Ortho week 1 - trauma call Flashcards
What does E4 indicate on GCS ?
spontaneous eye opening response (normal)
What does E3 indicate on GCS ?
Eye opening in response to speech
What does E2 indicate on GCS ?
eye opening in response to pain
What does E1 indicate on GCS ?
no eye response
What does M6 indicate on GCS ?
can physically obey commands
What does M5 indicate on GCS ?
can move to localised pain
What does M4 indicate on GCS ?
can flex away from pain
What does M3 indicate on GCS ?
abnormal flexion (decorticate)
What does M2 indicate on GCS ?
abnormal extension (decerebrate)
What does M1 indicate on GCS ?
no motor response
What does V5 indicate on GCS ?
patient is oriented to time, place and person (normal)
What does V4 indicate on GCS ?
patient is confused
What does V3 indicate on GCS ?
patient uses inappropriate words
What does V2 indicate on GCS ?
patient uses incomprehensible sounds
What does V1 indicate on GCS ?
no verbal response
what GCS score classes as ‘comatose patient’ ?
8 or less
what GCS score classes as ‘totally unresponsive patient’ ?
3
What is included in a primary survey of a trauma call patient ?
Airway maintenance and cervical spine control
Breathing and ventilation
Circulation with haemorrhage control
Disability (neuro status)
Exposure (completely undress patient to assess injuries)
How is a lower limb fracture managed in A&E?
- examine neurovascular status
- remove contamination
- take medical photos
- cover in saline soaked gauze
- splint the limb
- IV antibiotics
- theatre for wound washout, debridement and stabilisation
What are the main principles of treating fractures ?
- reduce
- stabilise and preserve blood supply
- rehabilitate
What methods are used to stabilise a fracture ?
- casts
- splints
- intramedullary devices
- plates and screws
- tension band wires
- k wires
- external fixators
what is a soft tissue injury ?
an injury to the muscles, ligaments and tendons
what are the 3 steps of the WHO analgesic ladder ?
- non-opioid with/without adjuvant analgesic
- opioid for mild to moderate pain, plus meds from step 1
- opiod for moderate to severe pain, plus meds from step 1
What does the term ‘patient controlled analgesia’ (PCA) mean?
patient is in control of their pain by self administering a small bolus of IV opiod via pressing a button to release a set dose.
there is a ‘lock out’ period that inhibits over use
what opioids are suitable for use in patient controlled analgesia ?
morphine, pethidine and fentanyl are most common, but all IV preparations can be used
in renal failure fentanyl is preferred as is short acting
where is morphine broken down?
in the liver
What condition is likely in fracture patients that are not responding to analgesia?
compartment syndrome
what is compartment syndrome ?
pressure within a fascial compartment exceeds perfusion pressure within the compartment, causing ischaemia to the tissues in that compartment
what should you do for a patient with suspected compartment syndrome?
- take full history
- examine patient (check neuromuscular status of limb)
- release dressings/casts that cause external pressure
- position limb to heart level
if you have tried to help a patient with suspected compartment syndrome and their pain continues to be unresponsive to analgesia, what should you do ?
contact a senior doctor as patient may need an emergency fasciotomy
What factors contribute to a delayed/non-union of a fracture ?
local factors = fracture location, blood supply to area, stability, infection, pattern of fracture
systemic factors = diet, diabetes, HIV, smoking, medications (steroids and NSAIDs)
Use of which medications increase risk of a failed fracture union?
- corticosteroids
- NSAIDs
what is a good system for reading fracture xrays?
- site = which bone and what part of bone
- type = transverse, oblique, spiral
- simple or comminuted
- angulated or displaced
- is the bone of normal consistency or not
what is a comminuted fracture ?
a fracture that fragments at the site of fracture
which is the main nerve at risk with a mid shaft humerus fracture ?
radial nerve
which is the main nerve at risk with a fibula neck fracture ?
common peroneal nerve
which is the main nerve at risk with a supracondylar fracture ?
median nerve
which is the main nerve at risk with a shoulder dislocation ?
axillary nerve
which is the main nerve at risk with a hip dislocation ?
sciatic nerve
what is neuropraxia?
reversible nerve conduction block due to injury to the axon sheath
what is axonotmesis ?
disruption to the myelin sheath and the axon
what is neurotmesis ?
complete nerve division and disruption of the endoneurium
what is the WHO definition of osteoporosis?
Bone mineral density of 2.5 or more SDs below the average value for a young healthy person of the same sex and race as the patient
what is the most sensitive method for diagnosing clinically relevant compartment syndrome ?
pain on passive stretch as well as disproportionate pain
