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46 Cards in this Set

  • Front
  • Back
what injuries are the most common in trauma?
limb injuries are most common, but head and visceral injuries are the most fatal
what are the leading cause of accidental deaths?
MVA
what are the leading cause of non-fatal injuries?
falls
what changes have had signigicant effect on injury pattern in MVA's?
automobile design change; use of safety devices
airbags reduce abdominal and chest injuries, but increase ortho limb injuries
tri-modal distribution of death
death within minutes
death in the first hour (golden hour)
death in days/weeks
initial assesment plans
resuscitation
primary survey
detailed secondary survey
initiation of definitive care
primary survey
A: airway maintenance with C-spine control
B: breathing and ventilation
C: circulation
D: disability (neurological status)
E: exposure (water, high/low temps)
secondary survey
A: allergies
M: medication
P: past medical history
L: last time of food or drink
E: events and environment related to injury
stages of multiple trauma patient treatment
I: treatment at scene--EMS
II: evaluation and resuscitation in ER
III: early treatment of chest and abdominal complications
IV: treatment of musculo injuries
V: long term rehab
MESS
mangled extremity severity score--
energy of trauma: 4 points
shock: 2 points
limb ischemia: 3 points
age: 2 points
*primary amputation is more than 6 points
fracture immediate demands
vascular compromise
hemorrhage
sprains vs. strains
sprain= supporting structures of a joint

strain= stretching or partial tear of a muscle
dislocation
joint surfaces are completely displaced and are no longer in contact
-should be reduced promptly
-shoulder is most frequent dislocation
subluxation
lesser degree of displacement such that the articular surfaces are still partly apposed
fracture
disrupt in continuity of a bone
closed fracture
skin over and near fracture is intact
open fracture
skin over and near fracture is lacerated or abraded by the injury
fractures occur because of:
1. traumatic events
2. repetitive stress
3. abnormal weakening of bone
fracture classification and description
1. by location on bone
2. orientation/extent of fracture line(s)
3. amt of displacement of fracture fragments
4. integrity of skin and soft tissue envelop around fracture
orient/extent of lines
-transverse (perpendicular to shaft of bone
-oblique (angulated)
-spiral (multiplanar and complex)
-comminuted (more than two fragments)
-segmental
location
epiphyseal- end of bone
metaphyseal-flared portion of bone at ends of shaft
diaphyseal-shaft of long bone
orientation, ctd.
intra-articular (line crosses articular cart and enters joint)
torus (buckle)
compression (impaction; vert or proximal tibia)
greenstick (incomplete with angulation deformity)
pathologic (bone weakened by disease or tumor
amt of displacement
nondisplaced
displaced
angulated
bayonetted (distal frag longitudinally overlaps proximal frag)
distracted (distal frag separated from proximal by gap)
diagnosis is confirmed with:
x-rays- always get joint above and below the bone involved
pathologic fracture
bone may be weakened by:
tumor
osteoporosis
metabolic conditions (paget's)
secondary bone healing
1. inflammatory phase (1-5 days)
2. reparative phase (7-40)
3. remodeling phase (>50)
delayed union
fracture fails to consolidaate in timeusually required for union to occur
causes of delayed union
inaccurate reduction, inadequate or interrupted immobilization, severe local trauma, infection, loss of bone substance, distraction of fragments
non-union
process of bone repair ceases after having failed to produce firm union (> 6 months)
causes of nonunion
separation of fragments, loss of bone substance, inadequate immobilization, repeated manipulation, interposition of soft tissue, infection, impairment of circulation
diaphyseal impaction
from axial compression load; usually intercondylar humerus, femur, tibial plafond
transverse
from bending; usually long bone diaphysis
spiral
torsion; any long bone diaphysis; often tibia, humerus
oblique transverse (butter-fly)
axial compression and bending; usually femur, tibia, humerus
oblique
axial compression + bending + torsion; usually tibial-fibular or forearm
fracture types
closed, open, fatigue, pathological
type I open fracture
clean wound less than 1 cm, inside/out injury, simple fractures (Ski injury)
no evidence of contamination
type II
skin laceration larger than 1 cm, some minor contusion around laceration, minimal comminution (low velocity auto accident)
-no soft tissue stripped from bone
type IIIA
moderate soft tissue injury, adequate soft tissue coverage of fractured bone
IIIB
extensive soft tissue injury, periosteal stripping with significant bone exposure
IIIC
all of IIIB and vascular injury
*this is an amputation risk
treatment
dress wounds, splint fractures, irrigation and debridement
*open contamination of wounds should be left open
treatment option
internal fixation, external fixation
complications of fractures
venous thrombosis and pulmonary embolism- dilemma is anticoagulant versus mechanical measures only
tetanus, gas gangrene, fat embolism, infection, avascular necrosis, amputation, malunion, delayed union, non-union
compartment syndrome
compression of nerves and blood vessels within an enclosed space, leading to impaired blood flow and nerve damage; most common in lower leg and forearm, but can also occur in hand, foot, thigh, and upper arm
signs of compartment syndrome
extreme pain out of proportion, pain on passive ROM of fingers/toes, pt holds injured part in position of flexion, pallor of extremity, paralysis, paresthesias (early loss of vibratory sensation), pulses