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Locomotor > Trauma > Flashcards

Trauma Flashcards

1
Q

What are the percentages for different mechanisms of injury?

A
  • Fall < 2m = 59%
  • Falls > = 11%
  • RTA = 15%
  • Assault = 5%
  • Other = 10%
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2
Q

Describe what is trauma

A

-Any external force applied to the body which results in injury
-High amount of morbidity in working age and the elderly
=Loss of income, pain, prolonged bed rest etc.
-Leading cause of death and disability in first 4 decades of life
-50% of Orthopaedics is dealing with consequences of trauma

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3
Q

What is a fracture?

A

A disruption in bone continuity

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4
Q

What is a dislocation?

A

Complete loss of continuity of 2 bones forming a joint

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5
Q

What is subluxation?

A

Partial loss of continuity of 2 bones forming a joint

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6
Q

What is comminution?

A

Multiple fragments

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7
Q

What does antra-articular mean?

A

Fracture extends into a joint

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8
Q

What is a fracture dislocation?

A

A dislocated joint with associated fracture

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9
Q

What causes a fracture?

A
  1. Injury mechanism that exceeds maximum force the bone can withstand leading to a fracture (normal bone, abnormal force)
  2. Comorbidity that increase risk of fracture after injury
  3. Comorbidity that increases risk of injury
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10
Q

Describe comorbidity that increases risk of fracture after injury

A 
-Congenital
=Osteogenesis imperfecta (brittle bones)
-Acquired
=Metabolic (Rickets/osteomalacia)
=Degenerative (Osteoporosis)
=Tumour
Abnormal bone, normal force
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11
Q

Describe comorbidity that increases risk of injury

A

-Visual impairment
-Alcohol/drug use
-Neuropathy
-Balance disorder
-Epilepsy
Normal bone, abnormal force, increased risk of trauma

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12
Q

Which fractures need fixed?

A

-Only the minority
=Anything which would cause suffering and prolonged bed rest e.g. hip fracture, femur, tibia
=To prevent long term complications or loss of function e.g. malunion or nonunion
-Major trauma patients with open fractures or long bone injuries need early intervention

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13
Q

What is the assessment map?

A 
A Airway (+ C-spin control)
B Breathing
C Circulation
D Disability
E Exposure
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14
Q

What do we look for in Airways?

A

-Talking?
-Noises
=Snoring
=Stridor
=No noise…
-Physical blockage
=Food, blood, vomit, tongue= at risk
-Evidence of injury
=Face, oropharynx, neck

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15
Q

How do we treat airway obstruction?

A

-Suction
-Remove foreign body
-High flow O2
-Basic manoeuvres
+ C-spine control
-Airway adjuncts
-Definitive airway
– don’t forget the neck
ATLS teaches the ‘live long and prosper sign’ either side of the patient’s ears

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16
Q

What do we look for in Breathing?

A
  • Colour of patient – pink, blue…
  • Work of breathing – hard, shallow
  • Evidence of injury – bruising, wound
  • Observations – SpO2, RR, pulse, BP
  • Chest symmetry
  • Air entry
  • Percussion note
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17
Q

How is thoracic cavity different in trauma from health?

A
  • In health – thoracic cavity full of lung
  • In trauma – thoracic cavity full of something else
  • OR a disrupted ‘shell’/ rib cage
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18
Q

What is Tension Pneumothorax?

A
  • Internal ‘one-way valve’

- Pressure on mediastinum= decreased venous return to the heart= cardiac arrest

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19
Q

Describe the presentation of a tension pneumothorax

A
  • Decreased breath sounds on affected side
  • Increased percussion note (hyper-resonant)
  • Engorged neck veins
  • Reduced lung expansion
  • Deviation of trachea to opposite side
20
Q

How do we treat tension pneumothorax?

A
  • High flow oxygen, needle decompression in 2nd intercoastal space
  • Definitive chest drain
  • Sternal angle, 2nd intercostal space
21
Q

Describe an open pneumothorax

A
  • ‘sucking chest wound’
  • External ‘one-way valve’
  • Air passes into the cavity through path of least resistance
  • Treat with oxygen and three-sided dressing
  • Definitive chest drain – 4th or 5th intercostal space, mid-clavicular line
22
Q

What is Flail Chest?

A
  • 2 or more ribs fractured in 2 or more places
  • Separation of a segment of the thoracic cage that is then unable to contribute to lung expansion
  • Paradoxical movement of a segment of the chest wall
  • Indrawing on inspiration
  • Moving outwards on expiration
23
Q

What do we look for in Circulation?

A
  • Colour of patient – pink, blue…
  • Work of breathing – hard, shallow
  • Evidence of injury – wound, blood loss
  • Observations – SpO2, RR, pulse, BP
  • Heart sounds
  • Pulses
  • Peripheral circulation - CRT
  • Mental state – cerebral perfusion?
24
Q

What is Cardiac tamponade?

A
  • Pericardium is a ‘fixed’ sac (like the skull)
  • Small pressure increase (from blood) has big effect
  • Pericardiocentesis
  • Under ultrasound guidance
25
Q

What is Beck’s Triad?

A
  • Hypotension: decreased stroke volume
  • Jugular venous distension: impaired venous return to the heart
  • Muffled heart sounds: fluid inside the pericardium
26
Q

What is a massive haemothorax?

A 
>1500 mls of blood in pleural cavity
-decreased breath sounds, respiratory compromise (=‘B’)
-large volume loss (= ‘C’)
-needs a chest drain (B)
AND fluid resuscitation due to SHOCK (C)
27
Q

What is Shock?

A

-End-organ dysfunction
=due to inadequate oxygen availability for tissues (perfusion)
=cardiac, GI, neurology, renal…
-Demand for O2 increased as delivery decreases

28
Q

What are the types of shock?

A
  • Anaphylactic
  • Cardiogenic
  • Haemorrhagic
  • Neurogenic
  • Septic
29
Q

Which types of shock affect supply and demand of oxygen?

A

Decrease delivery: anaphylactic, cardiogenic, haemorrhagic, neurogenic
Increase demand: septic

30
Q

Describe haemorrhagic shock

A
  • Most common in trauma
  • Body’s balance between blood loss and compensation
  • Four classes based on blood volume (70kg person has circulating volume of 5L= 70ml/kg)
31
Q

Describe the 4 classes of haemorrhagic shock

A
  1. <15% blood loss (<750ml), pulse <100, normal BP, >30 ml/hr urine output
  2. 15-30% (750-1500), 100-120, normal BP, 20-30 ml/hr
  3. 30-40% (1500-2000), 120-140, decreased BP, 5-15 ml/hr
  4. > 40% (>2000), >140, decreased BP, neg
32
Q

What trends develop in haemorrhagic shock?

A

-Through classes 1 to 3, the body compensates, but trends develop:
RESPIRATORY RATE – increases as lactic acid rises
PULSE – tachycardia; heart rate increases to compensate for falling stroke volume
BLOOD PRESSURE – remains fairly constant
URINE OUTPUT – falls with renal vasoconstriction
PERIPHERIES – cool with vasoconstriction
MENTAL STATE – increasing confusion / agitation with reduced cerebral perfusion

33
Q

What happens to compensation in class 4?

A

By class 4, compensation reaches ‘overload’
RESPIRATORY RATE – falls with fatigue
PULSE – tachycardia reaches maximum, chest pain due to myocardial ischaemia
BLOOD PRESSURE – drops dramatically
URINE OUTPUT –negligible
PERIPHERIES – cold, mottled
MENTAL STATE – confused, comatose

34
Q

Describe fluid resuscitation

A 
STOP THE BLEEDING 
=haemostasis is the most effective resuscitation
-Initial fluid bolus (10-20ml / kg) 
-Low thresh-hold for blood products= RBC, platelets, FFP
-Tranexamic acid promotes clotting
-Assess the response
-Permissive hypotension
=low BP is better in trauma
=just enough to keep cerebral perfusion
=not enough to start bleeding again
=roughly 80mmHg systolic
35
Q

What do we look for in Disability?

A 
-GCS
=best response in eye opening, verbal responses and motor, total out of 15
-AVPU scale
=alert, verbal, pain or unresponsive
-Temperature
-Blood Glucose
36
Q

What do we look for in Exposure?

A

-Full examination of the patient
-While keeping them warm
=clotting is temperature dependent
-Common sites to miss injuries:
=Back of head
=Back
=Buttocks
=Perineum
=Axillae
=Skin folds

37
Q

What are the life threatening conditions in trauma?

A 
Airway Obstruction
Tension Pneumothorax
Open Pneumothorax
Massive Haemothorax
Flail Chest
Cardiac Tamponade
38
Q

What occurs during secondary survey?

A

-Patient ABC stabilized - any change = review
-Systematic ‘top to toe’ examination with log roll
=Head, face, eyes, ears, nose and throat
=Neck
=Chest
=Abdomen
=Pelvis
=Back
=Extremities
=All wounds

39
Q

What occurs during tertiary survey?

A
  • Repetition of the secondary survey
  • Over several days
  • Broken pinky may be missed initially but still important!
40
Q

What questions are to be considered when examining peripheral injuries?

A
  • Where is it?
  • What side?
  • Which bone?
  • Open or closed?
  • Blood supply to leg?
  • Nerve supply?
  • What was the environment?
41
Q

Describe open fractures

A 
-Bone penetrates skin
=Bone can go back in!
-Skin penetrated from outside
-Prompt management is imperative
-Increased risk of infection
42
Q

How do you treat any fracture?

A 
-4 ‘R’s of fracture management
=Resuscitate
=Reduce
=Restrict
=Rehabilitate
43
Q

Describe A and E management

A 
-IV antibiotics
=Early as possible 
=Cefuroxime 1.5g TDS
=Clindamycin (pen allergy)
=Gentamicin if heavy contamination
-Anti Tetanus
=No tetanus within 5yrs- give booster
-Splint or Cast
=Correct length and alignment
=Get the bone back in
=Tamponade bleeding vessels
-Sterile saline soaked dressing
44
Q

Describe surgical management

A 
Within 24 hours or sooner…
-Primary
=Wound debridement
(Dead tissue = culture for bacteria)
=Skeletal stabilisation
(IM nailing)
(External fixation)
- +/- Secondary
=Tissue inspection and further debridement
=Wound closure
45
Q

Overview of open fracture assessment and treatment

A
  • Fracture with break of dermis in same area
  • Carefully examine the wound
  • Sterile saline dressing
  • Realign and splint wound
  • IV abx and Tetanus
  • Surgical referral

Locomotor (20 decks)

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