Musculosketetal

Question 1

Open fractures req what immunization

Answer 1

Tetanus
Know guidelines

Question 2

Open fracture
Wound < 1cm
Minimal contamination or soft tissue

OR

Open fracture
Wound 1-10cm
Moderate soft tissue damage
Comminution of fracture

Answer 2

First gen ceph
Gram + cov

*CEFAZOLIN

If anaphx to PCN —> give Clindamycin

Question 3

Open fracture
Severe soft tissue damage & substantial contamination w/ assoc vascular injury

Answer 3

First gen ceph
Gram + cov

*CEFAZOLIN

If anaphx to PCN —> give Clindamycin

AND aminoglycocide (gram - cov)

*GENTAMICIN

Question 4

Open fracture
Farmyard, soil, or standing water irrespective of wound size or severity

Answer 4

Broad spectrum gram + & - cov

*PIPERACILLIN/TAZOBACTAM

*if anaphylactic PCN allergy, consult ID or pharmacy

Question 5

Weight base dosing of Cefazolin for tx of open fracture

Answer 5

< 50 kg : 1gm q 8
50-100 kg : 2 gm q 8
>100 kg : 3 gm q 8

Question 6

CLINDAMYCIN Weight base dosing for tx of open fx

Answer 6

< 80 kg : 600 mg q 8
> 80 kg : 900 mg q 8

Question 7

GENTAMICIN Weight base dosing for tx of open fx

Answer 7

Loading dose in ER

2.5 mg/kg for child or (< 50 kg)

5 mg/kg for adults

i.e. 150lb pt = 340 mg

Question 8

PIPERACILLIN/ TAZOBACTAM Weight base dosing for tx of open fx

Answer 8

< 100 kg : 3.375 gm q 6 hr

> 100 kg : 4.5 gm q 6 hr

Question 9

Delay of onset of ___ hours in pt with open fx is relates to increases risk of infection

Answer 9

3