Orthopedic Emergencies Flashcards
focused assessment for trauma with sonography. finds blood around heart and abdominl organs
FAST scan
Decreases pelvic volume promoting tamponade. Prevents shifting of the fractures which causes more bleeding.
stabilize pelvis with external fixator
muscle breakdown products which can cause renal failure
rhabdomyolysis
At which joints do vessels and nerves go through tight spaces?
elbow and knee
Describe a class 1 open fracture
puncture wound, minimal signs of contamination
Describe a class 2 open fracture
open fracture with minimal soft tissue damage and contamination
Describe a class 3 open fracture
grossly contaminate wound with little skin coverage
When should you not close a bite wound?
if on hands and feet, crush injuries, deep punctures
When should you close a bite wound?
if on face, not infected, less than 24 hours
What abx should you use as prophylaxis for a cat bite, deep puncture, crush injury, or hand wound?
Amoxicillin clavulanate
What pathogen do you need to worry about with nail puncture wounds and can be treated with cipro?
pseudomonas
What is used to fill the defect left by tumor resection and operative fixation of an impending fracture from a tumor?
methylmethacrylate
Elevated interstitial pressure prevents muscle capillary flow. Ischemia in the compartment causes severe pain
acute compartment syndrome
Where does acute compartment syndrome occur most often?
in lower leg and forearm Fx’s
What is the most sensitive test for acute compartment syndrome?
pain with passive stretch of the muscles
What should you NOT do when treating compartment syndrome?
elevate the part
What is the definitive treatment of acute compartment syndrome?
fasciotomy
Seen in pelvic and long bone Fx’s, closed more than open. Clinical syndrome: pulmonary distress, CNS changes, petechiae. 72 hrs post injury
fat embolism syndrome
What is the prophylaxis for fat embolism syndrome that should be considered in closed pelvic and long bone Fx’s?
Low dose steroids
6 hours after ORIF for a supracondylar elbow fracture your patient complains of increasing arm pain. He has marked pain with passive dorsiflexion of his fingers. What do you do next?
measure compartment pressures
3 days after a femoral fracture your patient becomes confused and
short of breath. How do you treat him/her?
respiratory support
6 days after an open ankle fracture treated with surgery your patient complains of increasing wound pain and feels sick. What do you do?
wound inspection –antibiotics
10 days after rodding a femoral fracture you patient complains of
pleuritic chest pain and shortness of breath. How do you handle this?
anticoagulants and respiratory support
What is the most important treatment in open fracture?
initiation of abx
What it the protocol for someone who has an open fracture and isn’t up to date on their tetanus?
give tetanus antibody as well as antigen in opposite areas of the body
What should every patient who has an injury related to farming be given for abx?
penicillin G
What is the most sensitive clinical sign for compartment syndrome?
pain out of proportion to the injury
What are the 5 P’s of compartment syndrome?
Pain, Pulse, Pallor, Paralysis, Paresthesia
What value of a hand held monometer is too high to allow for capillary perfusion (ie compartment syndrome)?
value is within 30mmHg of the patients diastolic pressure
What is the difference between Colles and Smith fractures?
Colles is displaced dorsally whereas Smith is displaced volarly
fracture of the radius with dislocation of the distal radioulnar joint
Galeazzi fracture
a fracture of the proximal third of the ulna with dislocation of the head of the radius
Monteggia fracture
a fracture of the distal third of the humerus resulting in entrapment of the radial nerve.
Holstein-Lewis fracture
a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane
Maisonneuve fracture
