MSK Trauma

Vocabulary flashcards derived from key concepts in the Musculoskeletal Trauma lecture notes.

Trauma Mortality

CNS injury is 1/2

exsanguination is 1/3

increased if older or lower GCS

Most common preventable mortality

hemorrhage

Immediate Mortality

death at the scene

disruption of great vessels, heart, lungs, brain, major body cavity

Early Mortality

death 1-4 hours after injury

result of CV or pulmonary collapse

Late Mortality

death days to weeks after injury

result of sepsis or multiple organ failure

ATLS

standard for trauma patients

standardized protocol for patient eval

treat most severe first

ABCDE Approach

A method used in the primary survey

Airway, Breathing, Circulation, Disability, and Exposure

SALT Triage

Sort, Assess, Lifesaving interventions, Treat/Transport

a systematic approach for mass casualty situations

Level 1 Trauma Center

highest level of care

leaders in research, clinical care, and education

Level 2 Trauma Center

providers definitive care in wide range of complex trauma patients

Level 3 Trauma Center

provides initial stabilization and treatment

can care for uncomplicated traumas

Level 4/5 Trauma Center

provides initial stabilization

transfers all trauma for definitive care

Airway: Conscious Patient

ask for name, what happened, and what hurts

observe for respiratory difficulty

inspect oropharyngeal cavity and anterior neck

palpate anterior neck

Airway: Unconscious Patient

protect airway and C-spine

Maintenance of Airway Patency

suction of secretions

chin lift/jaw thrust

nasopharyngeal airway

definitive airway

Airway Support

oxygen

NRBM

bag valve mask

definitive airway

Definitive Airway

ET intubation

surgical crichothyoidotomy

Breathing Evaluation

inspect chest wall for asymmetry or paradoxical movement

auscultate

palpate for crepitus and deformity

xray unstable patients

Breathing: Threats to Life

tension pneumo

massive hemothorax

cardiac tamponade

Needle Decompression

Used to treat pneumothorax

adults- 4th/5th intercostal space at mid axillary

peds- 2nd intercostal space mid clavicular

Chest Tube

Used for hemopneumothorax

inserted in 5th intercostal space mid axillary

Circulation Evaluation

palpate carotid and femoral pulse

observe for injury and control hemorrhage

measure BP

place large bore IV catheter or IO

type and cross match

Disability Evaluation

GCS

pupil size, symmetry, light response

motor and sensory ability

Glasgow Coma Scale (GCS)

15 point maximum

8 or less is severe head trauma

Exposure

visualize entire body (naked patient)

control environment for hypothermia

Primary Survey

The initial assessment phase focused on stabilizing trauma patients and identifying life-threatening injuries.

Secondary Survey

A thorough examination post-primary survey to identify additional injuries, involving a detailed history and head-to-toe exam.

AMPLLE History

allergies

medications (especially blood thinners)

past medical history

last meal

last menstrual period

events before trauma

Lethal Triad

hypothermia, coagulopathy, and acidosis

Lethal Triad Treatment

remove wet clothing and warm patient

give blood products

stop bleeding and treat the shock

Skin PE

lacerations

abrasions

ecchymosis

hematoma

Head and Face PE

inspect and palpate

fractures

step off deformity

soft spots

Neck PE

distended neck veins

C-spine eval

Neuro PE

serial exams

Chest PE

ecchymosis, deformity, tracheal deviation, crepitus

auscultation

count wounds and holes

imaging if indicated

Abdomen PE

Cullen sign or Grey Turner sign

auscultate and palpate

imaging if indicated

UG and Rectum PE

inspect penis, vaginal region, perineum

rectal exam if spinal cord injury, pelvic fx, penetrating abdominal injurt

MSK PE

inspect and palpate extremities

ROM

radiographs

Battle Sign

bruising on the temple

indicate basilar skill fx and brain trauma

Raccoon Eyes

bruising around eyes

indicated basilar skull fx

Seat Belt Sign

chest bruise indicating severe abdominal injury

Cullen Sign

bruising around bellybutton after 24-48 hours

Grey Turner Sign

bruising on the flanks after 24-48 hours

Peds Trauma

Broselow emergency tape gives weight estimate based on height, medical dose info, and size specific equipment

Peds Head CT if less than 2

altered mental status

GCS below 15

palpable skull fx

Peds Head CT if 2+

altered mental status

GCS below 15

signs of basilar skull fx

Non Accidental Peds Trauma

incongruent mechanism

delay of treatment

multiple healing stages

multiple hospital visits

injury not within child age scope

Accidental Peds Trauma Locations

nose

forehead

shins

above the buttocks

crown of head

Pregnant Trauma

women can lose significant blood before symptoms present

abruptio placentae and uterine rupture require hours of monitoring

always get OB consult, monitor fetus, and screen for IPV

Main Cause of Fetal Death

maternal shock

maternal death

Pregnant Positioning

left lateral decubitus position

Pregnancy Imaging

do not skip CT if concern for intra abdominal injury

Hypotensive Pregnancy

displace uterus to left side, do not lay flat

Geriatric Trauma Concerns

medications (mainly blood thinners)

fragility

increased age

Warfarin

increased risk of mortality in geriatrics by 60%

Geriatric Complications

4x more likely to die from pelvic fx complications

3+ rib fx gets ICU admit