Trauma/Ortho Flashcards
1
Q
what is considered a low voltage injury
A
<240V
2
Q
what is considered a high voltage injury
A
> 1000V
3
Q
minimum assessment of someone with electrical injury
A
- ECG
- skin examination
4
Q
dispo for patients with high voltage electrical injury
A
observation for 12 hours to look for rhabdo, renal failure, cardiac disturbances
5
Q
what are arc burns
A
flash electrical burns that do not penetrate deeper than the skin
6
Q
what is more dangerous- AC or DC?
A
AC
7
Q
what type of electrical injury draws a person to the electircal source
A
AC- flexor>extensor contractions draw the person to the source
8
Q
DC currents are found in what
A
battery, lighting
9
Q
treatment for stingray injury
A
immerse in warm water so it can break down poison (around 45C)
10
Q
MC type of brain herniation from trauma
A
uncal herniation- temporal lobe pushes downward
11
Q
nerve injured in posterior elbow dislocation
A
median nerve
12
Q
nerve injured in humeral fracture
A
radial nerve
13
Q
nerve injured in anterior elbow dislocation
A
ulnar nerve
14
Q
frostbite with erythema and edema
A
first degree frost bite (epidermis)
15
Q
frostbite with hard edema and clear blisters
A
second degree (epidermis and dermis)
16
Q
frostbite with hemorrhagic bullae, pale gray extremity
A
third degree (hypodermis)
17
Q
frost bite that is insensate, black/gray
A
fourth degree (skin, muscles, tendons, bones)
18
Q
core temperature after drop after rewarming of frost bite
A
acidotic and hyperkalemic blood returns into circulation after extremity is rewarmed and vasoconstriction relieved
19
Q
MC injury from penetrating abdominal trauma
A
hollow viscous injury
20
Q
most injured organ in blunt abdominal trauma
A
spleen
21
Q
laparotomy after blunt trauma indicated if
A
- HD unstable
- peritonitis
- free air on XR
22
Q
hematoma above injuinal ligament after pelvic trauma
A
destot’s sign
23
Q
delta pressure
A
DBP - intracompartment pressure
24
Q
what delta pressure is suggestive of compartment syndrome
A
<30mmHg
25
normal compartment pressure
0-10mmHg
26
last finding in compartment syndrome
loss of pulses
27
complete loss of motor, pain, and temperature below lesion with preservation of proprioception and vibratory sensation
anterior cord syndrome
28
forced hyperextension injury with upper>lower weakness
central cord
29
management of flail chest
intubation
30
describe chest movements of flail chest
inspiration- piece of chest goes down, expiration, broken chest rises
31
mechanism of achilles tendon injury
plantar flexion against resistance
32
splint for achilles rupture
posterior splint with 20 to 30 degrees of plantar flexion
33
primary contraindication to nail trephination
disrupted nail edge
34
management of nail after trephination
antibiotic ointment and guaze dressing
35
what is associated with a proximal nail avulsion in a pediatric patient
seymour fracture- distal phalangeal physis fracture
36
indications for nail trephination
>50 nail bed or pain regardless of size
37
only two treatments rendered in START triage
airway repositioning and direct pressure for hemorrhage control
38
enophthalmos
posterior displacement of the globe with an orbital blowout fracture
39
phalen's test
bring dorsums of hands together and hold wrist in complete forced flexion for 30-60 seconds
40
finkelstein's test
thumb in palm, ulnar deviate the wrist
41
risk factors for carpal tunnel
RA, obesity, diabetes, pregnancy, hypothyroidism
42
reproduction of symptoms with palpation over carpal tunnel
tinel's sign
43
zone 1 injury location
clavicle to cricoid
44
zone 2 injury location
cricoid to mandible
45
zone 3 injury location
mandible to skull base
46
neck injury highest mortality
zone 1
47
most common cause of LOC after rapid descent from diving
arterial gas embolism
48
immediate treatment of arterial gas embolism
lay supine, oxygen by non-rebreather, IVF; definitive treatment is hyperbarics
49
nitrogen narcosis occurs when
descent >70 feet
50
mechanism of HAPE (High altitude pulm edema)
hypoxic vasoconstriction of pulm vessels leading to elevated pulm pressures and resultant endothelial damage and pulm edema
51
most common cause of death from high altitude illness
HAPE
52
what medication can be used to prevent high altitude illness
acetazolamide
53
initial agent that helps acclimatization and prevent high altitude illness
acetazolamide (also important to halt ascent)
54
patients allergic to what agents should avoid acetazolamide
sulfa drugs
55
tenderness along ulnar aspect of thumb with difficulty with pincer grasp
gamekeeprs thumb
56
treatment for gamekeepers thumb
thumb spica splint
57
dermatomome of nipple line
T4
58
biceps reflex dermatome
C5/C6
59
triceps reflex dermatome
C7
60
patella reflex dermatome
L4
61
achilles tendon dermatome
S1
62
risk of delayed repair of popliteal injury
amputation rate >90%
63
risk of untreated perilunate dislocation
median nerve compression, avascular necrosis, compartment syndrome, long-term disability
64
perilunate dislocation most often associated with what other bone fracture
scaphoid
65
bifirigency of gout crystals
negative
66
which bone is referred to when talking about a dislocation
distal bone
67
most commonly injured nerve in knee dislocation
peroneal nerve
68
unstable patient + negative fast
repeat fast or DPL
69
unstable patient + positive fast
laparotomy
70
eyes moving in opposite direction of head turning
oculocephalic reflex, indicates intact brainstem
71
best way to tell if laceration goes into joint
CT scan
72
most common carpal bone fracture
scaphoid fracture
73
treatment of high altitude for cerebral edema
dexamethasone and oxygen
74
pulmonary sequelae of near-hanging
pulmonary edema, bronchopneumonia, and ARDS
75
two types of pulmonary edema after hanging
1. neurogenic- centrally mediated sympathetic discharge
| 2. post-obstructive pulm edema
76
what to avoid in head injury patients in terms of MV
avoid hypercapnea
77
damage of peroneal nerve causes what
foot drop
78
vascular structure at risk with injury to the proximal fibula
anterior tibial artery
79
damage to tibial nerve causes
decreased foot inversion and plantar-flexion
80
damage to inferior gluteal nerve causes
decreased hip extension
81
which odontoid fractures are considered unstable
type 1 (stable), type 2 (unstable), type 3 (unstable)
82
direct effect from blast shockwave
primary blast trauma
83
impact of fragments from blast shockwave
secondary blast trauma
84
blast wave propels patient into object
tertiary blast trauma
85
most common blast injury
tympanic membrane rupture
86
indications for non-op management of fingertip amputations
no bone or tendon exposed, and less than 2cm of skin loss
87
compare jones and pseudo-jones fractures
jones is through base of 5th MT, pseudo jones is avulasion fracture through the tuberosity (proximal to articulation between base of 4th and 5th MT)
88
indications for reduction in a boxer's fracture
>40 degrees angulation-> ulnar gutter splint
89
alkali causes what kind of necrosis
liquefactive
90
destot's sign
hematoma above the inguinal ligament
91
what should be done before foley placement in pelvic fracture
urethrogram
92
treatment for decompression illness
fluids, O2, position in left lateral decubitis in mild trendelenberg, hyperbaric O2
93
prognosis for decompression illness
symptoms usually resolve but some people have symptoms that last months
94
scuba diver who develops confusion and hallucinations during descent- dx and mechanism
nitrogen narcosis caused by increased pO2 in CNS
95
five causes of death from blunt cardiac injury
1. dysrhythmias
2. acute heart failure
3. cardiac free wall rupture
4. laceration of coronary artery
5. rupture of atrial or ventricular septum
96
most common valve injured in blunt cardiac injury
aortic-> AR
97
how good is ECG at ruling out blunt cardiac injury
80-90% predictive value if it is normal
98
+ECG or troponin in blunt cardiac injury should lead to what next test
echocardiogram
99
MI on ECG + positive biomarkers after blunt cardiac injury-> next step
serial biomarkers, consultation with cards and cardiac surgery
100
bony, hard swelling of DIP are pathognomonic for what
OA (heberden nodes)
101
compare XR of RA vs OA
periarticular bone loss-> RA
| joint space narrowing/osteophytes-> OA
102
Most common hip dislocation
posterior
103
3 things that can get injured in a posterior hip dislocation
1. sciatic nerve
2. femoral nerve
3. femoral artery
104
most common fracture associated with a hip dislocation
acetabular fracture
105
name the shoulder reduction technique-> lie prone and hold weight
stimson method
106
risk of hippocratic method for shoulder reduction
axillary nerve injury
107
most common type of odontoid fracture
type 2
108
describe type 1 odontoid fracture
avulsion of tip
109
describe type 2 odontoid fracture
fracture at junction of base of odontoid and body of C2
110
describe type 3 odontoid fracture
fracture through upper portion of body of C2
111
bilateral facet dislocations- stable or unstable
unstable
112
describe galeazzi
distal radius fracture with distal radioulnar joint dislocation
113
describe monteggia fracture
proximal to mid ulna fracutre, radial head dislocation`
114
what nerve is at risk of injury from galeazzi fracture
anterior interosseous nerve, branch of median nerve
115
treatment of boutenierrre's deformity
splint PIP in extension
116
forefoot pain against a stabilized hindfoot
lisfranc fracture
117
most common complication of lisfranc injury
posttraumatic arthritis
118
compare acute mountain sickness and high altitude cerebral edema
acute mountain sickness- no neuro deficits (may have lightheadedness, headache, GI upset). HACE needs to be treated with descent immediately.
119
complications of perilunate dislocations
median nerve injuries, avascular necrosis
120
dose of propofol in procedural sedation
0.5 to 1mg/kg titrated to effect
121
indications for thoracotomy after chest tube placement
initial output of >20ml/kg (or 1500mL) or subsequent output of >200ml/hr
122
smallest amount of fluid that can be seen on a FAST exam
75-250cc
123
compartment pressure that indicates need for fasciotomy
>30mmHg
124
how to calculate delta pressure in compartment syndrome
DBP-direct pressure
125
what is more reliable for compartment syndrome and why
delta pressure becuase it is thought that a normotensive patient can tolerate an elevated direct pressure better (delta pressure <30 suggests compartment syndrome)
126
single, large, free-floating segment of tibia bone between two well-defined fracture lines
segmental fracture
127
most common long bone fracture
tibia fracture
128
splintering or shattering of bone from high mechanism injury
comminuted
129
posterior elbow dislocation can cause damage to what artery and nerve
brachial artery and ulnar nerve
130
which type of burns are included in parkland
anything but superficial
131
compare superficial to superficial partial burns
superficial- sun burn
| superficial partial- blisters
132
rim sign
distance between glenoid rim and humerus is increased in posterior shoulder dislocation
133
compression fracture of posterolateral humeral head after should dislocation
hill sach's deformity
134
fracture associated with posterior shoulder dislocation
reverse hill sachs
135
describe hawkins test and what it's used for
shoulder abduction to 90 degrees with shoulder internal rotation
136
pain in the anterior shoulder with radiation to biceps
biceps tendinitis
137
Most serious complication of elbow dislocation
Brachial artery injury
138
segund fracture associated with what ligamentous injury
ACL
139
Nerve injury from anterior knee dislocation
Common perineal (can’t dorsiflex foot)
140
Most common cause of death after strangulation
Pulmonary edema (cardiogenic and neurogenic)
141
Bilateral pedicure fractures of C2
Hangman’s fracture
142
Unilateral facet joint dislocation- stability and management
Stable, consult ortho
143
What level of spinal cord compression causes weakness in plantar flexion
S1
144
Normal ABI
>0.9, ankle to brachial
145
position of dislocated shoulder
abducted and externally rotated
