Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

MSK TRAUMA ATLS 9th Ed

Musculosketal Trauma. ATLS 9th Edition
by

Rej Bhumbra

on 17 September 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of MSK TRAUMA ATLS 9th Ed

Lower Limb Trauma
Prox Femur
Objectives
Compartment Syndrome
Fracture Descriptions
Open vs Closed
X-ray
Tibial Shaft
Classification of Open Fracture Type - Gustillo Anderson POST debridement
Type I
Skin opening of 1 cm or less, quite clean.

Type II
Laceration more than 1 cm long, with extensive soft tissue damage, flaps, or avulsion.

Type III
Extensive soft tissue damage including muscles, skin, and neurovascular structures. Often a high-velocity injury with severe crushing component.

Type IIIA Extensive soft tissue laceration,
adequate bone coverage.

Type IIIB Extensive soft tissue injury with
periosteal stripping and bone exposure.

Type IIIC
Vascular injury requiring repair.
2 1
4 3
Primary Survey
Secondary Survey
Explain the significance of musculoskeletal in patients with multiple injuries.
Airway
& C-spine control
Breathing
& Ventilation
Circulation
& Haemorhage Control
Disability
& Neurology
Exposure
& Environment
Chest, Pelvic Xray
Stabilise
Pack
Embolise
Pelvic Trauma
A condition where the pressure within an enclosed anatomical compartment rises sufficiently to obstruct the micro-vascular circulation causing tissue ischemia and, if left untreated, necrosis.
Pain
Disproportionate
Passive stretch
Tense compartments
Asymmetry
Paresthesia
Tissue pressures > 35 to 45 mm Hg
Radiographs do not show severed nerves, crushed muscles, ruptured blood vessels or torn ligaments, any more than they tell whether a wound is contaminated, how the injury occurred or how it should be treated.
Complications
type A
type B
type C
Injuries to the appendicular musculoskeletal system occur in many patients who sustain blunt trauma; they often appear dramatic, but rarely cause an immediate threat to life or limb.
Pelvic fractures and femur fractures are an important and often unrecognized source of shock.
MSK TRAUMA.
ATLS 9 Edition
Identify Life and Limb Threatening Injuries
What are the Strategies for MX MSK Inuries?
A wall collapses on a 44-year-old male worker
Blood pressure: 130/75;
Pulse: 110 Respiratory rate: 22
GCS score: 15
Painful, bruised, deformed left leg

What are your priorities?
Is this life- or limb-threatening?
What impact do musculoskeletal injuries have on the primary survey?
Stop and Splint
Prevents further blood loss and injury

Can restore or maintain perfusion

Relieves pain
Important during evaluation

Do not delay
Symptoms

Pain
Paresthesia
Signs

Look
Listen
Feel
Deformity
Wound(s)
Doppler signals
Bruit
Crepitus
Skin flaps
Neurologic deficit
Pulses
Tenderness
Key Info:
Preinjury status and predisposing factors
Mechanism of injury
Time of injury
Associated factors (e.g., environment)
Prehospital observations and care
Early Concerns:
Vascular Status
Vascular Status
Reduce fracture(s)
Splint fracture(s)
Assess by doppler
Ankle / brachial index
Obtain vascular input
Open Fractures
Apply appropriate splint
Cleanse/debride
Photo. Betadine dressing.
Consider time factor
Obtain orthopaedic input
Antibiotic / tetanus status
When do you get an X-ray?
When the pt is haemodynamically N
What X-ray do I Need?
Any area - one joint above, and one below.
When shall I wait?
If life-threatening injuries take priority
If patient transfer will be delayed
What injuries can cause
compartment syndrome?
Tibia, forearm fractures
Vascular and bony injuries
Injuries immobilized in tight dressings or casts
Severe crush injuries
Burns
SUMMARY
Musculoskeletal injuries may pose delayed threats to life and limb.
Stop the bleeding!
Reduce and immobilise fractures and dislocations
Recognise open #s & vascular compromise
Consider compartment syndrome
?
MSK TRAUMA
ATLS 9th Edition
Pitfalls
Remember to Document
Neurovascular Status
Altered sensation
Compartment syndrome
Vascular injury
Crush injuries / myoglobinuria
Occult fractures / soft tissue injuries
Coagulation disorders
Open Fractures
Compartment syndrome
Rej Bhumbra PhD FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Barts Health NHS Trust
Full transcript