Flashcards in ortho Deck (134)
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1
level 1 trauma center needs
all specialties/modalities avail 24hrs
MRI, Fluoroscopy, CT scan, etc avail for 24 hrs
2
The “Golden Hour”
Time we have to make a difference
ii. 1 hour – if you’re going to crump, you will crump
3
How does the PA student fit? Anticipate
Undress, log-roll (if on backboard), IV access, foley, doppler/API’s (looking for pulses, compartment syndrome), CPR, to CT
Lac repair, help ortho (reductions, etc), ophtho, ENT, etc
OR, care in-house
4
primary survey
ABCDE hx (if awake)
GCS and a C spine and a ULS
pt is phonating =has an airway
5
AMPLE survey
allergies
meds
PMH/PSH
last PO
events environment
6
Secondary Survey
1. Full systems exam, head to toe
2. More complete Hx
7
how to management pt with . GSW
Stabilize the patient if unstable - undress
Determine where, how many, other injury
Neurovascular integrity is the priority in extremities
Penetrate the joint?
8
checking neurovascular integrity should look like what
Check: pulses, pallor, temp (cold?), cap refill
2. Sensory exam
9
how to evaluate weather or not a shot has penetrated the joint
Air in joint = penetration
10
how should you report a fx with a GSW
"i have a GSW with an open fracture to the left tibia"
11
how to treat fxs
• X-ray all – joint above/below
• If fx, treat as open fx
• Local wound care, debridement
• Surgery, ortho consult
• Consider Abx
• Splint, close follow-up
• Tetanus
12
big concern with femur fracture
Risk for compartment syndrome
all of huge critical arteries that supply the leg will be pulled and the legg will probably need a steinman pin might be needed to correct
13
what should we be thinking about with pelvis fx
Internal injury common (strap them with stabilization device)
Surg admit, ortho consult
worry about the bladder, reproductive organs, rectum
14
big tell tale sign of hip fx
can't bare weight
15
risk for hip fx
Describe location
1. Classic – old woman who
fell down
Risk for AVN
Occult fx? CT(first test) or MRI*(definitive)
Ortho admits for pin or
replacement
16
talking to pts about knife and stab wound
We deal with extremities/stable pt only
think immediately about assault and police reports
Good history; police report made?
tell me what happened and show me what position you were in
17
how to approach stab wounds
Count, measure, explore deeper structures
i. Function, neurovascular exam
Imbedded objects are removed in the OR – don’t pull them out (may have lacerated one of the arteries but if you leave it in it stops the bleeding)
18
why would you do delayed primary closure
High risk, contaminated or neglected wounds – don’t suture
1. Hands, feet, over joints; immunocomp pt; crush, bite, puncture
2. Predict high infection risk
19
when to have pt return for high risk wounds
Copious irrigation, wound debriedment
iii. Leave open, no suture, dry dressing
iv. Follow-up in 3-5 days – suture the wound then if no infection
v. Pt Ed/document: Discussed, return signs infection, increased scar risk
20
arterial bleed 1st approach
Universal precautions, ABC’s
Check for foreign body, elevate
21
managing arterial bleed in the wilderness
1st small tightly folded nugget with pinpoint accuracy
2 incremental larger or less folded piece of gauze
22
TXA used for
Tranexamic acid
clott promoter arterial bleed
23
Traumatic ABI looks like
Comparison of ipsilateral upper and lower extremity systolic pressure
24
how to take ABI
Pt supine, BP cuff, doppler
Doppler brachial SBP, then highest of dorsalis pedis and posterior tibial
25
ABI
ABI = Ankle SBP/Brachial SBP
26
Arterial Pressure Index (API)
Compare injured extremity to the other one (for example – compare L foot to R foot)
API = Injured SBP/Uninjured SBP
27
Approach to Ortho Injuries
Mechanism and when occurred
Associated sx’s/risk – fall, high energy, helmet, protective gear
Sx’s other than pain? Numb? Weak? LOC? Weight bear? Hear noise?
Pain right away or delayed?
Blood loss estimate; arterial?
Dominant hand? DON;T MISS
Hx same/other injury in past?
Occupation? Work related?
Assault? DV? Police report?
PMH, Meds, Allergies
Tetanus?
Social situation
28
PE for ortho needs
anatomy, neurovascular exam are key
Master exam for each area
29
medication and imaging that needs consideration for ortho injuries
Pain control. Abx? Oral? IV?
Imaging: Xray 1st. Need CT?
Repair, reduction, splint?
ED splints; no cylindrical casting
Ortho consult, rec’s, f/u
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