Polytrauma

Question 1

Polytrauma

Answer 1

A syndrome of multiple injuries exceeding a defined severity with sequential systemic reactions that may lead to dysfunction or failure of remote organs and vital system, which have not been directly damaged.

Question 2

Objective

Answer 2

SURVIVE
Remember your ABC- cardiovascular, breathing, neuro function. 
Resuscitation.
Adequate perfusion and oxygenation
Decompression of body cavities
Control of hemorrhage
Treatment of open fractures
Prioritization of treatment

Question 3

Tension Pneumothorax

Answer 3

Emergency
One way valve. 
Intrapleural pressure> atmosphere
Reduced venous return.
Rapid cardiovascular collapse

Question 4

Thoracocentesis

Answer 4

Usually in sternal recumbency. Dorsal 1/3 if pleural air only. Ventral 1/3 pleural fluid only. Usually at 7/8 ICS. ALONG CRANIAL BORDER OF THE RIB
Insert at 45 degree angle ventral. 3 way tap.

Question 5

Fractures

Answer 5

Lower on the triage list. Temporary stabilization and protection of the fracture especially those with an open component

Question 6

Open fracture classification

Answer 6

Describe degree of soft tissue injury- guides emergency care and predictor of outcome.
Gustilo-Anderson system.
Type 1: an open fracture with wound <1cm and clean
Type 2: An open fracture with a laceration more than one centimeter long with extensive soft tissue damage, flaps, or avulsions
Type 3a: soft tissue available for wound closure despite vast soft tissue lacerations or flaps or high energy trauma
Type 3b: extensive soft tissue injury loss, periosteum stripped away from the bone and bone exposure.
Type 3c: Open fracture, arterial supply to the distal limb damaged, arterial repair required.

Question 7

Prevention of Infection: Initial management

Answer 7

Clipping, copious lavage.
Application of sterile dressing.
Administration of antibiotics.
Clinical and radiological evaluation of injuries.
Protect until surgery: cover and protect the wound while waiting for surgical correction.

Question 8

Antimicrobial therapy

Answer 8

70% of open wounds contaminated.
Lower infection rated with antimicrobials
Culture and sensitivity after 1st line therapy
Give ASAP
Grade 1 and 2: more likely gram+. 1st gen cephalosporin
Grade 3: more gram-. 1st and 3rd gen cephalosporin and fluoro

Question 9

First line antibiotics classification

Answer 9

Fracture classification:

1: 1st gen cephalosporin (cefazolin)
2: 1st gen ceph
3: 1st generation cephalosporin and fluoro (cefazolin and enrofloxacin) or 3rd gen ceph (cefpodoxime)

Question 10

Orthopedic examination

Answer 10

Minimum of 2 orthogonal views and contralateral limb

Temporary supporting dressing: must stabilize joint above and below.

Question 11

Neuro

Answer 11

Orthopedic and soft tissue trauma-> risk of neurovascular damage.
Transient or permanent.
Sustained monoplegia or loss of nociception-> poor prognostic indicator.

Question 12

Vascular

Answer 12

Vascular compromise: delayed healing and increased risk of infection.
Appropriately fluid resuscitate prior to assessment.
ID techniques: subjective (pulse quality, limb temperature, color, etc.
Objective: doppler ultrasonic flowmeter to assess blood flow, skin fluorescence, etc.

Question 13

Initial debridement

Answer 13

Golden period= 6 hours. Should be performed ASAP
Aseptic, deep sedation or anesthesia, sharp and blunt debridement, excise necrotic tissue and debris.
Irrigate, irrigate, irrigate. 1-2L. 300 PSI pressure bad-> fluid line-> catheter

Question 14

Wound management

Answer 14

Primary closure or 2nd intention healing following surgical debridement: intra-articular, type 1, most type 2.
Open wound management prior to repair: heavy contamination, type 3b and c. Close once healthy granulation bed

Question 15

Fracture management

Answer 15

Must be stable. 
Avoid external coadaptation- insufficient stability and hard for soft tissue treatment. 
Internal and external methods used. 
Internal fization
External fixators- good to manage

Question 16

Internal and External Fixation

Answer 16

External fixation: allows open wound management, less disruption of soft tissues, shorter operation tomes, easy implant removal. However, high owner compliance required, multiple vet visits, pin tract infection + pin loosening.
Internal fixation: easier fracture reduction and alignment, increased fracture stability, but increased soft tissue trauma, risk of infection-> implant removal, and no open wound management