6. Accidents and first aid

What’s an accident

an incident happening unexpectedly and unintentionally, typically resulting in injury or damage

What’s trauma

an acute physical injury to any part of the human body. caused by sudden external transfer or mechanical, thermal, electrical or chemical energy

Polytrauma

simultaneous sever injuries to two or more distinct body regions or organ systems. at least 1 injury is potentially life threatening, causing critical physiological derangement

7 steps on how to approach trauma

• check the scene’s safe

• check the patient’s safe

• call for help

• structured assessment of a patient- ATLS

• Primary survey, then resuscitate

• Repeat that until the patient’s stable.

• Secondary survey

what’s ATLS

advanced trauma life support

how to do advanced trauma life support

xABCDE

x meaning and what to do abt it

exsanguinating external haemorrhage

Control massive bleeding immediately to stop them from dying via bleeding out

A meaning

airway: maintain airway & cervical spine protection

how do you know the airway’s alright

if they’re talking/screaming

B meaning

Breathing: ensure adequate ventilation and oxygenation

C meaning

circulation: assess circulation control & control hemorrhage

D meaning

Disability: do a neurologic status evaluation

E meaning

Exposure/environment

completely undress patient, but prevent hypothermia

Do top-to-toe examination to check for more injuries

What sort of fracture does a high energy injury lead to

femoral or tibial shaft fracture, pelvic fracture

what sort of fracture does a twisting injury lead to

ankle fracture or soft tissue knee injury

what sort of fracture does a direct fall onto a knee lead to

patella or tibial plateau fracture

what sort of fracture does a dashboard injury lead to

hip dislocation or soft tissue knee injury

what sort of fractures can a fall from a height lead to

bruh anything

what sort of fracture can a fall landing on their feet cause

calcaneal fracture

What else do i check

• circulation

• sensation & motor function (neurovascular status)

how to check sensation of radial nerve

touch bit between thumb and index on the dorsal side

how to check sensation of the median nerve

touch bit between thumb and index on the palm bit of the hand

how to check sensation of the ulna nerve

touch bit between little and ring finger on the palm and dorsal bit of hand

how to check motor of the radial nerve

see if they can extend wrist and fingers at the knuckle joint

how to check motor of median nerve

see if they can touch their thumb and little finger together

how to check motor of ulna nerve

see if they can spread their fingers out

What are MRIs used for

soft-tissue injuries, occult fractures

conservative way of treating fractures

• sling

• splint

• cast

• functional rehab

operative way to treat fractures

• reduction

• external fixation

• internal fixation

• arthroplasty

how to treat open fractures (7)

• use IV antibiotics

• use a tetanus booster if needed

• get consent to take photos

• remove gross contamination

• cover wound w saline soaked gauze

• orthoplastics assessment

how much blood loss for femur

1-2 L

how much blood loss for tibia

0.5-1 L

how much blood loss for Humerus

0.5-0.75 L

What;s compartment syndrome

limb-threatening emergency caused by the build up of pressure in an enclosed muscle compartment, due to being surrounded by tight fascia that can’t stretch

Problems with increased pressure

compression of veins, reduced venous damage, fluid leaks into tissues, increasing pressure.

OR exceeds diastolic BP, arterial inflow’s compromised, Ischaemia and tissue teeth → permanent muscle damage

Compression of nerves → paraesthesia and later motor weakness

ways to treat compartment syndrome

• give analgesia

• remove all circumferential dressings done to skin

• give IV fluids and oxygen to improve perfusion

• reasses in 30 minutes

how do you know you’re too late

parasthaesia, pulselessness, paralysis

what to do when you’re too late

take them to theatre for emergency fasciotomies (cutting the fascia to relieve pressure)

What a typical dislocation in the hip

Posterior

important complication w hip dislocation

sciatic nerve injury

important complications of knee injuries

popliteal artery, common peroneal nerve

important complications w ankle dislocation + fracture (they go together usually)

skin/vascular compromise