Orthopedics- The ED side (Ross)- exam 2 Flashcards
What is a good ortho history?
OLD CARRTS
- If chronic complaint–> then a focused hx & don’t forget to ask if there isnumbness/weakness !!!
- How/when did it happen, the mechanism what is the complaint
- Did they hear a snap/crackle or pop?
- Right or left handed
- Previous injury
- ARE THEY UTD w/ TETANUS
- Ask when their last meal was (if acute)
Neurovascular Intact
Vital Sign of Musculoskeletal
- not just a word
- base it on pulses and the color of extremities
- base it on peripheral nerve function–sensory and motor
85 yo has left arm pain for 3 days. Staff has found that pt is unable to use arm when he presents to ED.
Check radial pulse–> its ok, you test sensory and motor function and notice wrist drop and sensory loss. What is wrong?
Radial nerve damage and fx of humeral shaft = causes wrist drop!!
surgical neck fracture= axillary nerve damage
An acute ortho injury: what questions should you ask the Pt about their MOI?
- Listen to mechanism that the patient describes
- OPEN Ended Questions
- Are they able to move affected area?
- After ABC’s Immediately assess neurovascular status
- **document before and after any manipulation
Signs and symptoms of Bone Fracture
- Deformity
- Tenderness (TTP)
- Splinting
- Swelling
- Bruising
- Crepitus
- False motion (they lift a body part and it goes the wrong way)
- Exposed fragments
- Pain
- Locked joint (usually a fracture of the knee or elbow that inhibits movement of the joint)
- *Document all of these on the chart!! A joint above and below!!!!!
say the Pt presents with an elbow injury. What do you HAVE to document?
- document below and above that joint
- ie document how their shoulder joint and wrist joint functions
Red Flags
for HX and PE:
Blood on clothing–>
open fracture
Pain out of proportion–>
compartment syndrome
Elderly Pt with hip pain (neg film)–>
Occult hip fracture (may need Ct, MRI or bone scan)
**if elderly Pt has pain with ambulation–> its a hip fracture until proven otherwise
Jumping from a height
–>
Calcaneous FX with vertebral body compression
Eldery, hx of malignancy, mechanism doesn’t fit–>
Pathologic fracture
Grossly deformed extremity in field, now normal–>
Dislocation reduced in the field query vascular injury
13 yo boy running at gym has severe pain and stops.
Pathologic fx from lesion: osteocondroma
bones heal by _____ ______
callus formation & Remodeling of deposits of new bone along the fracture line
Fractures: clinical relevance
Some folks you don’t see initial fracture repeat films in 10 days
stage 1-6 fractures
- impact
- Induction
- Inflammation
- Soft callus
- Ossification
- Remodeling
3 stages of bone healing: Inflammatory, ossification and remodeling
Pearls ED ortho:
- please examine first then order X-ray
- may find unexpected findings such as jewelry or clothing causing tourniquet
- may find incorrect side documented
- **may find other injuries
How to describe a Fracture (steps)
Closed vs Open Location of injury Orientation of fracture line Displacement Angulation Shortening -Dislocation or subluxation
ex: closed fracture of the —- that is ———with ——displacement, with no angulation or shortening
_____ fracture is typically pediatric
greenstick
Physical Exam: In addition to the basics of ABC– what other steps should be taken?
- Inspect deformity
- Edema
- Discoloration
- Assess passive and active ROM
- Palpation to detect deformity or tenderness
- Check for pulse and neuro eval
What is included for neuro and vascular for the arm exam?
radial /ulnar and cap refill
What is included for neuro and vascular for the leg exam?
popliteal, post tip, doraslis pedis
Vascular and neuro exam:
- how many hours until their limb is dead?
- what sign is problematic?
- 6 Hours until limb is DEAD
- check pulse distal to fracture
- *Skin tenting: problematic, needs to be addressed urgently.
What are the peripheral nerves (branches) of the upper extremity?
musculocutaneus, axillary, radial, median and ulnar
