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Orthopedic Emergencies PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "Orthopedic Emergencies", to know about Orthopedic Emergencies (sprains, strains, dislocations and fractures).

Tags : Emergency Medical Services, EMS, Orthopedic Emergencies, sprains, strains, dislocations, fractures

Published on : Aug 06, 2021 | Views : 3532 | Downloads : 10

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Slide 1-

Orthopedic Emergencies Patrick Sinclair, D.O., EMT-B
Slide 2-

Overview Sprains, strains, dislocations and fractures “VONCHOP” Vascular compromise Open fracture Neurologic deficit (cauda equina) Compartment Syndrome Hip dislocation Osteomyelitis (septic arthritis) Pelvic Fracture (unstable)
Slide 3-

WTF? A 33-year-old man was admitted to the emergency department after a motorcycle accident. Clinical examination of the intubated patient showed a hard, swollen, bluish scrotum and an externally rotated and slightly shortened left leg
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Strain vs. Sprain
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What Are We Getting At?
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Fractures: The Main Points Does one exist? Where is it located along the bone? Proximal, mid, distal Is it open or closed? Signs of Fracture Deformity False Motion Tenderness Locked Joint Guarding Pain Swelling Exposed Fragments Bruising Crepitus
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Fractures •Greenstick –An incomplete fracture that passes only partway through the shaft of a bone •Comminuted –A fracture in which the bone is broken into more than two fragments •Pathologic –A fracture of weakened or diseased bone
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More Fractures •Oblique –A fracture in which the bone is broken at an angle across the bone •Transverse –A fracture that occurs straight across the bone
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More Fractures •Spiral: suspicion of abuse in pediatrics –A fracture caused by a twisting force, causing an oblique fracture around the bone and through the bone •Incomplete –A fracture that does not run completely through the bone
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Splinting you can use pretty much anything you must immobilize the proximal and distal joint to effectively splint a fracture alway check PMS before and after!
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Visual Recap
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Dislocations Separation of two bones where they meet at a joint Shoulder, Elbow, Hip what are we primarily concerned about with a joint dislocation? Fracture and neurovascular compromise Treatment: always immobilize the joint in the position of comfort Pulse, Motor, Sensation! Crepitus and Point Tenderness of bony prominences!
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Shoulder Anterior (90-98%): caused by a blow to the posterior shoulder or abduction + external rotation + extension injury, most commonly seen in trauma Posterior (2-4%): direct blow from the anterior aspect of the shoulder or internal rotation + adduction + flexion injury, most commonly seen in seizures and electric shocks Inferior (~0.5%): usually a hyperabduction force which levers the humeral neck against the acromion or high energy force from above, usually associated with soft tissue injury or fracture
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Anterior Dislocation Presentation
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Posterior Dislocation Presentation
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Inferior Dislocation Presentation
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Elbow Dislocation usually due to a FOOSH mechanism (Fallen On an OutStretched Hand) most commonly posterolateral Presentation: elbow held at 45 degrees of flexion
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Hip Dislocation most commonly posterior dislocations often seen with knee-to-dashboard injuries one of the orthopedic emergencies as this must be reduced within 6hrs → high risk of avascular necrosis more likely to be seen in the setting of a hip replacement
Slide 21-

Compartment Syndrome an increase in the interstitial pressure over its capillary perfusion pressure due to the accumulation of necrotic debris and hemorrhage Acute causes: tibial or forearm fractures, ischemic reperfusion following injury, hemorrhage, vascular puncture, IV drug injection, casts, prolonged limb compression, crush injuries and burns. Chronic causes: exercise induced, usually not an emergency, goes away within 30 minutes of onset, but may lead to transient or permanent nerve damage, most commonly affects the anterior part of the leg (confused with shin splints)
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Compartment Syndrome The 6P’s Pain: out of proportion to clinical exam (most significant early sign) Pressure: Tense Swelling (Early consistent finding) Pain: With passive stretch Paralysis: muscle weakness Pulses: Present (Pale Toes) Paresthesia: Sensory Deficit (Usually Late)
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Where to Direct Your Trauma Assessment
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Why Pelvic Frx is So Concerning... Usually takes a tremendous amount of force The pelvis is highly vascularized One of the places you can lose a lot of blood without any obvious signs damage to the genitourinary system Major Assessment and Treatment make sure you “rock the pelvis” as part of your trauma assessment Apply pelvic binder
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Pelvic Binder In general, the literature demonstrates that in the hemodynamically stable, alert and oriented trauma patient with no distracting injury and no signs of pelvic fracture, pelvic stabilization is not required. if any of these criteria fail to be met, or you have a high enough suspicion you must apply a binder