CHAPTER 08 Ekstrem
Transcript of CHAPTER 08 Ekstrem
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Objectives
Recognize and describe the significance of
Musculoskeletal injuries.
Outline assessment priorities to identify
Life and limb-thereatening injuries.
Outline principles of management. Demonstrate ability to assess, assign
Priorities to, and initially manage injuries.
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Musculoskeletal Trauma Common, occasionally life -threatening
Major musculosekeletal injuries often
indicate other injuries
Hemorrhage, compartment syndrome,
Crush syndrome, fat embolism are life-
andlimb threatening problems
Continued reevaluation !
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Primary Survey/ Resuscitation Recognize and control hemorrhage
Direct pressure
Splint fractures
Aggressive fluid resuscitation
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Primary Survey Resuscitation
Adjuncts : Fracture immobilization
Goals
Hemorrhage control Pain relief
Prevent further softtissue injury
Apply splaint early,but avoid delay in
resuscitation
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Primary Survey/ ResuscitationAdjuncts : x-rays
Determinited by patient,s condition
Obtain AP pelvis early if hemodynamically
Abnormal and no obvious source of
bleeding
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Secondary SurveyHistory
Mechanism of injury
Environment
AMPLE history
Prehospital Care
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Secondary SurveyPhysical Examination
Expose / avoid hypothermia
Goal: Identify life-and limb-threatening,
and occult injuries
Examine Skin
Circulation
Neuromuscular
Skeletal
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Secondary SurveyLook
Bleeding deformity, color
Posteriorly using modified log roll
Spontaneous movement
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Secondary SurveyFeel
Temperature,tendernees,crepitus
Sensation
Joint stability
Back and pelvis: Tendernees, gap
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Secondary SurveyCirculatory Evaluation
Color, temperature
Pulse pressure, capillary refill
Paresthesia
Doppler: Ankle arm ratio Bruit / thril
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Secondary Survey
X-ray
Guided by clinical findings
Joint above and below
Obtain 2 views
Delay x-rays if: Vascular compromise
Impending skin breakdown
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Life- Thereatening Injuries
Major pelvic disruption with hemorrhage
Major arterial hemorrhage
Crush syndrome (rhabdomyolysis)
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Major Pelvic Disruption
Posterior pelvic structures disrupted
Pelvis open : vessels, nerves,rectum, skin
Mechanism of injury
Motorcycle
Pedestrian Crush
Falls > 12 feet (3.6 meters)
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Major Pelvic Disruption
Assessment and Management
Hemorrhage occurs rapidly, identify early
Unexplained hypotension
Open wounds, meatal blood, high prostate,
expanding hematoma
Palpable Motion of pelvic ring
Hemorrhage control, fluid resuscitation
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Major Arterial Hemorrhage Penetrating / blunt injury in close
proximity to artery
Hemorrhage ,hematoma,hypotension
Ischemic extremity
Stop the bleeding ! Immediate surgical consult
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Crush Syndrome Myoglobinuria
Metabolic acidosis, K ,Ca and
coagulopathy
Compartment syndrome
IV fluids,alkalization of urine
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Limb- Threatening Injuries
Open fracture and joint injuries
Vascular injuries
Compartment syndrome
Neurologic injury
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Open Fractures, Joint Injuries Wide- spectrum of soft-tissue injuries
Open wound = open fracture
Treatment
Splint sterile dressing tetanus
Immediate surgical consult
Tetanus prophylaxis
Antibiotics?
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Vascular Injury, Amputation Variable presentation : Assess pulses
Associated with fracture/dislocations
Realign
Check pulses after splinting
Immediate surgical consult
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Compartment Syndrome
Crush Injury with Compartment Syndrome
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Compartment Syndrome
Compartment preesure
Nerve/muscle ischemia necrosis Pain, paresthesia, paresis, swelling
Release constricting devices
Suspect in tibial, forearm fracture afterrevascularization inunconsciouspatient
Early surgical consult
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Neurologic Injury Due to fracture /dislocation
Posterior shoulder : Axillary nerve
Posterior hip : Seciatic nerve
Recognize injury and immobilize
Early surgical consult
Careful reduction, if possible, reassess
and splint
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Pitfalls
Occult injuries
Occult blood loss
Compartment syndrome
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Summary
Primary Survey :Indentify life-thereatening
Injuries
Secondary Survey :Indentify limb-
threatening injuries
Mechanism of Injuries :History important
Surgical consult
Early immobilization
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Question