Trauma. Flashcards
If there are any facial injuries around the eye, what should we always check?
look for diplopia
check eye movements
check the infraorbital nerve (comes out groove on cheek) sensation.
What are the five tetanus prone wounds?
wounds or burns that require surgical intervention that is delayed for more than six hours
wounds or burns that show a significant degree of devitalised tissue or a puncture-type injury, particularly where there has been contact with soil or manure
wounds containing foreign bodies
compound fractures
wounds or burns in patients who have systemic sepsis
When looking at elbow Xrays, what bone had the olecranon?
Ulnar.
When checking the distal nerves after elbow injury, what test can we do for each one?
ulnar - resist finger spread.
median - pincer
radial - cock wrist up resist.
When examining distal to an elbow injury what should we remember?
patient in pain, so can examine in the position they are in and not get them to try and raise their arm
Always check look, feel, move with the other limb.
injury might give false nerve tests as cant move from pain/deformity.
How do we check vascular status distal to wounds?
temp
colour
cap refill
pulses.
When do we need to give tetanus boosters in trauma?
if they were born in the EU most people have had them as kids so should be covered, unless they were in a tetanus prone country or had a tetanus prone wound.
How long does tetanus immunisation take to work?
a few days so not good if needed immediately.
What do we give if we need immediate tetanus cover?
anti-tetanus immunoglobulin.
Where can we find tetanus guidelines?
green book.
Who should we be wary about tetanus state with?
Vaccines only introduced in 1961 so elderly might not have had them (except soldiers)
kids not up to date e.g. hardly at school
anti-vaccers.
What can we do if we are unsure about a tetanus status in a patient?
Phone GP and ask.
What dressing is good for burns?
mepitel - holes allow granulation. Review in about 4-5 days.
Should we ever suture dog bites?
No as they tend to be mucky and so you want it to be able to drain. If it is on the face it will need sutured, but refer to maxfax and they can clean and suture in theatre.
Should we suture closed glass injuries?
Glass shows up incredibly well on xray, so Xray it first to make sure its all about beforehand. (DR Skelly, jam jar bottom in palm).
