Fast Track Surgery: Trauma, Orthopaedics and the ... - PasTest

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Trauma & orthopaedicsWhat life-threateningproblems must be excludedimmediately?How are these conditionsdetected clinically?The following:1. Tension pneumothorax: build up. of air under pressure in thethoracic cavity, compressing theipsilateral lung and displacing themediastinal contents andcontralateral lung.Occurs due to a one-way valvemechanism introducing air oninspiration, but blocking itsrelease during expiration2. Open pneumothorax: openchest wall wound connected tothe thoracic cavity. If chest walldeficit is of a significant diameter,air will follow the path of leastresistance and enter the thoraciccavity here on inspiration, ratherthan down the trachea. Syn.sucking chest wound due to thenoise produced as the aboveoccurs3. Massive haemothorax:collection of >1500 ml blood inthe thoracic cavity secondary tointercostal artery/large vesselrupture4. Flail chest: multiple rib fracturescausing a portion of the chestwall to move paradoxicallyinwards on inspiration due to alack of continuity with theremaining bony chest wallMust have a high index of suspicion.Also, obvious distress and hypoxia,and the following during the primarysurvey:Tension pneumothorax:• Decreased ipsilateral chestexpansion30
Chapter 4: The trauma call in orthopaedicsHow is tensionpneumothorax treated?What are the anatomicallandmarks forthoracocentesis?What are the anatomicallandmarks for chest draininsertion?• Tracheal deviation to contralateralside• Hyperresonance to percussionover ipsilateral side• Decreased ipsilateral air entry onauscultation• Tachycardia, tachypnoea anddistended neck veinsOpen pneumothorax:• Obvious chest wall defect withsucking noise on inspiration• Decreased air entry and expansionon ipsilateral side• Tachycardia and tachypnoeaMassive haemothorax:• Decreased ipsilateral chestexpansion• Dull percussion note on theipsilateral side• Decreased air entry on theipsilateral side• Tachypnoea, tachycardia and signsof hypovolaemiaFlail chest:• Paradoxical chest wall movement• Crepitus on palpation of damagedarea• Decreased air entry on ipsilateralside• Tachypnoea and tachycardiaImmediately by decompression byneedle thoracocentesis, thendefinitively by chest drain insertion(thoracostomy) at a later stage2nd intercostal space at themanubriosternal junction in themid-clavicular line5th intercostal space, mid-axial line31PART II
Page 1 and 2: Fast Track Surgery:Trauma,Orthopaed
Page 3 and 4: Fast Track Surgery:Trauma,Orthopaed
Page 5 and 6: CONTENTSAcknowledgementsForewordCon
Page 7 and 8: FOREWORDCurrent surgical training i
Page 9: PART IIntroduction
Page 12 and 13: IntroductionWhen studying surgery,
Page 14 and 15: IntroductionFIRST THING IN THE MORN
Page 17 and 18: CHAPTER 3: GETTING STARTED:SURGICAL
Page 19 and 20: Chapter 3: Getting started: Surgica
Page 31: PART IITrauma & orthopaedics
Page 34 and 35: Trauma & orthopaedicsWhat are the a
Page 36 and 37: Trauma & orthopaedicsWhat basic air
Page 40: Trauma & orthopaedicsHow is open pn

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