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CLASS 22010 TRAUMA > TRAUMATIC INJURIES TO EXTREMITIES > Flashcards

TRAUMATIC INJURIES TO EXTREMITIES Flashcards

1
Q

What is characterized by ischemia and muscle damage or death (rhabdomyolysis) ?

A

Crush syndrome

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2
Q

Reperfusion injury may cause up to __ L of third space fluid loss per limb which can lead to hypovolemic shock

A

10 L

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3
Q

What may result from a combination of nephrotoxic substances from muscle death (myoglobin, uric acid) ?

A

Acute Renal Failure (ARF)

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4
Q

Patients with what kind of injuries may appear with the following?

  1. Initially, may appear normal just after extrication
  2. Edema develops and extremity becomes swollen, cool, and tense
  3. Pain out of proportion with examination
  4. May mimic a spinal cord injury with flaccid paralysis but there will be normal bowel and bladder function
  5. Trunk/buttocks: may have severe pain out of proportion with examination in tense compartments
A

Crushing Injuries

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5
Q

Crushing injuries

Creatine Phosphokinase (CPK) is elevated with values >____ IU/mL

A

100,000IU/mL

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6
Q

What is usually elevated due to hemoconcentration from third-spacing fluid losses?

A

Hematocrit/Hemoglobin (H/H)

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7
Q

Crushing Injuries

What is the ultimate cause of death from cardiac arrhythmia?

A

Hyperkalemia

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8
Q

Crushing Injuries

What is the key in improving outcomes?

A

Early and aggressive fluid resuscitation

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9
Q

True or False

Fluid resuscitation needs to occur after extrication to minimize to toxic effects of myoglobin and potassium before release of limb

A

False

Resuscitation needs to occur before extrication to minimize to toxic effects of myoglobin and potassium before release of the limb.

Treat while on scene and trapped

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10
Q

The primary goal of treating crushing injuries is to prevent what?

A

ARF

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11
Q

A delay is fluid resuscitation results in renal failure in ___% of patients, a delay of 12 hours or more produces renal failure in almost ___% of patients

A
  1. 50%

2. 100%

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12
Q

Should potassium and lactate containing IV solutions be avoided for crushing injuries?

A

YES

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13
Q

Crushing Injuries

___L should be given prior to extrication and up to 1L/h (short extrication time) to a maximum of __ to __ L/d in prolonged entrapments.

A
  1. 1 L
  2. 6 - 10

Addition of one ampule (50mEq) of sodium bicarbonate and 10 grams of
mannitol to each liter of fluid to decrease the incidence of renal failure.

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14
Q

What can be recognized by the development of peaked T waves on a cardiac monitor?

A

Hyperkalemia

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15
Q

What are the standard protocol treatments for hyperkalemia?

A

Sodium Bicarbonate IV Dextrose and Insulin

Life threatening arrhythmia occurs, Calcium Chloride

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16
Q

Crushing Injuries : Urine Output

Establish and maintain urine output >___mL/h until pigments have cleared from urine and alkalinize the urine above pH ___

A
  1. > 100mL/h

2. pH 6.5

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17
Q

What is a limb threatening condition in which blood supply is compromised by increasing pressure in the limb?

A

Compartment syndrome

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18
Q

What are the two most common causes of compartment syndrome?

A
  1. Hemorrhage from a fracture

2. Edema following reperfusion injury

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19
Q

These are all signs of what condition?

  1. Paresthesia (most common)
  2. Pain (most common) out of proportion
  3. Pulselessness - uncommon, late finding
  4. Pallor
A

Compartment syndrome

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20
Q

Approximately __% of injuries seen in the Joint Theater Trauma Registry (JTTR) involves extremities

A

50%

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21
Q

True or False

Most extremity wounds from combat have no penetrating component

A

False

Most extremity wounds from combat have penetrating component.

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22
Q

As extremities are evaluated, each of the 4 functional components below must be considered and evaluated together; If 3 out of the 4 are damaged, then the patient is defied as having what?

  1. Nerves
  2. Vessels
  3. Bones
  4. Soft tissue
A

Mangled extremity

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23
Q

What are some systemic antibiotics that should be started at at the time of diagnosis of any open fracture as well as the site being cleaned of foreign material?

A
  1. Ertapenem
  2. Cefazolin
  3. Cefoxitin
24
Q

What should be anticipated with high voltage injuries and consultation for emergency fasciotomy should be made?

A

Compartment syndrome

25
Q

What are the hard signs of an arterial injury ?

A
  1. Active hemorrhage
  2. Expanding or pulsatile hematoma
  3. Bruit or thrill over wound
  4. Absent distal pulses
  5. Extremity ischemia
26
Q

What is common with musculoskeletal injuries?

A

Internal hemorrhage

27
Q

What kind of fracture is when the bone is broken without a loss of skin integrity and includes the following signs?

  1. Pain
  2. Tenderness
  3. Deformity
  4. Hematomas
  5. Swelling
  6. Crepitus
A

Closed Fractures

28
Q

What splint should be used for a femur fracture?

A

Traction splint

29
Q

What are the contraindications for a traction splint?

A

Suspected pelvic fracture, femoral neck fracture, amputation of foot/ankle, suspected fracture adjacent to knee

30
Q

What usually occurs when sharp bone penetrates through the skin?

A

Open Fracture

31
Q

ANY open wound near a possible fracture site needs to be considered an open fracture and treated with what?

A
  1. Irrigation and debridement
  2. Fixation/splinting
  3. Antibiotic prophylaxis
    a. cefoxitin
    b. cefazolin
    c. ertapenem
32
Q

True or False

If you suspect and have identified a pelvic fracture you still need to perform the pelvic rock

A

FALSE

If you suspect a pelvic fracture you do NOT need to aggressively perform a pelvic rock, gently palpate ONCE

33
Q

What are most common site for internal hemorrhage from a fracture?

A
  1. Femur

2. Pelvic fractures

34
Q

Blood loss is the leading cause of death in what kind of fracture?

A

Pelvic fractures

35
Q

What kind of pelvic fracture does not typically require surgical stabilization?

A

Rami fracture

36
Q

What kind of pelvic fracture generally requires surgery to optimize hip function?

A

Acetabular fracture

37
Q

What kind of pelvic fracture is divided into the following 3 types?

  1. Lateral compression
  2. Anterior posterior compression fracture, 15% (open book) symphysis pubis is disrupted and volume of pelvis is increased
  3. Vertical shear, smallest portion of pelvic ring fractures however tend to cause greatest bleeding (fall from height landing leg first)
A

Pelvic ring

38
Q

What is known when the tissue has been totally separated from the extremity and is either a loss of part or all of the limb?

A

Amputation

39
Q

What is the avulsion of skin from underlying structures and is usually a result of trauma?

A

Degloving injury

40
Q

Degloving injuries usually occur when the hand is caught by a force and pulled at a __ velocity

A

Low velocity

41
Q

What are the most common causes of degloving injuries?

A
  1. Road traffic accidents
  2. Conveyor belt injuries
  3. Ring avulsion Injuries
42
Q

What are some common sites for degloving injuries?

A
  1. Forearms
  2. Palms of hands
  3. Dorsum of hands
  4. Fingers
43
Q

Degloving injuries occur at what skin level?

A

Subcutaneous

44
Q

What is the field management of a degloving injury?

A
  1. Preserve as much of the structures as possible
  2. Wound cleaning an debridement
  3. Antibiotics to cover skin flora bacteria (staph and strep)
    a. Cefazolin
    b. Augmentin
    c. Doxycycline
    d. Ciprofloxin or
    e. Ertapenem
45
Q

The majority of injuries that involve pelvic fractures are due to what?

A

High energy blunt trauma

46
Q

Life threatening hemorrhage associated with pelvic fractures is from where in 80-90% of the cases?

A

Venous plexus

47
Q

Neurologic nerve deficits associated with pelvic ring fractures are most commonly associated with what vertebrae?

A

L5, S1

48
Q

The bony pelvis consists of what?

A
  1. Sacrum
  2. Coccyx
  3. 3 innominate bones: ilium, ischium, pubis
49
Q

The ilium, ischium, and pubis fuse to form what?

A

Acetabulum

50
Q

What are some types of pelvic fractures?

A
  1. Pelvic ring
  2. Lateral compression
  3. Anterior posterior
  4. Vertical shear
  5. Open book
51
Q

What is the common term to describe pelvic ring disruptions, the widening of symphysis pubis or rami fractures, and posterior ligamentous injury?

A

Open book

52
Q

When the anterior pelvic ring widens more than ____ cm, the posterior pelvis
(especially the anterior portion of the sacroiliac ligamentous complex) is frequently injured, increasing the risk of hemorrhage.

A

2.5

53
Q

What reduces pelvic volume and stabilizes fracture fragments, thereby reducing the risk of major hemorrhage in pelvic fractures?

A

Pelvic binder

54
Q

What is the gold standard imaging for a pelvic fracture?

A

CT scan

55
Q

True or False

If a significant pelvis injury is found or a patient with a pelvic fracture remains
hemodynamically unstable, the pelvis should be “wrapped” with either a sheet or
a commercial pelvic binder.

A

True

CLASS 22010 TRAUMA (12 decks)

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