WK 1- MSK Flashcards
What are the 5 categories of the triage system and in what time frame must they be seen (provide examples of each cat)
Cat 1. Dying→ seen immediately→apparent physiological abnormality already eg. Seizures, unconsciousness, hypotensive, multi-trauma, severe SOB, hypoxia
- Might die→ seen within 10 minutes→ physiologically normal but risk of severe/sudden deterioration eg. Chest pain (potential to have VF arrest→if unmonitored high mortality, if monitored able to be defib), trauma, moderate SOB, abdo pain, ectopic, AAA, severe pain
- Serious but stable (sick but probably wont die)→ needs to be seen but not too bad, seen within half hour→ moderate pain, abo pain, asthma, bronchiolitis, severe headache
- Something wrong but not actually sick→ acute illness but not unwell, eg. URTI, UTI, mild asthma, ankle injury, sprain
- Administrative, nothing wrong→ needs medical certificate, travelling, needs INR redone
What does each letter represent in DRABCDE and what do they entail
A= Airway (with cervical spine control)→ most important as can die within minutes if occluded B= Breathing→ give oxygen immediately C= Circulation→ can die within hours if circulation is obstructed D= Disability→ neurological abnormality, assess conscious state E= Expose→ check the whole patient
What is the 30 second assessment and what does it tell you
-Can you tell me your name
-What’s the problem
-Where does it hurt
→ by doing so, able to tell the patient is conscious, airways are clear, coherent, ca also observe
→ watch the patient as they walk in
-Are they walking normally
-Are they walking hunched over in apparent pain
-Are they sitting still or moving around
-Are they pale, sweaty, SOB
-Look at monitor
What is a fracture- when do they require immediate attention
a fracture is a break or rupture in a bone
-if a fracture damages a nerve or blood vessel or perforates the skin→ requires immediate treatment
What is a dislocation- when do they require immediate attention
- the displacement of joint surfaces such that normal articulation no longer occurs
- more urgent than fractures due to constriction of muscles around joint→if you don’t get a dislocation reduced within a day, it will most likely not be reduced
What is a nerve block
place anaesthetic where nerve is to provide better analgesia for peripheral injuries
What are the factors affecting the urgency of treatment for MSK injuries
-Abnormal ABC
-Bleeding
-Presence of vascular compromise
-Open wounds
-Presence of neurological compromise
-Pain
-Risk of loss of function if care not received
Immediate Care: analgesia, splinting, prevention of infection, reduction
What does comminuted mean for x-rays
more than 2 bone pieces
what does displacement mean in x-rays
bone ends are not aligned
what does angulation mean in x-rays
bone ends are on an angle
What are the benefits/purpose of reduction
reduce pain, reduce neurovascular structures, restore function, significant pain associated with reduction and should only be done with adequate analgesia
what are the benefits/purpose of splinting
-reduce pain, reduce bleeding, reduce further risk of compromise, promote healing
What is somatic pain
Somatic pain is a type of nociceptive pain that is also referred to as skin pain, tissue pain, or muscle pain. The nerves that detect somatic pain are located in the skin and deep tissues
What is visceral pain
Visceral pain is pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs). Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation, but relatively insensitive to other stimuli that normally evoke pain such as cutting or burning.
Why is the management of pain important
provides comfort to patient, can prevent further deterioration/alteration in vitals, makes patient more compliant
How do anaesthetics work
unionised form crosses membranes->ionised form will bind to sodium channels holding them in an inactive form so that depolarisation cannot occur and no action potential will be produced→ stops signal propagation
Why may an anaesthetic not be effective in an abscess
-abscesses normally have a lower pH
-unionised drugs are able to pass the lipid cell membrane more quickly than ionised, therefore are able to exert its effect more rapidly→ in infected tissues, the pH is lower meaning the
amount of unionised molecules are decreased, leading to lower effectiveness
How does ketamine work
Antagonises NMDA receptors and effects the movement of sodium and calcium across the membrane → causing blockage of sensory input
Why is ketamine useful in the ED setting
causes hypertension and tachycardia→ causes blood pressure to increase→ useful in hypotensive patients
-blocks sensation whilst keeping patient awake
What signs on physical examination suggest damage to the median nerve
•Carpal tunnel syndrome → numbness in thumb, index and middle finger and radial side of ring finder. Aching in thenar eminence. Weakness in adbuctor pollicis brevis and opponens pollicis
•Pronator syndrome → aching discomfort in forearm, weakness in hand, numbness in thumb and index finger
-Lack ability to abduct and oppose the thumb due to paralysis of thenar muscles
-Sensory loss in thumb, index finger, middle finger and radial aspect of the ring finger
-Weakness in forearm pronation and wrist and finger flexion
What signs on physical examination suggest damage to the radial nerve
Difficulty straightening the arm at the elbow
- Inability to pronate
- Difficulty to flex wrist and fingers
- Muscle atrophy in forearm
- Wrist or finger drop
What signs on physical examination suggest damage to the axillary nerve
- Generalised mild, dull and achy pain to the deep or lateral shoulder, with occasional radiation to the proximal arm
- Numbness and tingling of the lateral arm and/or posterior aspect of the shoulder
- Weakness of flexion, abduction and external rotation
What signs on physical examination suggest damage to the sciatic nerve
- inability to raise heel, ankle drop, difficulty flexing knee
- -> effect depends on level of damage
What is oral analgesia and when is it used
-analgesia like panadol that is able to be take orally, is cheap and easy to dispense and works well for minor injuries
What is parenteral analgesia and when is it used
includes both intramuscular injection and intravenous injection. Once administered these are usually stronger “pain killers” including opiate derivatives and are far more effective.
What is a regional block and when is it used
involve injection of a local anaesthetic around a nerve. This results in pain relief in the area of distribution of the nerve. This is good for isolated injuries but obviously has limited use, as a complete solution, in multiple trauma as the dose of local anaesthetic would be prohibitive.
What is the reasonable length of time to deliver analgesia
30 min
What are important points associated with using opioids as analgesics
- work well in severe pain
- give IV
- titrate the dosage to the affect–> do not give large dose initially, gradually increase until pain is gone
What muscles are innervated by the median nerve
flexor carpi radicalise, palmaris longus, pronator quadratus, pronator teres, digital flexors
What muscles are innervated by the ulnar nerve
flexor carpi ulnaris, flexor digitorum profundus, adductor pollicis, thenar muscles, digiti minimi
For a child with a deformed forearm fracture the most appropriate initial analgesia is what
nebulised fentanyl
When is the axillary nerve most often damaged and why
shoulder dislocations-> rotator cuff prevents posterior dislocation-> axillary nerve is anterior
How would you test the function of the axillary nerve
abduction-> testing deltoid
What nerve may be injured by a tight below knee plaster?
Common fibular- comes from popliteal fossa and winds around fibular head
How would you assess function of the common fibular nerve
Common fibular supplies dorsiflexors of ankle test ankle dorsiflexion
What physical findings would suggest ulnar nerve lesion
- The MCP joints are hyperextended, and the IP joints are flexed because the first and second lumbrical muscles are not paralyzed (degree of finger flexion retained due to flexor profundus superficialis supplied by the median, but flexor profundus is ulnar)
- Loss of abduction of the fingers (due to loss of interossi- all interossi are supplied by ulnar)
- adduction of thumb is by ulnar, so some adduction is lost
Ulnar claw hand is caused by loss of which muscles
Loss of function of lumbricals- specifically ulnar lumbricals
What muscles belong to the: -Anterior -Lateral -Superficial posterior -Deep posterior compartments of the leg
Anterior: tibialis anterior, extensor digitorum longus, extensor hallicus longus,fibularis tertius
Lateral: fibularis longus, fibularis brevis,
Superficial posterior: gastrocnemius, soleus, plantaris
Deep posterior: popliteus, tibialis posterior, flexor digitorum longus, flexor hallicus longus,
