ATLS 10.8 MUSCULOSKELETAL TRAUMA
1. Long bone fractures above and below the diaphragm are
associated with ________ injuries.:
internal torso
2. Unstable pelvic fractures and open femur fractures are
often associated with ________________.:
significant hemorrhage
3. Bilateral femoral fractures have higher risks for ________
and management should include ________:
1. significant blood loss, severe associated injuries, pulmonary
complications, multiple organ failure, and mortality.
2. early transfer to a trauma center.
4. Severe crush injuries can result in delayed ______, which
has this major complication:
rhabdomyolysis / leading to renal failure.
5. Crush syndrome is also known as:
traumatic rhabdomyolysis
6. Rhabdomyolysis has many complications, including:
acute renal failure
hemodynamic shock
disability
pulmonary failure
hyperkalemia
hypocalcemia
DIC
metabolic acidosis
7. Diagnostic features of crush syndrome include:
Dark amber urine that tests
positive for hemoglobin
A positive myoglobin assay
Serum creatinine kinase of e10,000 U/L
, Metabolic derangement (e.g. metabolic acidosis, hyperkalemia,
hypocalcemia)
Coagulopathy (e.g. DIC)
8. Management of crush syndrome:
Early and aggressive IV fluid resuscitation
Alkalinization of the urine with intravenous administration of
bicarbonate
Osmotic diuresis
Dialysis in select cases
9. Define compartment syndrome and its consequence.:
Swelling into an intact muscular fascial space can cause an acute
compartment syndrome that may lead to lasting impairment and
loss of extremity without immediate diagnosis and treatment.
10. Fat embolism syndrome definition and sequelae:
An uncommon but highly lethal complication of long bone
fractures, can lead to pulmonary failure and impaired cerebral
function.
11. Management of severe hemorrhage in MSK injuries:
1. Direct pressure is the most effective way to achieve
hemorrhage control for deep soft tissue lacerations.
2. Appropriate splinting of long bone fractures can significantly
reduce bleeding.
3. If a fracture is open, application of a sterile pressure dressing
typically controls hemorrhage.
4. Concurrent fluid resuscitation is an important adjunct to
mechanical measures.
12. Management of traumatic amputation:
1. Application of a tourniquet if accompanied by severe
hemorrhage.
2. When applying a tourniquet, tighten the tourniquet only until
bleeding stops.
3. Always demarcate the time when a tourniquet was applied.
1. Long bone fractures above and below the diaphragm are
associated with ________ injuries.:
internal torso
2. Unstable pelvic fractures and open femur fractures are
often associated with ________________.:
significant hemorrhage
3. Bilateral femoral fractures have higher risks for ________
and management should include ________:
1. significant blood loss, severe associated injuries, pulmonary
complications, multiple organ failure, and mortality.
2. early transfer to a trauma center.
4. Severe crush injuries can result in delayed ______, which
has this major complication:
rhabdomyolysis / leading to renal failure.
5. Crush syndrome is also known as:
traumatic rhabdomyolysis
6. Rhabdomyolysis has many complications, including:
acute renal failure
hemodynamic shock
disability
pulmonary failure
hyperkalemia
hypocalcemia
DIC
metabolic acidosis
7. Diagnostic features of crush syndrome include:
Dark amber urine that tests
positive for hemoglobin
A positive myoglobin assay
Serum creatinine kinase of e10,000 U/L
, Metabolic derangement (e.g. metabolic acidosis, hyperkalemia,
hypocalcemia)
Coagulopathy (e.g. DIC)
8. Management of crush syndrome:
Early and aggressive IV fluid resuscitation
Alkalinization of the urine with intravenous administration of
bicarbonate
Osmotic diuresis
Dialysis in select cases
9. Define compartment syndrome and its consequence.:
Swelling into an intact muscular fascial space can cause an acute
compartment syndrome that may lead to lasting impairment and
loss of extremity without immediate diagnosis and treatment.
10. Fat embolism syndrome definition and sequelae:
An uncommon but highly lethal complication of long bone
fractures, can lead to pulmonary failure and impaired cerebral
function.
11. Management of severe hemorrhage in MSK injuries:
1. Direct pressure is the most effective way to achieve
hemorrhage control for deep soft tissue lacerations.
2. Appropriate splinting of long bone fractures can significantly
reduce bleeding.
3. If a fracture is open, application of a sterile pressure dressing
typically controls hemorrhage.
4. Concurrent fluid resuscitation is an important adjunct to
mechanical measures.
12. Management of traumatic amputation:
1. Application of a tourniquet if accompanied by severe
hemorrhage.
2. When applying a tourniquet, tighten the tourniquet only until
bleeding stops.
3. Always demarcate the time when a tourniquet was applied.
