Trauma - OSCEs

Question 1

Complications of a displaced tibia/fib fracture

Answer 1

Prolonged healing time
Osteomyeltitis (increased if compound)

Nerve injury (peroneal)

Compartment syndrome

Shortened leg

Arthritis

DVT

Question 2

Assess a peroneal nerve injury

Answer 2

If sedated - nerve conduction studies

Not sedated - sensation - dorsum of foot (but NOT 1st 2nd interspace)

Look of ankle jerk
Foot Drop
Foot inversion of strength testing

Question 3

Features of compartment syndrome

Answer 3

Pain out of proportion to injury

Paraesthesia

Paralysis

Late pulselessness

Tense swollen shiny skin

Venous congestion of toes. Increased CRT

Question 4

Measuring compartment pressures

Answer 4

Needle attached to transducer

Transducer levelled at level of compartment

Needle into compartment

Question 5

Compartments of lower limb

Answer 5

Anterior - tibialis anterior

Lateral - extensors hallucis and digitoris

Deep posterior - rib posterior

Superficial posterior - Soleus and gastroc

Question 6

Abnormal compartments pressures

Normal pressure

Answer 6

> 30mmHg

OR

30mmHg difference between compartment pressure and diastolic (ie compartment perfusion pressure <30)

Normal - less than 10-12 mmHg

Question 7

Treatment of compartment syndrome

What risks to be aware of

Answer 7

Urgent referral to ortho

Fasciotomies

Analgesia

Risks - Rhabdomyolysis, AKI

Question 8

Definition of massive transfusion

Answer 8

Transfusion of half the blood volume in 4 hours

OR

One blood volume in 24 hours

Question 9

Causes of a raised isolated APTT

Answer 9

Heparin
Sample contamination

Antiphospholipid antibody
Lupus anticoagulant

Deficiency of factors - haemophilia

DIC

Question 10

What pathway and what factors does APTT test

Answer 10

Intrinsic

1, 2, 5, 8, 9, 11, 12

Started by factor 12

Question 11

Apart from coag, what other lab tests can you do in trauma

Answer 11

Fibrinogen
Fibrin degradation products

Point of care - TEG/ROTEM

Question 12

Describe TEG

Answer 12

Haemostatic assay

Assess visco-elastic properties of whole clot formation

DOES NOT CORRELATE WITH APTT AND PLTS

Measures - aggregation, clot strength, fibrin cross linking and fibrinolytic

Question 13

Dose of TXA

Answer 13

1g gram iv over 10-15 minutes

1g iv over 24 hours

Question 14

Principles of trauma, with tachy and low BP

Answer 14

C spine, ABC

Primary survey and treat like threatening injuries

Control haemorrhage, stabilise fractures (binder)

Look for other sources of haemorrhage

Massive transfusion protocol 1:1 FFP/RBX with plts every 4

Avoid hypothermia and acidosis

Calcium

TXA