Trauma_Scenario

Question 1

Trauma_Scenario

Answer 1

1. History
   
   1. ATLS - ABCDEs
   2. Age/Sex - Given
   3. Onset of pain
      
      1. MOI
   4. P osition
   5. R adiation
   6. S ymptoms associated
      
      1. Neurologic
      2. Mechanical
         
         1. able to ambulate
         2. able to move arm/leg/back
      3. Local
   7. PSHX, PMHX, Meds, Allergies
      
      1. Previous Injury
   8. Social Hx (EtOH, tobacco)
   9. Handedness, Occupation, Sports
   10. ROS
       
       1. LOC, CP, SOB
   11. Last Meal
2. Physical Exam
   
   1. General
   2. JAB
   3. Look
      
      1. Gait
      2. S welling
      3. E rythema / Ecchymoses
      4. D eformity
      5. S kin changes
         
         1. Open?
   4. Feel
      
      1. Palpate all extremities and spine
   5. Move
   6. NV Exam
      
      1. Upper extremities
         
         1. Axillary
            
            1. Motor – shoulder abduction
            2. Sensory – Lateral arm
         2. Musculocutaneous
            
            1. Motor – biceps
            2. Sensory – lateral forearm
         3. Radial
            
            1. Motor – wrist extension, thumb extension
            2. Sensory – 1^st web space
         4. Ulnar
            
            1. Motor – Finger abduction
            2. Sensory – ulnar D5
         5. Median
            
            1. Motor – abduction of thumb, flex DIP D2
            2. Sensory – distal palmar D2
         6. Medial cutaneous nerve of the arm
         7. Medial cutaneous nerve of the forearm
         8. Posterior Cutaneous nerve of the forearm
      2. Lower Extremities
         
         1. Obturator
            
            1. Motor – hip adduction
            2. Sensory – Medial Thigh
         2. Femoral Nerve
            
            1. Motor – Quads: knee extention
         3. Anterior femoral cutaneous
         4. Lateral femoral cutaneous nerve
         5. Posterior Femoral cutaneous
         6. Sciatic Nerve
            
            1. Tibial N
               
               1. Motor – Gastrosoleus: PF, tib post, FHL, FDL
               2. Sensory – plantar aspect of foot
            2. Common Peroneal N
               
               1. Deep Peroneal
                  
                  1. Motor – EHL: 1^st toe extension, Tib Ant, EDL, EDB
                  2. Sensory – 1^st web space
               2. Superficial Peroneal
                  
                  1. Motor – Peroneus longus and brevis: Foot Eversion
                  2. Sensory – dorsum of foot
         7. Sural Nerve
            
            1. Sensory – Lateral border of foot
         8. Saphenous nerve
            
            1. Sensory – Medial border of foot
      3. Pulses and cap refill
         
         1. Tibial
         2. Dorsalis Pedis
   7. Special Tests
      
      1. ABI
3. Imaging
   
   1. Splint then send for Xrays, other modalities
4. Diagnosis or DDx
   
   1. Implications (AVN risk, infection, etc.)
5. Acute Rx and work-up
   
   1. Reduce/splint/XRAY/traction, ER tests/consults, admit, further imaging, plan OR for trauma
6. Treatment plan
   
   1. Goals
   2. Non-operative Rx
      
      1. Options
      2. follow-up
   3. Operative Rx
      
      1. Options
   4. Consent
      
      1. Outcome
      2. Risks
         
         1. immediate
         2. late
   5. Pre-op
      
      1. labs (x-match), tests (ECK, CXR), old OR reports, consults
   6. Post the case
      
      1. patient, surgery, implants, adjuncts (teams, consultants, special equipment), table, flouro, monitoring
7. Technique
   
   1. Position, ABX
   2. Incision, approach, fixation
8. Post-op
   
   1. NV exam, compartment check
   2. Xrays
   3. Immobilization
   4. Weight Bearing Status
   5. Physio
9. Disposition and Follow-up
   
   1. F/U plan
10. Complications
    
    1. List potential complications
    2. Prevention
    3. Treatment