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ATLS > Musculoskeletal trauma > Flashcards

Musculoskeletal trauma Flashcards

1
Q

Order of steps in aim of extremity bleeding control

A

Pressure to wound
Pressure dressing
Compression of artery proximal to injury
Tourniquet

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2
Q

Potentially life threatening extremity injuries

A

Major arterial haemorrhage
Bilateral femur fractures
Crush syndrome
Pelvic disruption

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3
Q

Management of life threatening extremity injuries

A

Traction splint fractures
Fluid resuscitation
Direct pressure to open wounds
Reduce joint dislocations when possible

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4
Q

Aim of splinting fractured extremities

A

Prevent bone movement which:
- Decreases blood loss
- Decreases pain
- Helps preserve distal perfusion

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5
Q

Management of open fractures

A

Reduce the fracture
(pull bone ends back into wound if needed)

Clean wound

Sterile saline soaked pressure dressing over wound

Abx

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6
Q

Indication for tourniquet

A

Traumatic amputations - high risk with major arterial haemorrhage

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7
Q

Sign of interrupted arterial blood supply

A

Cold, pale pulseless extremity

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8
Q

Sign of significant vascular injury

A

Rapidly expanding haematoma

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9
Q

Indication for arteriography and other diagnostic tools

A

Patients with no haemodynamic compromise only

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10
Q

Indication for urgent surgery for extremity injuries

A

Clear vascular injuries

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11
Q

When to consider trial of deflating tourniquet

A

If time to surgery is > 1 hour

One attempt only - life over limb

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12
Q

Another name for crush syndrome

A

Traumatic rhabdomyolysis

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13
Q

Crush syndrome

A

Direct muscle injury
Muscle ischaemia
Cell death and release of myoglobin
Acute renal failure and death

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14
Q

When is crush syndrome and highest risk

A

Compression injury to significant muscle mass

Eg thigh or calf

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15
Q

Assessment if suspected crush syndrome

A

Myoglobin assay

OR

Amber coloured urine with Creatinine Kinase > 10,000

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16
Q

Management of crush syndrome

A

Aggressive fluid therapy
Intravascular fluid expansion

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17
Q

When to check neurovascular status of a limb

A

Before and after manipulation / splint

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18
Q

Management of joint dislocations

A

Reduce and immobilise in anatomical position

If unable to reduce, splint in position it was found to control bleeding and pain

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19
Q

Deformities seen with anterior shoulder dislocation

A

Squared off

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20
Q

Deformities seen with posterior shoulder dislocation

A

Locked in internal rotation

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21
Q

Deformities seen with posterior elbow dislocation

A

Olecranon prominent posteriorly

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22
Q

Deformities seen with anterior hip dislocation

A

Extended, abducted and externally rotated

23
Q

Deformities seen with posterior hip dislocation

A

Flexed, adducted and internally rotated

24
Q

Deformities seen with anteroposterior knee dislocation

A

Loss of normal contour
Extended

May spontaneously reduce prior to evaluation

25
Q

Deformities seen with lateral ankle dislocation

A

Externally rotated
Prominent medial malleolus

Lateral dislocation most common

26
Q

Deformities seen with lateral subtalar joint dislocation

A

Laterally displaced os calcis (calcaneous)

Lateral dislocation most common

27
Q

Deformities seen with lateral subtalar joint dislocation

A

Laterally displaced os calcis (calcaneus)

Lateral dislocation most common

28
Q

When to treat an injury to the extremity prior to X ray

A

Presence of vascular compromise
Impending skin breakdown

29
Q

Open fracture definition

A

Open wound on same limb segment as associated fracture

30
Q

Open joint injury definition

A

Open wound over / near joint
Confirm with CT or saline / dye injection

Needs Orthopaedic consult

31
Q

Antibiotics used for open fractures

A

First generation cephalosporins IV (Eg cefazolin)
Clindamycin if anaphylactic penicillin allergy

Weight based dosing

32
Q

Management of vascular injury to extremity

A

Operative revascularisation
Within 6 hours

33
Q

Compartment syndrome definition

A

Increased pressure within musculofascial compartment
Results in ischaemia and necrosis

34
Q

Causes of compartment syndrome

A

Increase in compartment contents - Eg bleeding

Decrease in compartment size - Eg restrictive dressing

35
Q

Common areas of compartment syndrome occurrence

A

Lower leg
Forearm

36
Q

Signs of compartment syndrome

A

Disproportionate pain

Pain in passive stretch of affected muscle

Tense compartment swelling

Paraesthesia / altered sensation distal to affected compartment

37
Q

Management of compartment syndrome

A

Release all restrictive dressings / casts / splints

Fasciotomy

38
Q

Method for splint application

A

Inline traction

Immobilise joint above and below the fracture

Assess neurovascular status before and after

39
Q

Management of lacerations

A

Debride and close

Consider tetanus immunisation

40
Q

Management of contusions to extremities

A

Limit extremity function
Cold packs

41
Q

Management of crushing or degloving injuries

A

Suspect based on mechanism if injury
Palpate component involved
Consider surgical consult for drainage / debridement

42
Q

When to splint fractures when transferring patients

A

Prior to transfer

43
Q

Immobilisation guidelines for femoral fractures

A

Traction splint

Do NOT apply traction when have ipsilateral tibial shaft fractures as can cause neurovascular damage

44
Q

Immobilisation guidelines for femoral fractures + tibial shaft fractures

A

Use long leg posterior splint for the lower leg

45
Q

Immobilisation guidelines for knee injuries

A

Immobilise knee with 10 degree flexion

Commercial knee immobiliser

OR

Posterior long leg plaster splint

46
Q

Immobilisation guidelines for tibial fractures

A

Plaster splints

47
Q

Immobilisation guidelines for ankle fractures

A

Well padded plaster splint

48
Q

Immobilisation guidelines for forearm / wrist fractures

A

Padded or pillow splint

Splint wrist and fingers in functional position where possible

49
Q

Immobilisation guidelines for elbow injuries

A

Partially flexed position

Padded splints

50
Q

Immobilisation guidelines for upper arm injuries

A

Sling and swath device
+/- thoracobrachial bandage

51
Q

Immobilisation guidelines for shoulder injuries

A

Sling and swathe device

52
Q

Immobilisation guidelines for hand injuries

A

Short arm splint

53
Q

Hand position for immobilisation of hand injuries

A

Slight dorsiflexion
Fingers flexed 45 degrees at metacarpophalangeal joints

54
Q

Injuries associated with calcaneus fractures

A

Spinal injuries / fractures

ATLS (14 decks)

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