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31 Cards in this Set
- Front
- Back
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Ottawa Ankle Rules for Ankle radiographs
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Must have pain in the malleolar region AND any of the following
1. tenderness of post edge of distal 6 cm or tip of lateral malleolus 2. Tenderness of post edge of distal 6cm or tip of medial malleolus 3. unable to bear wt both immediately after the injury and at the time of evaluation |
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Ottawa Ankle Rules for Foot radiographs
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Must have pain in the midfoot region and
1. tenderness of the navicular bone 2. tenderness at the base of the 5th metatarsal 3 Unable to bear wt both immediately after the injury adn the time of evaluation |
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What are some of the limitations of the Ottawa ankle rules?
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- Intoxication
- Multiple trauma - Head injuries - Decreased sensation/ neuro deficit |
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What is an Avulsion fracture?
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- Bone fragment pulled from its normal position by a tendon or ligament
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What is an intrarticular fracture?
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- Fracture involves articular surface
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How to classify Open fractures?
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Grade I : wound < 1cm
Grade II: wound 1-5cm w/o excessive contamination, crush injury or soft tissue loss Grade III: wound > 5cm or gross contamination, crush injury or excessive soft tissue loss |
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Is an open fracture considered an orthopedic emergency?
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YES!!!!!!!!
High risk of osteomyelitis |
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What antibiotics are you going to give with open fractures?
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1st gen cephalosporin
aminoglycoside for type II and III |
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What are you concerned about with open fractures?
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COMPARTMENT SYNDROME
neurovascular disruption hemorrhagic shock from blood loss |
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What is the clinical presentation of compartment syndrome?
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pain paresthesias
pallor paralysis pulselesness |
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How is compartment syndrome diagnosed and what is the Tx?
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with manometry
normal pressure near 0 Pressure >30 usually requires intervention Tx: fasciotomy |
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What are other complications of fractures?
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osteomyelitis
fat embolism avascular necrosis RSD |
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What is the management of fractures in the ED?
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NPO
Ice elevation analgesics immobilization |
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What are the 3 main options for management of fractures?
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Splint
close reduction and splint open reduction and internal fixation |
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Why splint instead of cast?
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keeps bone alignment maintained while allowing room for soft tissue swelling
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What are true orthopedic emergencies that require ortho to see pt in ED?
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compartment syndrome
open fracture circulatory compromise irreducible dislocation injuries needing surgical repair |
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What is a Greenstick fracture?
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An incomplete angulated fracture of a long bone
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What are the clinical presentation of subarachnoid hemorrhage?
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Thunder clap HA
Nuchal rigidity 50% AMS in 50% Sentinel HA |
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What is the diagnostic test for SAH?
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non contrast CT
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When is a CT for SAH most reliable?
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12 hrs 98%
93% at 24hrs 50% at 1 week |
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What is the next step if the CT scan is negative but the clinical suspicion for SAH is high?
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Lumbar puncture look for:
RBC if < 12hrs Xanthochromia > 12hrs |
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What is angle closure glaucoma?
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disruption of aqueous humor outflow resulting in abrupt increase intraocular pressure
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What are the clinical presentation of angle closure glaucoma?
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Severe eye pain, HA, vomiting, visual disturbances
-cloudy cornea -injected conjuctive -mid sluggish or fixed pupils |
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What is the treatment of angle closure glaucoma?
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-Decrease aqueous humor: azetazolamide, timolol
-decrease intraocular volume: mannitol -decrease pupil size pilocarpine |
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What is the clinical presentation of temporal arteritis?
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HA
visual loss in one eye Jaw claudication temporal tenderness |
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How do you diagnosis Temporal arteritis?
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ESR abnormal > 90%
artery biopsy |
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What is the treatment of temporal arteritis?
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STEROIDS
-IF SUSPECT begin steroids and refer for biopsy |
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Most common cause of acute poisoning death?
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Carbon monoxide
often presents with non specific symptoms such as HA, dizziness, vomiting |
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What is the first line therapy for migraines in the ER?
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Prochlorperazine (compazine)
can cause akisthesia |
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What are other meds used to treat migraines in the ER?
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metocloperamide
Ketorolac triptans dihydroergotamine |
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How do you treat cluster HA?
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the same as migraines + O2
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