Trauma/Extremity Injury Flashcards
Isolated trauma to an extremity with associated vascular injury has ____% rate of mortality or limb loss
10%
What is more common, injuries involving lower extremity or upper extremity?
Lower extremity is more common
What are the 2 most commonly injured blood vessels?
Femoral and popliteal
Nerves, bone, soft tissue, vascular supply
Evaluate extent of injury
Most common causes of penetrating trauma?
Gunshot wounds and stab wounds
Larger extent of tissue damage, wider range of patterns of injury
Gunshot wounds
More straightforward, predictable pattern of injury
Stab wounds
List 3 signs of vascular trauma
- Absent or diminished distal pulses
- Obvious arterial bleeding
- Large expanding or pulsatile hematoma
- Audible bruit
- Palpable thrill
- Distal ischemia
How do you manage definite vascular injury to extremity?
Vascular surgery consult
How do you manage a lower extremity injury if you are highly suspicious of vascular injury?
CT angiography
How do you manage an extremity injury if there are no signs of vascular injury?
ABI
Additional testing for vascular injury
Creatinine before CT w/ contrast, CBC if signif. blood loss, radiography for fracture
Complete disruption of a joint
Dislocation
Partial disruption of a joint
Subluxation
Tearing injury to muscle fibers
Strain
Tearing injury to ligaments of a joint
Sprain
Open fracture, subluxation/dislocation, neuromuscular injury, compartment syndrome are all???
Orthopedic emergencies
Gross deformity is pathognomonic for??
Fracture
If a shoulder is anteriorly dislocated, what nerves should you check?
Axillary (lateral aspect of shoulder), musculocutaneous (extensor aspect of arm)
How do you manage a fracture in the ED?
Control pain and swelling, reduce fracture deformity, reduce dislocation, withhold food/drink if going to surgery
When should you call for an ortho consult in the ED?
Compartment syndrome, irreducible dislocation, circulatory compromise, open fracture, surgical intervention
When should you splint a patient?
Fracture or after reduction of a dislocated joint
Used for clavicle fracture, AC separation, shoulder dislocation, humeral neck fx
Shoulder immobilizer
Used for non displaced radial head fx
Arm sling
Used for elbow fx and elbow dislocation
Long-arm gutter splint
Used for wrist or forearm fx
Sugar tong splint
Used for metacarpal or proximal phalanx fx
Short-arm gutter splint
Used for scaphoid fracture, thumb metacarpal or proximal thumb phalanx fx
Thumb spica splint
Used for patellar fx or subluxation, knee dislocation, tibial plateau fx, knee ligament or meniscus injury/tear
Knee immobilizer
Used for ankle dislocation or fx, unstable ankle fx (eg, high, distal fibular fx or medial and/or posterior malleolar fx), widened medial mortise, metatarsal fx
Posterior ankle mold splint
Used for simple ankle sprain, stable lateral malleolar fx
Ankle stirrup
Used for toe fx, some metatarsal fx
Hard-soled shoe
Used for some toe or foot fx where weight bearing is allowed
Short-leg walking boot
When should a patient return immediately after discharge for trauma?
Pain is severe or increasing, numbness is new or worsening, skin discoloration distal to the splint
If you see a scaphoid fracture on x-ray what splint do you use?
Thumb spica
If you see a distal radial head fx on x-ray, what splint do you use?
Sugar tong
If you see a distal 5th metacarpal fracture (boxers fracture), what splint do you use?
Ulnar gutter splint
If you see a proximal 5th metatarsal fracture (jones fracture) what type of splint do you use?
Posterior ankle splint
If you see an isolated lateral malleolar fracture of the fibula, what splint do you use?
Ankle stirrup
If you see a trimalleolar fracture, what splint do you use? spoiler alert there’s two
Ankle stirrup + posterior ankle
