chapter 8, musculoskeletal trauma
Post on 10-Sep-2015
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ObjectivesEstablish the principles for assessing the patient with musculoskeletal injuries.Establish treatment priorities.Identify the importance of musculoskeletal injuries in the multiply injured patient.
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Key QuestionsHow do musculoskeletal injuries impact on the primary survey?What are my priorities?What are my management principles?
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External bleeding Occult blood loss Long bone fracturesPelvic fractures
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Primary survey management?The 3 SsStop the bleeding!Splint the extremityStabilize the pelvis
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Why is splinting useful?Prevents further blood loss and injuryMay restore or maintain perfusion Relieves pain Important during evaluationDo not delay
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What are my early concerns?Vascular compromise Open fractures
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Assess and manage vascular compromise?Reduce fracture(s)Splint fracture(s)Assess by DopplerObtain consult (time is critical)Consider angiography
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Information to help my assessment?Mechanism of injury Energy forces involvedAssociated factorsTime of injury Location of injury
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How do I manage open fractures?Apply appropriate splintCleanse / debride (now or later)Consider time factorObtain orthopaedic consult
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Secondary SurveyLookFeel Listen
For What?
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For What?LookDeformity Pain TendernessWound(s)FeelCrepitusSkin flaps Neurologic deficit PulsesListen Doppler signalsBruit
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Secondary SurveyWhat x-rays do I need?Any suspected area One joint above and below When do I obtain them?Patient is hemodynamically normal
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Secondary SurveyWhen should I delay getting x-rays?If life-threatening injuries take priorityIf patient transfer will be delayed
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What injuries may cause compartment syndrome?
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What injuries may cause compartment syndrome?Tibia and forearm fracturesVascular and bony injuries Injuries immobilized in tight dressings or castsSevere crush injuries to muscle Burns
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How do I recognize compartment syndrome?PainParesthesia PallorParalysisPulse loss (late)Tissue pressures >35 to 45 mm Hg
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What are the pitfalls?Occult fracturesVascular injuryCompartment syndromeMinor injuries AnticoagulationAltered sensorium
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Manage life-threatening injuries first Stop the bleeding!Reduce and immobilize fractures and dislocationsRecognize vascular compromise Avoid delay in management
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