Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
73 Cards in this Set
- Front
- Back
|
what is the classification system for open fractures
|
gustillo-anderson
|
|
|
GA type 1
|
clean wound
<1cm |
|
|
what is usual fracture pattern in type 1 GA
|
transverse or oblique
|
|
|
GA type 2
|
moderate contamination
>1cm but <5cm |
|
|
what is fracture pattern in GA type 2
|
transverse or short oblique
|
|
|
GA type 3
|
greater contamination
>5cm or open fractures greater than 8 hrs old |
|
|
3a
|
adequat st limited periosteal stripping
|
|
|
3b
|
massive contamination
local or free flaps |
|
|
3c
|
requires prophylatic fasciotomies
requires vascular repair most go to amputation |
|
|
which type 3 is most likely to get infected
|
3b
|
|
|
what is the golden window
|
first 6-8 hrs take that long for bacteria to replicate to a high enough level for infection
|
|
|
antibiotics in open fractures are what
|
therapeutic
|
|
|
infections in open fractures are usually caused by what
|
nocosomial organisms
|
|
|
all open fractures are what
|
contaminated
|
|
|
when should you obtain cultures
|
after you irrigate and debride
|
|
|
antibiotics should be given when with open fractures
|
within the first three hours
|
|
|
most common organism
|
staph aureus
|
|
|
most common gram negative organisms
|
pseudomonas and enterobacter
|
|
|
what is antibiotic of choice in GA type 1 and 2
|
2nd gen cefalosporin
Cefazolin or Ancef |
|
|
what is dosing of 2nd gen ceph
|
2 G IV stat
1 G IV q8 x 3 days |
|
|
what is antibiotic of choice for GA type 3
|
gentamycin or tobramycin
|
|
|
what is problem with gentamycin or tobramycin
|
ototoxicity and nephrotoxicity
|
|
|
which problem with gentamycin is irreversible
|
nephrotoxicity
|
|
|
what is dosing of gentamycin or tobramycin
|
1.5mg/kg stat
3-5 mg/kg QD in divided doses for 3 days |
|
|
what dosing should you consider with aminoglycosides
|
6mg/kg body weight in on daily dose
|
|
|
bacteriocidal effect of aminoglycosides is a result of what
|
peak concentration to minimun inhibitory concentration
|
|
|
nephrotoxicity and ototoxicity of aminoglycosides is a result of what
|
trough concentrations
|
|
|
antibiotic for farmyard accidents
|
penicillin G
|
|
|
antibiotic for freshwater and saltwater injuries
|
doxycycline
tetracycline |
|
|
what do you do if infection is still present after 3 days
|
more debridement
|
|
|
all patients should get this
|
tetanus
|
|
|
which patients get toxoid
|
all patients
|
|
|
which patients get immunoglobulin
|
those with last booster greater than 5 yrs ago
|
|
|
tetanus for no immunization and wound other than clean
|
.5ml td
|
|
|
previous immunization booster within 1 yr
|
none
|
|
|
immunization within 10 yrs no subsequent booster
|
.5ml Td
|
|
|
immunization more than 10yrs booster within 10 yrs
|
.5ml Td
|
|
|
immunization > 10yrs no booster within 10 yrs wound minor clean and treated appropriately
|
.5ml Td
|
|
|
immunization > 10yrs no booster within 5 yrs wound other than clean not treated appropriately
|
.5ml Td and 250-500 u TIG
|
|
|
no h/o immunization wound minor and clean adequate treatment
|
.5ml Td and schedule further immunization
|
|
|
no h/o immunization wound other than clean inadequate treatment
|
.5ml Td and 240-500 u TIG
|
|
|
what is the substance used in local delivery of aminoglycosides
|
polymethylmethacrylate
|
|
|
how high are the levels with local delivery
|
up to 20x therapeutic levels
|
|
|
how long is local delivery therapeutic for
|
4 wks
|
|
|
CaSO4 breakdown product looks like what
|
pus
|
|
|
what does devitailized tissue do
|
ihibits phagocytes and creates an anaerobic environment
|
|
|
what should be avoided during debridement
|
tourniquet and epinephrine
|
|
|
what indicates viability in skin
|
active bleeding from dermal skin
|
|
|
what part of tendon do you want to preserve
|
peritenon
|
|
|
what must be done with exposed tendon
|
must be covered with a graft muscel flap or primary closure
|
|
|
what is criteria for dertermining viability
|
color
consistency contractility capacity to bleed |
|
|
what part of bone should you maintain if possible
|
periosteum
|
|
|
how much irrigant should be used
|
10L
|
|
|
when is internal fixation the best
|
intra-articular ankle and rearfoot fractures
|
|
|
what should not be done with internal fixation
|
wound should not be primarily closed
|
|
|
when do you remove fixation
|
only if loose
|
|
|
best bone graft
|
autogeneous cancellous bone
|
|
|
what types can be primarily closed
|
type 1 and type 2 if adequately debrided and irrigated
no tension contamination or crush component <8hrs |
|
|
when should type 3 wounds be closed
|
within 3 days
|
|
|
where is best place for split thickness skin graft
|
dorsal and extensor surfaces
|
|
|
what is criteria for dertermining viability
|
color
consistency contractility capacity to bleed |
|
|
what part of bone should you maintain if possible
|
periosteum
|
|
|
how much irrigant should be used
|
10L
|
|
|
when is internal fixation the best
|
intra-articular ankle and rearfoot fractures
|
|
|
what should not be done with internal fixation
|
wound should not be primarily closed
|
|
|
when do you remove fixation
|
only if loose
|
|
|
best bone graft
|
autogeneous cancellous bone
|
|
|
what types can be primarily closed
|
type 1 and type 2 if adequately debrided and irrigated
no tension contamination or crush component <8hrs |
|
|
when should type 3 wounds be closed
|
within 3 days
|
|
|
where is best place for split thickness skin graft
|
dorsal and extensor surfaces
|
|
|
what type of wound coverage requires a plastic surgeon
|
local rotational and free tissue flaps
|
|
|
what method is used to determine if amputation is indicated
|
MESS
|
|
|
what are the clinical variables in MESS
|
limb ischemia
shock age skeletal and soft tissue injury |
