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11 Cards in this Set
- Front
- Back
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Indications for an angiogram?
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1. ABI <.0.9
2. Cool extremity with slow cap refill 3. High energy trauma in high risk area |
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Trauma radiographic series?
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Lateral of:
1. Cervical spine AP of: 1. Thorax 2. Abdomen 3. Pelvis |
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Gustilo and Anderson classification of open fractures?
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I. <1 cm long, clean
II. 1-10 cm long, moderate contamination IIIa. > 10 cm, crushing IIIb. > 10 cm, degloving IIIc. > 10 cm, vascular compromise |
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Tscherne classification of open fractures?
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Grade I: small laceration - contusion
Grade II: small laceration + contusion Grade III: large laceration with sizable soft tissue damage Grade IV: incomplete or complete amputation |
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Timing of operative intervention for open fractures
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Within 8 hours, as after 8 is correlated with higher incidence of infection and osteomyelitis.
If surgery is delayed at night until the AM, explore, irrigate, and debride initially in the ER. |
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Antibiotics for open fractures?
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Based on the Gustilo and Anderson classification:
Grade I: cefazolin 1g q8h Grade II: cefazolin 1g q8h Grade III: cefazolin 1g q8h + aminoglycoside 3-5 mg/kg/d Farm injuries (organic contamination): PNC + aminoglycoside |
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What prophylactic immunizations in the ER?
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Tetanus:
1. Everyone gets diphtheria toxoid and tetanus toxoid 2. If incomplete tentaus series, also administer tetanus Ig. |
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Operative treatment of an open wound?
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1. Extend wound proximal and distal.
2. Debride meticulously (devitalized bone out, keep tendons). 3. Lavage >10L. 4. Serial debride. |
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How frequently to serial debride?
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Debride q24-48 hours until no more necrotized soft tissue or bone.
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When to close the wound?
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Once there is no further evidence of necrosis.
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The Mangled Extremity Severity Score?
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The summation of tissue injury, limb ischemia, shock, and age. Score >7 predictive of amputation:
Tissue injury points: 1 - low energy (stab, etc) 2 - medium energy 3 - high energy 4 - very high energy (gross contamination) Limb ischemia 1 - pulse reduced 2 - pulseless, paresthesias 3 - cool, paralyzed, insensate Shock: 0 - SBP > 90mmHg 1 - hypotensive, transient 2 - hypotensive, persistent Age: 0 - <30 1 - 30-50 2 - >50 |
