Trauma/Burns OSCE

Question 1

Compartment syndrome

Answer 1

> 30mmHg or >30mmHg difference between compartment and diastolic BPPain out of proportion to injuryParaesthesia, paralysis, skin changes, venous congestionNeedle with pressure transducer inserted into compartment - zeroed at level of compartment being measuredMx - mx BP, cut off cast, limb at level of heart, ortho, fasciotomies, mx AKI/rhabdo if occur

Question 2

Burns

Answer 2

Extent on burns1 - rule of 9s (head, arm, leg anterior, leg posterior, torso 18%, back 18%, perineum 1%)2 - Lund-browder charts3 - hand = 1%FluidsParkland formula = 4mls/kg x TBSA burn - 50% in 8 hrs and 50% in 16 hrs

Question 3

Rhabdomyolysis

Answer 3

Causes:1 - Trauma - burns, crush2 - Drugs - statins, cocaine, amphetamines3 - MH, Serotonin syndrome, NMS4 - Thyroid storm, phaeo

Pathophysiology: damage to calcium-ATPase pump in myocytes, increase in sarcoplasmic calcium with unopposed contraction, skeletal muscle disintegration, release of intracellular proteins and electrolytesHigh phosphate, urate, K, myoglobin.Low calciumComplications:1 - AKI - myoglobin casts causing tubular obstruction, myoglobin also causes renal vasoconstriction2 - Electrolyte emergencies3 - DIC

Mx:FluidsCorrect electrolytesBicarbonate - aim urine pH >6.5 to reduce myoglobin precipitation RRT

Question 4

Drowning

Answer 4

Resp compromise due to submersion (airway below liquid) or immersion (liquid across face) Fresh water and salt water drowningRFs: Young children and adults, intoxication, pre-existing neuro disease (epilepsy), occupation and hobbies, previous self harmDiving reflex - apnoea, bradycardia and vasoconstriction - aims to conserve O2Pathophys:1 - CVS - catecholamine surge and myocardial dysfunction/arrythmias, pulm oedema 2 - Resp - breath holding, laryngospasm, hypoxia, hypercapnia, alveolar toxicity, surfactant washout and bronchospasm, pulm oedema and pulm HTN —- ARDS3 - Neuro - hypoxia brain injury4 - Metabolic - hypothermia5 - Infective - gram +ve from upper airway, gram -ve in fresh water Mx:ABCDE +/- c-spine controlOptimise O2, I&V, lung protective vent, bronchInotropes, fluidsWarm to 35Correct electrolytes Manage associated issues - eg intoxication, c-spine, TBI

Survival factors:1 - Age - young better2 - Type of drowning3 - Vol of aspiration - >22ml/kg 4 - length of submersion - > 10mins5 - Low GCS or unreactive pupils on presentation6 - Cardiac arrest7 - pH < 7.1 on presentation