WK 1- MSK

Question 1

What are the 5 categories of the triage system and in what time frame must they be seen (provide examples of each cat)

Answer 1

Cat 1. Dying→ seen immediately→apparent physiological abnormality already eg. Seizures, unconsciousness, hypotensive, multi-trauma, severe SOB, hypoxia

2. 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
3. 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
4. Something wrong but not actually sick→ acute illness but not unwell, eg. URTI, UTI, mild asthma, ankle injury, sprain
5. Administrative, nothing wrong→ needs medical certificate, travelling, needs INR redone

Question 2

What does each letter represent in DRABCDE and what do they entail

Answer 2

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

Question 3

What is the 30 second assessment and what does it tell you

Answer 3

-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

Question 4

What is a fracture- when do they require immediate attention

Answer 4

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

Question 5

What is a dislocation- when do they require immediate attention

Answer 5

• 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

Question 6

What is a nerve block

Answer 6

place anaesthetic where nerve is to provide better analgesia for peripheral injuries

Question 7

What are the factors affecting the urgency of treatment for MSK injuries

Answer 7

-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

Question 8

What does comminuted mean for x-rays

Answer 8

more than 2 bone pieces

Question 9

what does displacement mean in x-rays

Answer 9

bone ends are not aligned

Question 10

what does angulation mean in x-rays

Answer 10

bone ends are on an angle

Question 11

What are the benefits/purpose of reduction

Answer 11

reduce pain, reduce neurovascular structures, restore function, significant pain associated with reduction and should only be done with adequate analgesia

Question 12

what are the benefits/purpose of splinting

Answer 12

-reduce pain, reduce bleeding, reduce further risk of compromise, promote healing

Question 13

What is somatic pain

Answer 13

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

Question 14

What is visceral pain

Answer 14

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.

Question 15

Why is the management of pain important

Answer 15

provides comfort to patient, can prevent further deterioration/alteration in vitals, makes patient more compliant

Question 16

How do anaesthetics work

Answer 16

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

Question 17

Why may an anaesthetic not be effective in an abscess

Answer 17

-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

Question 18

How does ketamine work

Answer 18

Antagonises NMDA receptors and effects the movement of sodium and calcium across the membrane → causing blockage of sensory input

Question 19

Why is ketamine useful in the ED setting

Answer 19

causes hypertension and tachycardia→ causes blood pressure to increase→ useful in hypotensive patients
-blocks sensation whilst keeping patient awake

Question 20

What signs on physical examination suggest damage to the median nerve

Answer 20

•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

Question 21

What signs on physical examination suggest damage to the radial nerve

Answer 21

Difficulty straightening the arm at the elbow

• Inability to pronate
• Difficulty to flex wrist and fingers
• Muscle atrophy in forearm
• Wrist or finger drop

Question 22

What signs on physical examination suggest damage to the axillary nerve

Answer 22

• 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

Question 23

What signs on physical examination suggest damage to the sciatic nerve

Answer 23

• inability to raise heel, ankle drop, difficulty flexing knee
• -> effect depends on level of damage

Question 24

What is oral analgesia and when is it used

Answer 24

-analgesia like panadol that is able to be take orally, is cheap and easy to dispense and works well for minor injuries

Question 25

What is parenteral analgesia and when is it used

Answer 25

includes both intramuscular injection and intravenous injection. Once administered these are usually stronger “pain killers” including opiate derivatives and are far more effective.

Question 26

What is a regional block and when is it used

Answer 26

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.

Question 27

What is the reasonable length of time to deliver analgesia

Answer 27

30 min

Question 28

What are important points associated with using opioids as analgesics

Answer 28

• 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

Question 29

What muscles are innervated by the median nerve

Answer 29

flexor carpi radicalise, palmaris longus, pronator quadratus, pronator teres, digital flexors

Question 30

What muscles are innervated by the ulnar nerve

Answer 30

flexor carpi ulnaris, flexor digitorum profundus, adductor pollicis, thenar muscles, digiti minimi

Question 31

For a child with a deformed forearm fracture the most appropriate initial analgesia is what

Answer 31

nebulised fentanyl

Question 32

When is the axillary nerve most often damaged and why

Answer 32

shoulder dislocations-> rotator cuff prevents posterior dislocation-> axillary nerve is anterior

Question 33

How would you test the function of the axillary nerve

Answer 33

abduction-> testing deltoid

Question 34

What nerve may be injured by a tight below knee plaster?

Answer 34

Common fibular- comes from popliteal fossa and winds around fibular head

Question 35

How would you assess function of the common fibular nerve

Answer 35

Common fibular supplies dorsiflexors of ankle test ankle dorsiflexion

Question 36

What physical findings would suggest ulnar nerve lesion

Answer 36

• 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

Question 37

Ulnar claw hand is caused by loss of which muscles

Answer 37

Loss of function of lumbricals- specifically ulnar lumbricals

Question 38

What muscles belong to the:
-Anterior
-Lateral
-Superficial posterior
-Deep posterior 
compartments of the leg

Answer 38

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,