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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

30

pt education should include

• Splint care
• Importance of f/u
• Red Flags to return
• Recovery period
• Document!