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NP 730 Diagnostic Measures > X-rays and Splinting > Flashcards

X-rays and Splinting Flashcards

1
Q

Volar Wrist Splint

A
  • Restricts wrist flexion and extension
  • For wrist sprains, stable wrist fractures
  • Splint to MCP level, fingers free
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2
Q

Sugar tong

A
  • Restricts elbow motion, wrist flexion/extension as well as pronation/supination
  • Forearm fractures
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3
Q

Thumb Spica

A
  • Any thumb sprain or fracture
  • Thumb metacarpal fracture
  • Acute scaphoid fracture
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4
Q

Coaptation

What nerve should be monitored during eval + application of this for this type of fracture?

A
  • Humerus fractures
  • Radial nerve
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5
Q

Long arm

A
  • Distal humerus fractures
  • Proximal radius fractures
  • Olecranon fractures
  • Splint elbow at 90 degrees
  • Elbow dislocation
  • Maintain wrist in neutral position
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6
Q

Ulnar gutter

A
  • Boxer’s fracture
  • Ulnar metacarpal injuries
  • Splint MCP joints at 90 degrees, intrinsic plus position
    • MP collateral ligament length
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7
Q

Stirrup and posterior short leg splint

A
  • Ankle fractures, dislocations
  • Ankle sprains
  • Splint ankle at 90 degrees
  • Achilles tendon injury
  • Calcaneus and talus fractures
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8
Q

AP vs PA x-rays

A
  • AP = anterior-posterior
  • PA = posterior-anterior
  • PA film – in pt back (smaller cardiac view)
  • AP film – heart appears larger
  • Direction the beam travels through chest to plate
  • Know which one you’d order and why. Which organs are closer to AP vs PA
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9
Q

Radiodensity x-ray

A

More dense structures will be lighter and less dense will be darker

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10
Q

Four indications for lateral chest x-ray

A
  1. To localize lesion seen on frontal CXR
  2. To clarify lobar collapse/consolidation
  3. To explore a retrosternal or retrocardiac shadow
  4. To confirm presence of fluid in one of the fissures

Always L lateral view (beam enters on R, plate positioned to pt’s L side)

L lower lobe more visible in this view

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11
Q

ABCDE method for CXR

A
  • Airways
  • Bones
  • Cardiac silhouette mediastinum
  • Diaphragm and gastric bubble visible
  • Everything else (lines, tubes, drains, EKG sticker)
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12
Q

ABCDE abnormalities - position causes

A
  • Position of the patient
    • Rotation off plate
    • Mediastinum off center
    • Clavicles rotated
    • Do not place supine - want 90 degrees or upright d/t gravity
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13
Q

ABCDE method: A (what to look for)

Common abnormalities

A
  • See trachea in line, lung fields clear and symmetrical
    • See bifurcation
  • White lines = lung markings all the way out to edge
  • black lines = defining lines of lobes
  • Blood vessels of hilum noted

Abnormalities: lung consolidation (PNA); tension PTX (look for medial sternal shift); COVID PNA; cancer masses

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14
Q

ABCDE method: B (what to look for?)

Common abnormalities

A
  • Clavicles equal and intact? How many ribs when at full lung capacity? (8-9 good)
  • Ribs and Shoulders intact?

Abnormalities: seeing all 10 ribs, clavicles not equal

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15
Q

ABCDE method: C (what to look for?)

Common abnormalities

A
  • L/R vent?
  • Atrium central line?
  • Width of heart should be as long as ribs (not less or more)
  • Mediastinum central and noted w/aortic arch
  • Cardiac size ok? CTR

Abnormalities: cardiomegaly

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16
Q

Cardiac Size on CXR

A
  • Measured in relation to the total thoracic width - the Cardio-Thoracic Ratio (CTR)
    • CTR = Cardiac width : thoracic width
  • Cardiac size is measured by drawing vertical parallel lines down the most lateral points on each side of the heart, and measuring between them.
  • Thoracic width is measured by drawing vertical parallel lines down the inner aspect of the widest points of the rib cage, and measuring between them.
17
Q

ABCDE method: D (what to look for?) and E

A
  • Rounded at bottom w/BL sharp costophrenic angles
    • Intact BL
  • Air noted at bottom of left side
  • No air on bottom right
  • E: write down what you see (bullets, leads, tubes, etc)

Abnormalities: blunted CPAs → COPD (w/flat diaphragm); air presence in diagphragm (fluid); diaphragm

E (foreign bodies, leads, etc)

18
Q

Imaging for muscular or soft tissue injuries

A

Clinical exam

MRI imaging

19
Q

Imaging for bony injuries

A

Clinical exam

X-ray imaging

Occasionally CT imaging - tibial plateau fracture

20
Q

Systematic view of ortho xrays

What to check?

A
  • Correct patient, side, most recent (date/same day)
  • 2 views (AP/lateral)
    • Can get 3 views
  • Joint above and joint below site of injury or 2 adjacent (I.e.: compare two hips)
21
Q

Rationale for Splinting and purpose

A
  • Prevents further blood loss and injury
  • Can restore or maintain perfusion
    • Kinked extremity = perfusion
    • Splint ASAP
    • Lengthen extremity before splinting
  • Relieves pain
  • Important during evaluation
  • Do not delay
22
Q

Reasons scaphoid fracture is a DO NOT MISS condition?

A
  • Fractured → only vascularized in one end → will die if not immobilized → thumb will be useless
23
Q

Cause, classic symptoms, of scaphoid fracture

Imaging? Type of splint?

A
  • FOOSH (fall on outstretched hand) w/pain in wrist and hand
  • Snuff box tenderness (suspect fracture)
  • CT, MRI, Bone scan
  • Thumb spica → holds thumb in extended position
  • Refer to hand consult
24
Q

Colle’s Fracture

what, MOI, imaging

A
  • Fracture of distal radius, sometimes w/fracture of distal ulna or ulnar styloid → dorsal angulation of bone fragment
  • Most are stable but can be unstable if articular surface involved
  • MOI: FOOSH
  • Imaging: X-ray
25
Q

Colle’s fracture

Treatment

A
  • Varies based on stability and deformity
  • Stable or non-angulated → volar splint
  • Unstable or angulated → closed reduction (align bones)
    • Hematoma block (lidocaine) → traction/ counter-traction
    • THEN volar or sugar tong
  • Most require surgery
  • Can use chinese trap finger mechanism
26
Q

Ottawa Ankle Rules

A
  • Ankle X-ray series only required if there is any pain in malleolar zone and…
    • Bone tenderness at posterior edge or tip of lateral malleolus
    • “ ” medial malleolus
    • Inability to bear weight both immediately and in ED for four steps
27
Q

Bimalleolar fracture + treatment

A
  • NOT STABLE
  • Need surgery and splinting
    • Posterior and sugar tong splint
    • Help immobilize ankle in two planes of movement
28
Q

Pilon fracture + treatment

A
  • Fractured tibia at base near ankle
  • EXTREMELY UNSTABLE b/c cannot bear weight
  • Can make it worse
  • Fracture will continue up tibia if bearing weight → can make it worse if putting weight on it
29
Q

Trimalleolar fracture

A
  • WORSE CASE SCENARIO
    • dislocation of tibial-talor joint & bilmalleolar fracture
  • Fracture can move around
30
Q

Masionneuve Fracture + treatment

A
  • DO NOT MISS
  • Proximal fibular fracture accompanying any kind of ankle fracture
  • Rotational forces transmitted up to knee (ankle inversion)
  • Palpate proximal fibula in any ankle injury (image whole) - palpate 5th metatarsal AND up by knee
  • Treatment: long-leg posterior splint → ortho referral
    • strict non-weight bearing
31
Q

5th metatarsal fracture

A
  • Important to palpate 5th MT in ankle injury assessment
  • Hard to see on x-ray films - low threshold to view
  • Treatment: posterior splint or JONES dressing

No foot film necessary if no pain on palpation

NP 730 Diagnostic Measures (11 decks)

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