Term
| leading cause of death for all races and socioeconomic statuses ages 1-34 |
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Definition
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Term
| Trauma is the ___ leading cause of death for all age groups. |
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Definition
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Term
| __% of pediatric ER visits are due to trauma. |
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Definition
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Term
| ___ pediatric deaths per year are due to trauma. |
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Definition
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Term
| Most common cause of death in the non-infant child is __ |
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Definition
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Term
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Definition
“Neglected Disease”
Leading cause of death for people age 1 to 34 years of all races and socioeconomic levels
Third leading cause of death for all age groups
10,000 pediatric deaths per year due to trauma
30% of pediatric emergency room visits are due to trauma
Most common cause of mortality in the non-infant child |
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Term
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Definition
- physical and psychological effects of pain, limitation of daily activities, loss of independence, and quality of life
- expense of dx and tmt
- expense due to lost labor and diminished productivity |
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Term
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Definition
- Bone
- Tendon
- Muscle
- Nerve |
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Term
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Definition
1. Hematoma formation and angiogenesis- "sticky"
2. Cartilage formation with subsequent calcification- radiographic evidence of mineral formation
3. Cartilage removal and bone formation- filling in the gap
4. Bone remodeling- removal of bone from one site and deposition of bone into another site |
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Term
| Articular cartilage is made of ___ __ and ___. |
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Definition
- extracellular matrix (ECM)
- chondrocytes |
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Term
| Articular cartilage is/is not vascularized. |
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Definition
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Term
| Articular cartilage gets its nutrition from __ __. |
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Definition
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Term
| Since articular cartilage is not vascularized, it might not heal right and fill in with fibroid cartilage instead. This is why we immobilize these fractures but allow some movement so that synovial fluid will circulate. |
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Definition
| Motion circulates this fluid (This is the rationale behind rigid fixation of a fracture for early ROM, and early WB of immobilized joints) |
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Term
| Damage to articular cartilage can cause rupture of the __ and __ __. |
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Definition
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Term
| Acute or repetitive blunt trauma to articular cartilage has __ for __. |
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Definition
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Term
| With articular cartilage, chondral fissures, flap tears, or chondral defects have __ __ for __. |
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Definition
| - little chance for repair |
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Term
| With osteocohondral injuries such as hemorrhage, fibrin clot formation, and inflammatory responses, __ usually replaces the articularcartilage. |
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Definition
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Term
| Tendons are nourished by __ __ secreted by the __ __ that covers the tendon and the __ surface of the sheath. When a tendon ruptures, it is very difficult for it to repair itself. |
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Definition
- synovial fluid
- synovial membrane
- parietal surface |
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Term
| Muscles are composed of different fiber types classified based on their __ __ and __ function. Slow twitch fibers have a __ speed of contraction and are __ to fatigue, these are more numerous in __ athletes. Fast twitch fibers have a __ speed of contraction and are __ to fatigue, these are more numerous in __ athletes. |
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Definition
- metabolic activity and mechanical function
- slow
- difficult
- endurance
- fast
- easy
- power athletes |
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Term
| Muscle healing requirements: |
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Definition
- muscle regeneration
- reinervation of denervated muscle
- inflammatory reaction
- formation of connective tissue |
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Term
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Definition
In my practice I will often see patients who sustained a contusion at a nerve or stretched the nerve, giving the patient either paresthesias or no sensation on the skin with light touch or even pin prick
When peripheral nerves are disrupted, often it may only return to normal 1mm per day
Loss of normal sensation at a surgical site also falls into this disruption with a recovery of 1mm per day. Often the surgeon cuts a superficial nerve in the skin to perform the surgery. ACL and TKA patients may c/o loss of sensation to touch at their knee.
Acetabular fractures often require access to the fracture near the sciatic nerve. If the sciatic nerve is disrupted in any way, and not cut, it can take 2 years for patients to recover from this (ie. Recover from drop foot or from not being able to move the leg)
An amputated finger requires a well trained surgeon to reattach the finger and repair necessary soft tissues, including the nerve
Children have more optimistic outcomes than adults |
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Term
| Life threatening emergencies to always tend to first: |
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Definition
ABCDE
- Airway
- Breathing
- Circulation
- Disability
- Environmental and exposure |
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Term
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Definition
| spine and extremity issues |
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Term
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Definition
- History
- General examination
- Neuro exam
- Muscle exam
- Imaging studies |
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Term
| radiograph films include: |
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Definition
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Term
| A __ __ is very important in a trauma patient if they cannot communicate. |
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Definition
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Term
| complications in the ortho trauma pt: |
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Definition
Acute respiratory distress syndrome
Systemic inflammatory response syndrome
Multisystem organ failure
Fat embolism syndrome
Thromboembolic disease – PE and DVT
Atelectasis
Sepsis
Ectopic bone formation
Compartment syndrome |
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Term
| limb swelling and pain should always put __ in ddx. |
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Definition
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Term
| If a trauma pt has SOB and/or chest pain, immediately asssume ___. Get patient to ER stat. |
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Definition
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Term
| 6 Ps of Compartment Syndrome: |
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Definition
- Pallor
- Pulselessness
- Pain
- Paresthesias
- Paralysis
- Poikilothermia |
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Term
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Definition
Acute vs. Chronic
Occurs primarily in the LEs
Occurs anywhere in the body where there is a compartment
Occurs with open and closed fractures
Occurs with trauma
Do not ignore this possibility, because the patient could lose his/her limb |
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Term
| With compartment syndrome, __ is a late finding, so even if pts have a __, this does not rule out compartment syndrome. |
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Definition
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Term
| With compartment syndrome, __, __, __, and __ __ __/__. |
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Definition
- immobilize
- cool
- elevate
- remove constricting wrappings/splints |
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Term
| With compartment syndrome, acute pressure greater than or equal to __ mmHg requires immediate intervention and ___. |
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Definition
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Term
| what do you use to measure pressure in pts muscle to assess for compartment syndrome? |
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Definition
| - Stryker Intra-compartmental pressure monitor |
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Term
| possible causes of compartment syndrome: |
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Definition
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Term
| Anytime there is a cervical spine injury, also assume there is a ___ injury. |
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Definition
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Term
| With a cervical spine injury, __ the head and neck immediately until radiographs prove no fracture, subluxation, or dislocation present. |
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Definition
immoblize
Must palpate the spine fully to pin-point the location of the pain
Any spine injury requires a thorough neuro exam |
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Term
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Definition
- brachial plexus neurapraxia
- cervical strain
- cervical sprain
- cervical cord neurapraxia with transient tetraplagia
- cervical radiulitis |
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Term
| Brachial plexus neuraplexia is aka ___ aka __. |
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Definition
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Term
| Cervical spinal cord neurapraxia with transiet tetraplegia- have to stop playing sports all together |
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Definition
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Term
| Brachial plexus neurapraxia: |
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Definition
STINGER
Pinching or stretching of the brachial plexus in one of the upper extremities
Usually short duration
Pain free ROM of the neck and no neck pain
If neck pain suspect cervical spine fracture (always palpate the spine)
Common in contact sports
May return to sport with complete resolution of symptoms (No weakness and/or numbness)
Persistent symptoms –then NO RETURN TO SPORT – get X-ray and EMG, and refer to specialist
If have bilateral symptoms, but resolve – NO RETURN TO SPORT – must refer to the specialist urgently |
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Term
| 2 situations that a pt with stinger would not be able to go back to sports: |
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Definition
- persistent symptoms
- bilateral symptoms |
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Term
| Mechanism of injury for brachial plexus neurapraxia: |
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Definition
| - stretching or pinching of brachial plexus |
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Term
| Stinger symptoms usually resolve in __ minutes. The more often a pt has stingers, the longer the symptoms will occur. |
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Definition
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Term
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Definition
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Term
| Cervical sprain/strain with NO radiculitis: |
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Definition
In your office you may see a patient who sustained a neck injury in a motor vehicle collision (MVC). Do not assume a sprain/strain without x-rays. Fractures from a ‘whiplash’ injury can be subtle on x-rays. If x-ray is positive recommend immobilizing the neck, and referral to the orthopedic specialist. Also, give the patient ER precautions.
It is o.k. to give the patient a muscle relaxer, anti-inflammatory, and pain medicine.
If no fracture suspected treat the patient conservatively
If the pain is intense you can use a cervical collar for a brief amount of time
I recommend seeing the patient with significant pain again in 3 to 5 days, and if pain improved but still present send the patient for PT
May prescribe a muscle relaxer, anti-inflammatory and a short course pain medicine |
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Term
| How long should pts be on muscle relaxers? |
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Definition
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Term
| Cervical spinal cord neurapraxia with transient tetraplagia: |
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Definition
- patient has weakness or complete paralysis
- c/o burning pain, numbness, tingling, or loss of sensation
- recovers in 10-15 minutes usually
- gradual resolution may occur in 36-48 hours
- R/O spinal stenosis and other cervical causes
- occurs b/c of cervical instability or cervical disc disease
NO MORE CONTACT SPORTS/ACTIVITIES |
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Term
| Can a pt with cervical cord neurapraxia with transiet tetraplagia continue sports? |
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Definition
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Term
| Cervical radiculitis is pain generated from __ of the __ in the __ __ __. |
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Definition
| - inflammation of the nerves in the cervical spine canal |
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Term
| Most common causes of cervical radiculitis: |
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Definition
- spinal stenosis
- degenerative disc disease
- herniated disc |
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Term
| Presentation of a pt with cervical radiculitis: |
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Definition
- deep pain in upper extremity and sometimes neck pain (but neck pain not always present)
- numbness and sometimes weakness in UE
- feels better when arm is extended overhead |
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Term
| __ test helps dx Cervical Radiculitis. With this condition, DTRs are often __ or __. Dermatomes may be affected. Always get __ films. |
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Definition
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Term
| One such sign, ‘Spurling’s test’ is the reproduction of the patient's nerve symptoms by movements of the neck. It is performed by extending the neck, rotating the head, and then applying downward pressure on the head. The test is positive when the pain arising in the neck radiates in the direction of the corresponding dermatome. |
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Definition
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Term
| Tmt of cervical radiculitis: |
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Definition
- oral corticosteroids (work really well for acute), followed by oral non-steroidal antiinflammatory
- physical therapy- cervical traction, stretching, strengthening
- short course of pain meds
(Don't give the steroids to pt if immunocompromised or Diabetic) |
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Term
| Mr. Jones presents to you clinic with an acute onset of pain radiating down his arm to his finger tips, which is his only symptomatic complaint. Based on his exam you suspect cervical radiculitis. What image will you order? |
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Definition
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Term
| Mr. Jones has a normal image. Since he has good strength, normal reflexes, and normal sensation, what is your treatment/plan for this patient? |
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Definition
| Physical therapy, short course of pain meds, maybe corticosteroids |
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Term
| What if Mr. Jones does not respond to conservative treatment? What will you do next? |
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Definition
| If not better in 6-8 weeks> MRI to look for herniated disc |
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Term
| Now, let’s meet Mrs. Pearson who presents to you with obvious weakness and loss of sensation in a dermatome for 6 weeks. She has had no improvement of her symptoms. What will you consider doing to work-up this patient? |
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Definition
MRI
(b/c when there is weakness and loss of sensation with no improvement> concern about nerve being pinched> MRI) |
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Term
| What interventions can be performed other than surgery in patients who have radiculitis symptoms? |
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Definition
| ESI: epidermal steroid injections |
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Term
| What medical condition do you have to think about when a patient comes to you with neck pain and a fever? |
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Definition
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Term
| very common mechanism of injury for low back pain: |
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Definition
| - lifting and/or twisting mechanism |
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Term
| With any back pain, make sure there is __ ____ __. |
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Definition
| - no bladder/bowel incontinence (this is an emergency) |
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Term
| With low back pain, if the pt is non-tender with bony palpation and they had a MOI that caused symptoms, an __ is not needed. |
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Definition
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Term
| If you have a 50 yo male who c/o of low back pain without any trauma, what do you need to think about? |
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Definition
| - Prostate cancer (ask about most recent PSA and what was it, recent weight loss,etc. ) |
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Term
| Most common causes of lumbar radiculitis: |
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Definition
- degenerative disc disease
- spinal stenonis
- herniated disc |
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Term
| what must you remember to ask about with lumbar radiculitis? |
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Definition
| bladder/bowel incontinence |
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Term
| Patients with lumbar radiculitis often have a postive __ __ test. |
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Definition
| positive straight leg test (sciatic nerve inflamed) |
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Term
| Pts with lumbar radicultis may have diminished or absent DTRs. Also be sure to check clonus/Babinski |
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Definition
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Term
| Other non-musculoskeletal causes of back pain? |
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Definition
- gall stones
- kidney stones
- AAA
- cancer |
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Term
| Spondylolysis is disruption of the __ ____. |
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Definition
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Term
| Spondylolysis results from __ __ around the __ __ during ___ of the lumbar spine |
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Definition
- repeated stress
- pars interarticularis
- hyperextension |
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Term
| Radiographs of Sponydlolysis may be __ initially. If positive you will see the __ __ __ on the __ view. |
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Definition
- normal
- Scottie Dog sign on the oblique view |
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Term
| x-ray finding of sponydlolysis: |
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Definition
| - scottie dog sign on oblique view |
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Term
| Who might you see spondylolysis in? |
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Definition
| - gymnasts and wrestlers (from repetitive hyperextension) |
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Term
| If you suspect spondylolysis, and radiographs come back normal, what other test can you do? |
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Definition
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Term
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Definition
- keep them out of sports for a few months, and these kids will heal
- follow up bone scan to make sure they healed |
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Term
| Spondylolysis can become ___, which occurs with __ __ or __ __. |
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Definition
- spondylolisthesis
- repeated hyperextension
- chronic arthritis |
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Term
| Treatment of acute/subacute spondylolithesis is __ ,usually heal in __ __. |
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Definition
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Term
| If there is no success with conservative treatment of spondylolisthesis, then __ will have to be performed. |
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Definition
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Term
| Not everyone with spondylolisthesis has __ or __ symptoms. |
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Definition
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Term
| The __ classification system is used to classfy spondylolisthesis. |
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Definition
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Term
| If spondylolysis does not heal the spine may actually __ and be called __. |
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Definition
- move
- spondylolisthesis |
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Term
| Myerding Classifications of spondylolisthesis; |
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Definition
Grade I 1-25% slippage
Grade II 26-50% slippage
Grade III 51-75% slippage
Grade IV 76-100% slippage |
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Term
| Most common locations for spondylolisthesis to occur: |
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Definition
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Term
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Definition
Tenderness at the SI joint
Often seen in athletes, but I have also taken care of this problem in the general population
In the older population the SI joint may have osteoarthritis
Any change in the spinal curvature or pelvic tilt can inflame this joint
Patients respond well to PT and oral anti-inflammatories
If PT or oral meds do not work, a steroid shot is usually successful (best if performed under fluoroscopy) |
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Term
| Management of SI joint dysfunction: |
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Definition
- 1st: PT and oral anti-inflammatories
- 2nd: steroid shot via fluoroscopy |
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Term
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Definition
High incidence of mortality
Large amts of bleeding can occur – 1 to 5+ L
Consider if:
Scrotal hematoma
Urethral blood
Abnormal prostate
High velocity pelvic fractures will not show up in your private clinic |
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Term
| Consider a pelvic fracture if you see __ __, __ __, or an __ __. |
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Definition
- scrotal hematoma
- urethral blood
- abnormal prostate |
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Term
| Severe pelvic ring injuries are usually associated with __ and __ __. |
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Definition
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Term
| If hypotension is present with a pelvic fracture, the survival rate is __%. |
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Definition
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Term
| __ fractures are often seen in the PCP office. |
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Definition
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Term
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Definition
DRE important – check for blood and prostate position and palpate for fractures
Examine penis, testes, and vagina to evaluate for assoc. urologic and gynecologic injuries
No urinary catheter if suspect penile injury – obtain retrograde cystogram and call urologist
Check stability of pelvis
Always call the orthopedist |
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Term
In private practice I often see pelvic rami fractures
Many of these patients ambulate
In fact, the majority find it more comfortable to stand
They cannot get comfortable sitting down
Those who walk into your clinic generally have a stable fracture
Treatment is time and a comfortable seat |
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Definition
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Term
| Compression fracture tmt: |
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Definition
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Term
| Compression fx pts usually have/do not have NV complaints. |
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Definition
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Term
|
Definition
Trauma is due to a fall, usually onto the buttocks
If it is an isolated compression fracture, patients generally only complain of pain at the site of the fracture without NV complaints or findings
Treatment is rest and a brace |
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Term
| What age of pts is predisposed to compression fractures and why? |
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Definition
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Term
Idopathic scolioiss does not need tmt in adult unless symptomatic.
Bracing not effective in adults but is effective in kids. |
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Definition
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Term
|
Definition
Very common in the primary care office/urgent care
Control bleeding and clean
Check motor function and NV status – do this before anesthetizing
Numb the area with xylocaine – DO NOT use epinephrine on digits
Digital or local block
Once anesthetized examine wound and depth
Check for muscle, tendon, and nerve involvement |
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Term
ALWAYS CHECK NERVE FUNCTION AND NEUROVASCULAR STATUS BEFORE ANESTHATIZING. KNOW THIS.
DO NOT USE EPINEPHRINE IN DIGITS B/C IT’S A VASOCONSTRICTOR > NECROSIS |
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Definition
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Term
|
Definition
If no involvemebut subcutaneous tissue involved you may need to suture this tissue with bio-absorbable sutures (chromic gut)
I will generally close the skin with mattress or simple sutures with nylon
Sometimes I will use staples – usually scalp lacerations
If muscle, tendon, and/or nerve involvement suture and splint the patient and send to orthopedics the next day
nt of muscle, tendon, or nerve,
Augmentin if NOT allergic to penicillin or Bactrim if not allergic to sulfa
l |
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Term
| Lacerations managment continued: |
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Definition
Is the patient’s tetanus up to date – I will give tetanus if patient has not been updated in the previous 5 years
Prevent infection and prescribe an antibiotic – I usually prescribe Augmentin 875mg bid x 7 days or Bactrim DS bid x 7 days or Doxy 100mg po bid x 7 days
Give patient ER precautions and educate on signs of infection
Follow-up in 2 days. Why? |
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Term
| Compartment syndrome, fractures, and dislocations, stinger, neuropraxias- when you check neurvascular |
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Definition
|
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Term
| check NV status before anesthatize and before and after you suture |
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Definition
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Term
|
Definition
I do not suture these injuries immediately
Firstly, I control the bleeding
Secondly, I get an x-ray – why?
I then will I&D the wound after anesthetizing
If there is a huge gaping wound I may do several very loose sutures
The patient needs to be on an antibiotic about 4 days before the wound can be sutured
I will also give an antibiotic shot
These wounds must be watched closely
I have every laceration f/u in 2 days for a wound check |
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Term
| organism you worry about with dog bites: |
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Definition
- Pasturella
- Augmentin treats this well |
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