close proximity to arterial vasculature

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15
Q

What is the best way to manage a haemorrhage to a limb?

A

Direct pressure and the use of a tourniquet

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16
Q

If a fracture is associated with arterial bleeding, what is advisable?

A

Realignment of the boney structure with concurrent application of pressure - where possible joint dislocation should be relocated

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17
Q

What does crush syndrome refer to?

A

The clinical sequela of injured muscle

18
Q

What happens if crush injuries are left untreated?

A

Lead to acute renal failure

19
Q

What is the muscular injury seen in crush injury a combination of?

A

Direct muscle injury, muscle ischaemia and cell death

20
Q

What is muscular trauma often associated with?

A

Rhabdomyolysis - which can range from an asymptomatic illness with elevated creatinine kinase to life threatening associated with acute renal failure and disseminated intravascular coagulation (DIC)

21
Q

What is the initial management and goal for crush syndrome?

A

Aggressive fluid resuscitation in order to protect the kidneys and avoid acute renal failure

22
Q

What helps to prevent myoglobin-induced renal failure?

A

Intravascular expansion and osmotic diuresis to maintain a high tubular volume and urine flow

23
Q

Why do open fractures require timely multidisciplinary management?

A

The consequence of infection following open fractures can be significant and lead to life long disability

24
Q

What are the BOAST-4 guidelines?

A

Guidelines that focus specifically on the management of open fractures

25
Q

Where should patients be taken if they have an open fracture to the long bones, hind or mid foot?

A

Taken directly or transferred to a specialist centre that has the ability to provide orthoplastic care

26
Q

When should antibiotics be given for an open fracture?

A

Within 1 hour of injury

27
Q

For an open fracture that should the documentation of the examined limb contain?

A

Assessment of neurological and vascular status

28
Q

Should an open fracture limb be realigned and splinted?

A

Yes

29
Q

Prior to formal debridement of an open fracture, how should the wound be handled?

A

Only to remove gross contamination and allow for photographs to be taken. The wound should be dressed in saline soaked gauze and occlusive dressing

30
Q

When should debridement be undertaken using fasciotomy tones for wound extension?

A
  • immediately for heavily contaminated wounds (agricultural, aquatic or sewage) or associated vascular compromise
  • within 12 hours of injury for other solitary high energy open fractures
  • within 24 hours for all other low energy open fractures
31
Q

What is acute compartment syndrome of a limb caused by?

A

Raises pressure within a closed fascial compartment causing local tissue ischemia and hypoxia

32
Q

In clinical practice when is acute compartment syndrome of a limb commonly seen?

A

After tibial and forearm fractures
High energy wrist fractures
Crush injuries
Restrictive dressings or casts
Prolonged immobilisation
Reperfusion of ischemic limb

33
Q

What should be part of routine evaluation of patients presenting with significant limb injuries?

A

Assessment for compartment syndrome

34
Q

What should you be documenting for a patient with suspected compartment syndrome?

A

Time and mechanism of injury
Time of evaluations
Level of pain
Level of consciousness
Response to analgesia
Whether regional anaesthesia has been given

35
Q

What are the clinical key finding for a patient with compartment syndrome?

A

Pain out of proportion to the associated injury
Pain on passive movement of the muscle of the involved compartments

36
Q

What should patients who are at risk of compartment syndrome have?

A

Hourly documented nursing assessment of the injured limb

37
Q

Patient with symptoms or clinical signs of compartment syndrome and are wearing a dressing should have what done to them?

A

All circumferential dressing to the skin releases and the limb elevated to heart level

38
Q

What should all hospital that treat patients with significant limb injuries have?

A

The ability to measure inter compartmental pressures

39
Q

Is compartment syndrome a surgical emergency?

A

Yes, surgery should occur within 1 hour of the decision to operate

40
Q

For patient shaving compartment pressures measured, what else should be monitors and what would be the sign that the patient has an increased risk of compartment syndrome?

A

Diastolic blood pressure should be monitored. A difference between the diastolic pressure and the compartment pressure of 30mmHg suggests risk of compartment syndrome

41
Q

If absolute compartment pressure is greater than 40 mmHg and the patient has clinical symptoms of compartment syndrome, what should be done?

A

Urgent decompression should be considered - immediate open fascial decompression of all involved compartments

Trauma Course (17 decks)

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