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Cholangitis Case
Cholangitis Case
Cholangitis Case
▪ Pain
▪ Deformity
▪ Length
▪ Angulation
▪ Rotation
▪ Swelling / ecchymosis
▪ Loss of function
▪ Grating
▪ Exposed bone ends
POTENTIAL COMPLICATIONS OF
FRACTURES
▪ Bleeding
▪ Compartment Syndrome
▪ Pain
▪ Pallor
▪ Pulselessness
▪ Paresthesias
▪ Paralysis
GENERAL PRINCIPLES OF ASSESSMENT
AND MANAGEMENT
Secondary Survey
Determine the mechanism of injury
Identify chief complaint
Head-to-toe survey
Assess the neurovascular status of the injured extremity
GENERAL PRINCIPLES OF ASSESSMENT
AND MANAGEMENT
Purpose of splinting:
Alleviates pain
Prevent further injuries
Prevent a closed fracture from becoming an open type fracture
Prevent further damage to surrounding soft tissues
Helps control bleeding
Facilitate transport
Acquire adequate radiographic evaluation
GENERAL PRINCIPLES OF ASSESSMENT
AND MANAGEMENT
For open fractures
DO NOT attempt to push exposed bones ends back beneath the skin.
Immobilize the joint above and below the fracture.
Re-check the neurovascular status. Free the hands and feet from the splint
to access periodic evaluation of the distal pulses.
GENERAL PRINCIPLES OF ASSESSMENT
AND MANAGEMENT
Pad rigid splints generously.
Be sure to immobilize all the fractures before moving the patient.
Elevate the injured extremity once it splinted.
When in doubt, SPLINT.
Strategies of Splinting
- Elbow -
Strategies of Splinting
- Applying a vacuum splint -
Splinting the forearm and fingers
Strategies of Splinting
Strategies of Splinting
- Applying a traction splint -
Strategies of Splinting
- Applying a traction splint -
Strategies of Splinting
- Long Bone -
Gustilo open fracture Classification
I Open fracture, clean wound, wound <1 cm in length
II Open fracture, wound > 1 cm but < 10 cm in length[4] without extensive
soft-tissue damage, flaps, avulsions
III Open fracture with extensive soft-tissue laceration (>10 cm[4]), damage, or
loss or an open segmental fracture. This type also includes open fractures
caused by farm injuries, fractures requiring vascular repair, or fractures that
have been open for 8 hr prior to treatment
III A Type III fracture with adequate periosteal coverage of the fracture bone
despite the extensive soft-tissue laceration or damage
III B Type III fracture with extensive soft-tissue loss and periosteal stripping and
bone damage. Usually associated with massive contamination. Will often need
further soft-tissue coverage procedure (i.e. free or rotational flap)
III C Type III fracture associated with an arterial injury requiring repair,
irrespective of degree of soft-tissue injury.
Type I
Type II
Type III A
Type III B
Type III C
Type III injuries
Farm Injuries
High velocity gunshot wounds
Shot gun wounds
Open Fractures more than 8 hours post injury
Mass casualties
Open segmental fractures
Traumatic amputations
Principles in the Management of Open
Fractures
Treat open fractures as emergency
Give antitetanus prophylaxis
Give appropriate antibiotics
Do debridement of wound
Stabilize the fracture
Plan for wound coverage
Plan for rehabilitation
Fracture Type Clinical Infection rate (%) Antibiotic Choice Antibiotic Duration
I 1.4 Cefazolin Every 8 hours for 3 doses