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Orthopaedics and Trauma > Trauma principles > Flashcards

Trauma principles Flashcards

1
Q

Components of airway assessment in primary survey

A

Listen: Patient talking? Quality? Airway noise (bubbling/stridor)

Look: Bleeding/soft tissue swelling, objectsin airway

Feel: Crepitus/emphysema, C-spine stepping

Immobilise if blunt trauma above clavicle or high-energy trauma

Resuscitate: C-spine immobilisation, airway adjunct, inform ITU

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2
Q

Components of breathing assessment in primary survey

A

Look: Bruising, injuries, chest movements (symmetry, paradoxicality), respiratory rate

Listen: Air entry throughout

Feel: Chest expansion, percussion, midline trachea

Investigate: Oximetry, CXR

Resuscitate: O2 if required

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3
Q

Components of circulation assessment in primary survey

A

Look: peripheral and central capillary refill, bleeding (external, abdomen, pelvis)

Feel: Pulse - rate, rhythm

Investigate: IV access, BP, ECG, ?echo, FAST scan, pelvic XR

Resuscitate: Warm colloid/blood/FFP, tranexamic acid, activate major haemmorhage protocol

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4
Q

Components of disability in primary survery

A
  • Brainstem reflexes (esp pupils)
  • GCS (incl unequal responses to pain indicating weakness)
  • Plantars
  • Blood glucose
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5
Q

Components of exposure in primary survey

A

Temperature - measure and treat accordingly

Expose patient + log-roll for other sources of injury

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6
Q

Sources of blood in trauma

A

On the floor and:

  • Chest –> drain
  • Abdomen –> surgery
  • Long bones –> splint
  • Pelvis –> binder
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7
Q

Life-threatening chest injuries

A

ATOM FC

Airway obstruction

Tension pneumothorax

Open pneumothorax

Massive haemothorax

Flail chest

Cardiac tamponade

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8
Q

Management of airway obstruction

A

Clear foreign objects, suction for aspiration, airway adjuncts, ITU

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9
Q

Management of tension pneumothorax/massive haemothorax

A

Finger thoracostomy + chest drain insertion in safe triangle

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10
Q

Anatomical borders of safe triangle

A

5th intercostal space

pec major

lat dorsi

Base of axilla

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11
Q

Management of open pneumothorax

A

Three-way dressing, chest drain insertion

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12
Q

Reversible causes of cardiac arrest

A

4Hs and 4Ts

Hypothermia

Hypo/hyperkalaemia

Hypovolaemia

Hypoxia

Tension pneumothorax

Tamponade

Thrombosis

Toxins

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13
Q

Management of cardiac tamponade

A

clamshell thoracotomy

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14
Q

Describe the major fracture patterns

A
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15
Q

System for describing a fracture

A
  • Bone: Which bone(s)? Where in bone?
  • Type of fracture: Spiral, oblique, etc…
  • Displacement: Rotation, translation, angulation, shortening (refer to distal fragment)
  • Joint: Intra- or extra-articular; dislocation/subluxation
  • Neurovascular: O/E any compromise
  • Soft tissues: Open/closed, compartment syndrome
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16
Q

AO classification for diaphyseal fractures

A
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17
Q

AO classification for metaphyseal fractures

A
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18
Q

Forms of fracture management

A
  • No treatment (beware in neuropaths)
  • Non-surgical immobilisation
  • External surgical fixation
  • Internal surgical fixation
    • Intramedullary/extramedullary
  • Replacement
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19
Q

Rule of 3s for fracture healing

A

Closed

Paediatric

Metaphyseal

Upper limb fracture

Takes 3 weeks. Any change = doubling of healing time

20
Q

Risk factors for poor fracture healing

A

Older age

Co-morbidity (e.g. diabetes, malignancy)

Smoking

NSAIDs/steroids

Osteoporosis

Local infection/poor blood supply

21
Q

Principles of fracture management

A

Reduction

Immobilisation

Rehabilitation

22
Q

Aims of fracture reduction

A
  • Anatomical position to promote union
  • Maintain neurovascular supply
  • Pain relief
  • Stability
23
Q

Indications/advantages of external fixation

A

Burns/skin loss/open fractures

Minimises soft tissue disruption + allows postoperative manipulation

24
Q

Indications/advantages of internal fixation

A

2 #s in one limb

Unstable fractures

Intra-articular #s

allows early restoration of function

25
Q

Forms of internal fixation for fractures

A

Plate and screws: Used for long bones, bu may hold apart

Intramedullary nail: For shaft fractures

Dynamic screws: Compression screw plate aka dynamic hip screw –> allows it to be forced together as NOF

K-wires: For small metaphyseal segments

26
Q

Initial management of open fracture

A
  • Assess neurovascular stuts
  • Assess for compartment syndrome
  • IV antibiotics
  • Tetanus prophylaxis
  • Irrigate
  • Wound cover - saline-moistened sterile occlusive dressing
  • Splintage and immobilisation
  • X-ray and photograph
  • Debride IN THEATRE
27
Q

Gustillo grade I fracture definition

A

Open wound <1cm, clean, minimal soft tissue injury

28
Q

Gustill-Anderson grade II open fracture

A

Wound >1cm, without extensive soft tissue damage

29
Q

Gustillo-Anderson grade IIIa

A

Open wound, soft tissue damage (flaps, avulsions) but with adequate cover

30
Q

Gustillo-Anderson grade IIIb

A

Bone exposure (extensive soft tissue damage

31
Q

Definition of compartment syndrome

A

Raised pressure within a closed compartment (fascial, burns, plaster) resulting in tissue ischaemia and necrosis

32
Q

Clinical presentation of compartment syndrome

A

Red, swollen, tender muscle

Very painful for passive stretch

Pain out of proportion to clinical appearance

33
Q

Injuries with high index of suspicion for compartment syndrome

A

Crush

gunshot

burn

polytrauma (+ low GCS)

Tight plaster casts

34
Q

Treatment of acid burns

A

ABC

Irrigation

Calcium gluconate

Treat hyperkalaemia + protect kidneys (fluids)

35
Q

Analgesia in trauma settings

A

IV diamorphine up to 10mg titrated to effect

2nd line: Ketamine

36
Q

Medication for major haemmorhage

A

1g TXA

37
Q

GCS - Eye response

A

Spontaneously

Verbal command

Pain

None

38
Q

GCS - motor response

A

Obeys commands

Localises pain

Flexion/withdrawal

Abnormal flexion

Extension

No response

39
Q

GCS - vocal response

A

Oriented

Disoriented

Words

Sounds

None

40
Q

CURB-65 scoring

A

>=2 –> admit

Confusion

Urea >7

RR >30

BP: <90/60

Age >65

41
Q

Gold-standard treatment of traumatic pneumothorax

A

Bilateral finger thoracostomy + chest drain

42
Q

Classes of haemmorhagic shock

A

I: 0-15% blood loss, pulse <100

II: 15-30% blood loss, pulse 100-120

III: 30-40% blood loss, pulse 120-140

IV: >40% blood loss, pulse >140

43
Q

Complications of open fractures

A

Infection (esp gas gangrene from C. perfringens)

Compartment syndrome

Neurovascular damage

44
Q

Ortho history taking components

A

Pain (esp night pain)

Loss of f(x) - ADL, occupation

Swelling - timing

Stiffness

Deformity

PMHx- esp ortho, hip replacements

45
Q

Approach to MSK radiology - COPE

A

Check - right pt, right date, right side, right view

Old/other films - >1 view if necessary

Penetration - adequate?

Exposure - Full view given on film?

46
Q

Approach to MSK radiology -ABCS

A

Alignment - check joint space, bone lines

Bone - Check for any jagged edges, colour change, density change, cysts, enlargement

Cartilage/cortex - Check for cartilaginous defect or breaks in bone cortical edge/periosteal reactions

Soft tissue - check for swelling, bleeding, hardware/foreign bodies

Orthopaedics and Trauma (8 decks)

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