TRAUMA PRINCIPLES

Question 1

physiologic criteria for the following?

GCS
systolic BP
resp rate
sustained pulse

Answer 1

<13
<90
<10 or 29
>120

Question 2

what requires tx of trauma centers?

Answer 2

pelvic fx
proximal amputations
limb paralysis
two or more proximal, long bone fx

Question 3

what compromises the secondary survey?

Answer 3

AMPLE

allergies
medications
past illness
last meal
events

Question 4

how do we define a high energy injury?

Answer 4

always soft tissue injury w/ axial load

Question 5

what are the examples of high energy injuries?

Answer 5

axial load
crush injury
-closed fx like compartment syndrome
-open fx like GSW

Question 6

Crush injury examples?

Answer 6

open fx
closed fx
degloving injury
compartment syndrome

Question 7

what three components make up crush injuries?

Answer 7

soft tissue
bones
joints

Question 8

what are the soft tissue examples?

Answer 8

skin
tendon
muscle
nerve
vessels

Question 9

what are the injuries of bones called?

Answer 9

closed fx, compartment syn

open fx, GSW

Question 10

this is tissue damage from crushing is always far worse than that which is immediately and grossly apparent?

Answer 10

zone of injury

Question 11

the zone of injury of which demarcation develops takes how long?

Answer 11

days to weeks

Question 12

what are the worst fracture blisters?

Answer 12

`blood filled are worse, can’t do incision thru

Question 13

what grade for soft tissue injury is bad?

Answer 13

grade 2/3

Question 14

what scenario most likely results in compartment syndrome?

less common?

Answer 14

crush injuries, mid foot/lesser tarsal fx dislocations

calcaneal fx, pilon fx

Question 15

what is common for the development of metabolic bone disease?

Answer 15

disuse osteoporosis

Question 16

this is a fixation principle in which we maintain reduction and still keep the mechanical stimulation for fx repair by callus formation?

Answer 16

relative stability

-external fixators, intramedullary nails, internal fixators; not screws

Question 17

relative stability can be achieved via?

Answer 17

external fixaton

Question 18

this is a fixation principle that provides mechanically neutral environment at the fx site, no motion at the fracture site?

Answer 18

absolute stability

-lag screws, plates

Question 19

most important to note above closed reduction technique?

Answer 19

increase deformity, distract, and reduce

Question 20

goals of external fixation?

Answer 20

msk stability
maintenance of alignment
fx reduction
restoration of length

Question 21

what is the Gustilo Classification System of open fxs?

Answer 21

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

Question 22

classic recommendations for IV antibiotics?

Answer 22

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

Question 23

IV antibiotic prophylaxis? duration?

Answer 23

cephalosporin and gentamicin, 72 hrs or wound closure