TRAUMA PRINCIPLES Flashcards
physiologic criteria for the following?
GCS
systolic BP
resp rate
sustained pulse
<13
<90
<10 or 29
>120
what requires tx of trauma centers?
pelvic fx
proximal amputations
limb paralysis
two or more proximal, long bone fx
what compromises the secondary survey?
AMPLE
allergies medications past illness last meal events
how do we define a high energy injury?
always soft tissue injury w/ axial load
what are the examples of high energy injuries?
axial load
crush injury
-closed fx like compartment syndrome
-open fx like GSW
Crush injury examples?
open fx
closed fx
degloving injury
compartment syndrome
what three components make up crush injuries?
soft tissue
bones
joints
what are the soft tissue examples?
skin tendon muscle nerve vessels
what are the injuries of bones called?
closed fx, compartment syn
open fx, GSW
this is tissue damage from crushing is always far worse than that which is immediately and grossly apparent?
zone of injury
the zone of injury of which demarcation develops takes how long?
days to weeks
what are the worst fracture blisters?
`blood filled are worse, can’t do incision thru
what grade for soft tissue injury is bad?
grade 2/3
what scenario most likely results in compartment syndrome?
less common?
crush injuries, mid foot/lesser tarsal fx dislocations
calcaneal fx, pilon fx
what is common for the development of metabolic bone disease?
disuse osteoporosis
this is a fixation principle in which we maintain reduction and still keep the mechanical stimulation for fx repair by callus formation?
relative stability
-external fixators, intramedullary nails, internal fixators; not screws
relative stability can be achieved via?
external fixaton
this is a fixation principle that provides mechanically neutral environment at the fx site, no motion at the fracture site?
absolute stability
-lag screws, plates
most important to note above closed reduction technique?
increase deformity, distract, and reduce
goals of external fixation?
msk stability
maintenance of alignment
fx reduction
restoration of length
what is the Gustilo Classification System of open fxs?
type I: wound <1 cm, clean
type II: wound> 1 cm, no extensive soft tissue damage
type IIIA: extensive soft tissue damage with adequate coverage
type IIIB: extensive soft tissue with inadequate coverage
type IIIC: arterial injury requiring repair
classic recommendations for IV antibiotics?
absence of organic/sewage contamination
-ancef 2 gm or clindamycin 600 mg
Gustilo Type III fx
-aminoglycosides 1.5 mg/kg loading dose
organic/sewage contamination
-PCN +/- metronidazole
IV antibiotic prophylaxis? duration?
cephalosporin and gentamicin, 72 hrs or wound closure
