Surgery: Ortho_extra notes Flashcards

1
Q

Components of vascular assessment

A
  • skin temperature (is it warm?)
  • skin appearance (is it pale?)
  • cap refill
  • pulse and its character

Compare both sides

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2
Q

What to do if you can’t feel the pulse?

A

Use doppler

(if still cannot do with doppler → CT angiogram to confirm vascular compromise)

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3
Q

What does triple immobilisation of spinal cord consist of? (3)

A
  • hard collar
  • block (sides)
  • tape over forehead
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4
Q

What is used to look for internal haemorrhage in the trauma setting?

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5
Q

Where to look for haemorrhage using FAST scan? (4)

A
  • thorax
  • abdo
  • pelvis
  • limbs
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6
Q

Why do we put a pelvic binder on every patient in a trauma setting?

A

to close pelvic injury/fracture → to minimise potential bleed

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7
Q

What to do first in a fracture of a long bone and a bleed?

A

Put the bone in a better alignment to prevent significant bleed

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8
Q

What is the secondary assessment in trauma setting?

A
  • head to toe examination done by an orthopaedic

(looking and assessing any lesions, bruises, deformities, fractures)

  • to identify the need for extra imaging
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9
Q

What’s a tertiary assessment?

A
  • Done on the ward (once a traumatic patient has stabilised)
  • It is a repetition of secondary assessment to make sure nothing has been missed during a trauma setting (pressure, easy to miss some minor injuries)
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10
Q

What the most important analgesic in the management of fractures?

A

Reduce the fracture!

This helps to reduce pain (due to less tension on soft tissues, vessels and skin)

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11
Q

Do we leave a ‘metalwork’ in? E.g. plate and screws

A

Usually in unless:

  • infection
  • children up to 16 years of age (as the bone will grow)
  • clavicle/ ankle → thin skin so the metalwork will be visible and maybe catching on clothes etc
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12
Q

Mono-lateral external fixator

  • use
  • how long do we leave it in for?
A

Use: When a tissue around the fracture is to distorted/swollen to be able to close in again after a potential surgery → to temporarily fixate the bone until swelling settles down → further surgery will be required to fix the bone properly

How long for: max 2 weeks due to risk of infection → then further fixation (surgery)

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13
Q

Mechanism of injury leading to spiral fracture

A

twisted/torsional force

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14
Q

A child with a long bone spiral fracture - what is the possible mechanism of injury?

A

Possibly non-accidental injury

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15
Q

Possible mechanism of a transverse fracture?

A

Side force

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16
Q

Where to test for sensation (possible neurological compromise) for medial, radial and ulnar nerve? (3)

A

In the point where there is no anatomical overlap

  • Medial: in between of thumb and index finger (hand surface)
  • Ulnar: little finger (palm surface)
  • Radial: dorsum of the hand
17
Q

How to test for a motor function of (neuro compromise assessment):

  • Median n.
  • Ulnar n.
  • Radial n.
A
  • Median → ‘OK’ sign (circle made of thumb and index finger)
  • Ulnar → fingers spread out and back together
  • Radial → wrist and finger extension (‘cock wrist back’)
18
Q

How to test for motor function (neuro compromise) in children?

A

Play ‘paper, rock, scissors’

  • Median n. → rock
  • Radial n. → paper (wrist + finger extension)
  • Ulnar n. → scissors
19
Q

What do we MUST do before attempting a reduction of a shoulder dislocation?

A

Check for axillary nerve injury:

  • ‘regiment badge’ sensation (below deltoid)
  • motor function - ask to move deltoid muscle (even little flicker will be enough for a positive motor function) we can do it by asking a patient ‘can you push in’ (with shoulders)