What are the steps in PILSDUCT for fracture management and identification?
Pain Inflammation Loss of function Swelling Deformity Unusual movement Crepetis Tenderness
What are the 4 P’s that are fracture danger signs?
Pallor - colour and cap refill
Paraesthesia - pins and needles
Pulses - diminished or absent
Paralysis - inability to move
What is the goal of splinting?
Immobilise body part to:
- alleviate pain
- minimised further damage, injury, bleeding and contamination
- simplifies transport
- Immobilise fractures and dislocations to position of comfort
- Ensure good perfusion below level of injury
- joint injuries are only realigned if no distal pulse
- Elevate if possible
What are the different types of splints
- SAM Splint
- Air splint
- Hard padded splint
- Traction splints
- SAM pelvic splint
- Vacuum splint
- Vacuum matress
- Spine board
- Anatomical splints
What are the principles of fracture management according to AV CPG’s?
- Control external haemorrhage
- Support injured area
- Immobilise joint above and below the fracture
- Provide pain relief and correct hypovolaemia
- appropriate splinting can assist in pain reduction and arrest of haemorrhage
What are the actions before and after splinting according to AV CPG’s?
- Realign long bones fractures in as close to normal position as possible
- open fractures with exposed bone should be irrigated with a sterile isotonic solution prior to realignment and splinting
- manage middle third femur fractures and upper two-third tibia/fibula fractures with a traction splint, unless there are distal dislocations or fractures.
- in suspected fractures of the pelvis, legs should be anatomically splinted together and pelvis splinted
What are the steps for basic fracture management?
- o2 if necessary
- pain relief
- open fracture clean
- irrigate open wound and cover with moist dressing
- splint if appropriate
What are the Ottowa Ankle Rules?
Ankle xray is only required if:
- Bone tenderness on posterior edge of lateral or medial malleoulus (end of tib/fib) - 6 cm region
- Pain in midfoot and at base of metatarsal
- Inability to bear weight
When can’t you use the Ottowa Ankle Rules?
Patients under 18 intoxicated or uncooperative other distracting injuries diminished sensation in legs goss swelling preventing palpation
What is the difference between dislocation and sublucation?
Dislocation when normal articulating ends of two or more bones are displaced
Subluxation - partial dislocation
what is the purpose of the primary survey?
designed to detect actual or imminent life threats and prevent complications from these injuries
what are the main life threats seen in breathing of primary survey?
tension pneumothorax massive haemothorax open pneumothorax flail chest ruptured diaphragm
What is the most common cause of shock?
Hypovolaemic shock
What type of IV access do you gain for trauma patients?
2x large bore IV cannulas
Why should we always check BGL?
Altered conscious state could be because of hypo/hyperglycaemic
