Principles of Fracture Management Flashcards
Trauma and Fractures
Can be minor or severe
- Can be minor or severe
Trauma and Fractures
- Motorcycle accident
- Open book … fracture
- Significant proximal … fracture
- … of left hip
- Motorcycle accident
- Open book pelvic fracture
- Significant proximal femoral fracture
- Dislocation of left hip
Complications of Surgery
- Loss of …
- Loss of …
- Loss of …
- Loss of Life
- Loss of Limb
- Loss of function
Complications of Surgery
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- I…
- D…
- N… damage
- F…
- Metalwork failure
- Operation specific
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- Infection
- Dislocation
- Neurovascular damage
- Fracture
- Metalwork failure
- Operation specific
Complications of Surgery
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- Infection
- Dislocation
- Neurovascular damage
- Fracture
- M… failure
- O… specific
- General/Systemic
- CVS,RS,GIT,GUS,NS
- Specific/Local
- Infection
- Dislocation
- Neurovascular damage
- Fracture
- Metalwork failure
- Operation specific
Trauma
Acute Management - Acute handover
- ATMIST
- A..
- T..
- M..
- I… (top to toe)
- S..
- T…
- ATMIST
- Age
- Time
- Mechanism
- Injuries (top to toe)
- Signs
- Treatment
ATLS
- Revolutionised the treatment of … patients in 1980s
- Plane crash in Nebraska in 1976
- Now international system taught in 47 countries
- Revolutionised the treatment of trauma patients in 1980s
- Plane crash in Nebraska in 1976
- Now international system taught in 47 countries
What is the ATLS approach??
- A - Airway - With cervical spine control - Give oxygen - How do you control the cervical spine? (Manually - tape, hold with 2 hands/ foam blocks) -How do you assess the patency of an airway? - ask where they are, see if they answer - When might the airway be compromised? blood, vomit, swelling, tongue - What might you need to do? surgical airway potentially or formal tracheostomy
- B - Breathing And ventilation - What is the difference? Breathing = mechanical process, negative pressure is created within thoracic cavity and expand lung and draw air, ventilation - gaseous exchange at membrane level - How do you assess this? - assess What might interfere with breathing?- What might you need to do?
- C - Circulation - With haemorrhage control - How do you assess this? - Classes of shock? - Where can you bleed from enough to die quickly?
- D - Disability -
- E - Exposure
A - Airway - With cervical spine control - Give oxygen - How do you control the cervical spine? (Manually - tape, hold with 2 hands/ foam blocks) -How do you assess the patency of an airway? - ask where they are, see if they answer - When might the airway be compromised? blood, vomit, swelling, tongue - What might you need to do? surgical airway potentially or formal tracheostomy
B - Breathing And ventilation - What is the difference? Breathing = mechanical process, negative pressure is created within thoracic cavity and expand lung and draw air, ventilation - gaseous exchange at membrane level - How do you assess this? - assess What might interfere with breathing?- What might you need to do?
C - Circulation - With haemorrhage control - How do you assess this? - Classes of shock? - Where can you bleed from enough to die quickly?
D - Disability -
E - Exposure
A - Airway - With cervical spine control - Give oxygen - How do you control the cervical spine? (Manually - tape, hold with 2 hands/ foam blocks) -How do you assess the patency of an airway? - ask where they are, see if they answer - When might the airway be compromised? blood, vomit, swelling, tongue - What might you need to do? surgical airway potentially or formal tracheostomy
B - Breathing And ventilation - What is the difference? Breathing = mechanical process, negative pressure is created within thoracic cavity and expand lung and draw air, ventilation - gaseous exchange at membrane level - How do you assess this? - assess What might interfere with breathing?- What might you need to do?
C - Circulation - With haemorrhage control - How do you assess this? - Classes of shock? - Where can you bleed from enough to die quickly?
D - Disability -
E - Exposure
Save Life
- … care vital
- Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
- … essential
- All singing from same hymn sheet
- Multidisciplinary care vital
- Anaesthetists, Orthopaedics, General Surgery, Cardiothoracic Surgery, Neurosurgery etc etc
- Communication essential
- All singing from same hymn sheet
Save Limb
- Only once … … and patient …
- What contributes to loss of limb?
- Only once life saved and patient stabilised…
- What contributes to loss of limb (Vessels, Nerves, Bones, Soft tissues/muscles)
Vascular problems
- Direct … injury
- What to do?
- … of venous outflow
- How might this occur in a trauma patient?
- Direct arterial injury
- What to do?
-
Occlusion of venous outflow
- How might this occur in a trauma patient?
Compartment syndrome
- What is the treatment?
Compartment syndrome
- What happens if you miss this diagnosis??
Bony injuries
- Can these lead to loss of a limb?
- Directly? - open lower leg tibial fracture
- Indirectly? - soft tissue wound can risk ..
- Can these lead to loss of a limb?
- Directly? - open lower leg tibial fracture
- Indirectly? - soft tissue wound can risk infection
How to talk the talk - X-ray fracture management
- How you ‘think’
- 1.It’s a tibia
- 2.It the far end of it
- 3.Its broken
- 4.It goes into the joint
- 5.The bits have moved!
- change order…
- “This is a ….”
- 1.Displaced
- 2.Intra-articular
- 3.Fracture
- 4.Of the distal
- 5.Tibia
Polytrauma
- Damage Control Vs Early Total Care
- Physiological parameters
- A… (Lactate<2)
- H…
- C…
- = terrible triad of trauma
- Damage Control Vs Early Total Care
- Physiological parameters
- Acidosis (Lactate<2)
- Hypothermia
- Coagulopathy
- = terrible triad of trauma
