Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CORTEX > week 6: trauma > Flashcards

week 6: trauma Flashcards

1
Q

all major trauma patients are given ___ of __ ____ initially

A

2L

IV ``crystalloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

the first manifestation of hypovolaemia is __ followed by reduction in __ ___. ___ or ___ may also be present

A

tachycardia
blood pressure
Lethargy
Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

hypovolaemia should respond to ___ ___. Transient response suggests ongoing bleeding. No response with chest trauma, particularly penetrating injuries, may indicate ___ ____(look for distended neck veins and muffled heart sounds) which can be confirmed with an ____ and may require ____ or surgery.

A

fluid resuscitation
cardiac tamponade
echocardiogram
pericardiocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

pelvic fractures can result in substantial blood loss from arterial bleeding. which artery is affected

A

internal iliac artery + branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

open book pelvic fracture

A

the 2 hemi pelvises are sprung apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

external bleeding controlled by

A

direct pressure with gauze (plug, press, elevate)
or
temporary tourniquet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A quick neurologic assessment should be performed to establish the level of consciousness, identify signs of severely raised intracranial pressure from intracranial haemorrrhage - ____ __ and ____

A

pupil fixed

dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Level of consciousness is determined by the Glasgow Coma Score (Eye, Motor & Verbal response). GCS of___ or less implies severe head injury with potential loss of airway control and requires a ____ ____ ___

A

8

placement of a definitive airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

signs of significant head injury (7) which will require CT scanning

A 
loss of consciousness >5mins 
<1 episode of vomiting 
amnesia >30mins 
severe headache
obvious skull fracture 
focal neurologic deficit 
GCS <15 (2hrs post) or GCS <12 at any time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

significant head injuries increase risk of __-__ injury

A

C-spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define decorticate posture

A 
abnormal posturing (damage to 1/oth corticospinal tracts)
arms adducted and flexed, wrisrs and fingers flexed on chest
legs - extended and internally rotated, with plantar flexion of the feet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

With major trauma involving multiple injuries, unstable major long bone fractures can cause ongoing blood loss with _____, ___, increased ___ ___ , amplfication of the __ and ___ ___ which can result in deterioration of the patient’s clinical condition

A 
pain 
hypovolaemia 
sympathetic response
inflammation
fat embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Systemic inflammatory response ocurs when there is an amplification of ___ ___ in response to trauma with pyrexia, ___, ___ and leukocytosis

A

inflammatory cascades
tachycardia
tachypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ARDS may occur due to 4

A

hypoperfusion
SIRS
aspiration
fat embolism (causing inflame of lung parechyma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

in polytrauma, rapid skeletal stabilisation is required, why

A

limits biological load of trauma

limits bblood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

primary bone healing

A

minimal fracture gap ( <1mm)

bone bridges gap with new bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

cells responsible for bone regrowth in primary bone healing

A

osteoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

secondary bone healing

A

gap at fracture site, scaffolding required for new bone to be laid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

seconday bone healing is an inflammatory response and requires __ ___ __

A

pluripotent stem cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

outline the fracture process of secondary bone healing

A

fracture
haematoma + inflame from damaged tissues
macrophages + osteoclasts remove debris
granulation tissue forms (from fibroblasts + new blood vessels)
chondroblasts form cartilage (soft callus)
osteoblasts lay done bone matrix - enchondral ossification (collage 1)
calcium mineralisation - immature bone (hard callus)
remodelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

soft callus is usually formed by __/__ week whilst hard callus takes approx _____

A

2nd/3rd

6-12 wekks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

smoking may impair fracture healing, why

A

vasospasm

vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

define atrophic non union and give causes

A

bone does not heal properly - due to lack of blood supply, no mvoement, too big a gap, or tissue trapped in fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

hypertrophic non unions occur due to 2

A

excessive movement

too much hard callus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

5 types of fractures

A

transverse - bending force, cortex side 1 fails in compression, cortex side 2 fails in tension
oblique - shearing force (fall from height), screws
spiral- torsional force, screws
comminuted - 3+ fragments, high energy injury/poor bone
segmental - fractured in 2 separate places

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

transverse fractures may not shorten but may ___ or result in ___ ____

A

angulate

rotational malalignment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

oblique fractures tend to __and may also ___

A

shorten

angulate

28
Q

spiral fractures are most unstable to __ __ but can also ___

A

rotational forcces

angulate

29
Q

comminuted fractures are very ___ and tend to require

A

unstable

surgery

30
Q

segmental fractures are very ___ and require stabilization with ___ __ or __

A

unstable
long rods
plates

31
Q

A fracture of a long bone can be described according to the site of the bone involved in terms of the ____, ___ or ___ ___ It can also be described according to the type of bone involved –____, ___ or ___

A 
proximal 
middle 
distal third 
diaphyseal (shaft) 
metaphyseal 
epiphyseal
32
Q

A fracture at the end of a long bone (metaphyseal / epiphyseal) can be ____ or ____

A

intra-articular (extends into joint)
extra-articular

Intra‐articular fractures have a greater risk of stiffness, pain and post‐traumatic osteoarthritis

33
Q

Translation of the distal fragment can described as ___ or __ displaced and medially or laterally ____

A

anteriorly
posteriorly
translated

(in hand - volar/palmer and dorsal instead of ant./post,.
ulnar and radial instead of medial/lateral)

34
Q

Angulation desribes the direction in which the distal fragment points towards and the degree of this deformity. IN the upper limb, ___ or __ and __or __ angulaton are used. In the lower limb, __ and __ are used instead of medial or lateral

A

radial or ulnar
dorsal or volar
varus
valgus

35
Q

how is angulation measured

A

longlitudinal axis of the diaphysis of a long bone

36
Q

signs of fracture 4

A

localised bony tenderness
swelling
deformity
crepitus (cracking/popping)

37
Q

when shd an x-ray be requested in suspected fractures

A

if patient cannot weight bear

38
Q

assessment of an injured limb 4

A

injury - open or closed
distal neurovascular status (Cap refil, pulse,temp ect)
compartment syndrome present
assess status of skin/soft tissue envelope

39
Q

when would a ct be used

A

assess fractures of complex bones

40
Q

what imaging is used to detect stress fractures

A

technetium bone scans

41
Q

initial management of long bone fracture

A

assess
analgesia
splintage/immobilisation
investigation

42
Q

early local complications of fractures 4

A

compartment syndrome
vasuclar injury
nerve compression
skin necrosis

43
Q

early systemic complications of fractures 8

A 
hypovolaemia
fat embolsism 
shock
ARDS
acute renal failure 
SIRS
MODS 
Death
44
Q

late local complications

A 
stiffness
loss of function 
chronic regional pain syndrome 
infection 
non/mal union 
ischaemic contracture (VOlkmanns) 
post traum. osteoarthrtiis 
DVT
45
Q

late ssystemic complications of fractures

A

PE - days to weeks

46
Q

compartment syndrome

A

groups of muscle bound in tight fascial compartments - limits capacity to swell

47
Q

Rising pressure can compress the venous system resulting in____ within the muscle and____ ___as oxygenated arterial blood cannot supply the congested muscle. Muscle ischaemia is manifested by___ ___, and pressure rises can also compress nerves resulting in ____ and ____ ___

A

Rising pressure can compress the venous system resulting in congestion within the muscle and secondary ischaemia as oxygenated arterial blood cannot supply the congested muscle. Muscle ischaemia is manifested by severe pain and pressure rises can also compress nerves resulting in paraesthesiae and sensory loss

48
Q

clinical signs of compartment syndrome

A

incr pain on passive stretching of muscle involved
severe pain - outwith anticipated severity
tensely swollen, tender

49
Q

in compartment syndrome if there is a loss of pulse this indicates

A

end stage ischaemia

too late

50
Q

initial management of compartment syndrome

A

removal of bandages

fasciotomy

51
Q

after fasciotomy, the wound is left open for a few days t/f

A

true

most likely require skin graft

52
Q

nerve injury associated with fractures is usually a neurapraxia or axonotmesis, define eac h

A

neurapraxis - nerve has temporary conduction deficit (compression or stretch) resolves over time
axonotmesis - systained compression/ stretch - long nerve cells axons distal to point die (wallerian degeneration) , regenerate, recovery time variable

53
Q

define neurotmesis

A

complere transection of nerve

penetrating injuries

54
Q

nerve injury is not an indication for surgical exploration, when would surgical exploration take place

A

nerve entrapment within fracture, causing sev. neuralgic pain,

55
Q

most fracture related nerve injuries require surgery t/f

A

false

observation usually best

56
Q

A shearing force on the skin can result in avulsion of the skin from its underlying blood vessels known as ______which can result in ___ __ and ____

A

de-gloving
skin ischaemia
necrosis

57
Q

signs of degloving

A

skin wiil not blanch on pressure

no physical sensation on touch

58
Q

signs of non-union

A

ongoing pain
ongoing oedema
movement at fracture site
bridging callus

59
Q

bones prone to problems (due to poor blood supply)

A

scaphoid waste fractures
distal clavicle
subtrochanteric fractures of femur
jones fracture of 5th metatarsal

60
Q

intra-articular fractures may not unite, why

A

synovial fluid inhibits healing if a fracture gap exists

61
Q

3 fractures prone to AVN

A

femoral neck
scaphoid
talus

62
Q

other than intra-articular fracture, 2 causes of post-traum OA

A

ligamentous instability

fracture malunion

63
Q

define sprained

A

intra-substance tearing of some fibres

64
Q

presenting features of septic arthritis

A 
severly painful 
red 
hot 
swollen and tender joint 
pain on any movement
65
Q

2nd most common organism causing SA

A

strep

66
Q

in elderly, IVDU, and seriously, most common organism causing SA

A

e.coli

CORTEX (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions