Managing Ortho Injuries Multiple Trauma Patients - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Managing Ortho Injuries Multiple Trauma Patients - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes management of Orthopaedic multiple trauma patients. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC View my profile on Linkedin:   / nabilebraheim   Managing orthopedic injuries in multiple trauma patients is a challenge. You will probably have a patient that is unstable. That patient will have multiple orthopaedic problems, and the physician must manage these complex problems adequately. These problems may not be easy to manage. The patient will come with different varieties of injuries. If you find in the question, that there is a hip or knee dislocation, you must do urgent closed reduction. If the patient has a high ISS score and the patient also has a hip dislocation and has multiple fractures, you start by doing closed reduction of the hip. If you find a fractures that is open, then you will give antibiotics immediately, and if the patient is going to the operating room, you are going to do debridement. If you find fractures of the humerus and forearm, then you will probably do splinting for these fractures initially, followed by surgery later on when the patient is stable. If you find tension pneumothorax, then you will probably need a chest tube. You may start by inserting a needle at the second intercostal space midclavicular line followed by insertion of a chest tube. If you have a patient with a pelvic fracture and bleeding, then you will do transfusion in the ration of 1:1:1 ratio (blood fresh frozen plasma and platelets). If you have an unstable patient with a pelvic fracture because of bleeding, and the patient has an open book fracture as seen in the x-ray or clinically, like when you see a scrotal hematoma and the legs are externally rotated, then you will need to “close the book” by placing a pelvic binder around the pelvis. The anteroposterior Type III pelvic fracture bleeds a lot (requires a lot of blood transfusion), and it is associated with significant abdominal trauma and shock. If you have a pelvic fracture and the patient is in shock, then you need to resuscitate the patient. Transfuse the patient (1:1:1 ratio). Open book fractures of the pelvis bleed a lot. You need to close the book with a pelvic binder and add skeletal traction if there is a vertical shear component. If the patient has a lateral compression fracture, and the patient is unstable, look for other sources of bleeding. A lateral compression fracture does not cause a lot of bleeding. Lateral compression may also be associated with head injury or chest injury. Monitor the patient and maintain the cerebral perfusion. It is not advisable to do definitive surgery. At that point, the concern will be that the patient may go into episodic intraoperative hypotension. When you have a patient that is bleeding and the blood pressure is starting to become affected, then this patient is in Class III hemorrhage (approximately 30-40% blood loss). If the patient is hypotensive and in Class III shock, you will start resuscitation with two liters of crystalloid fluid and have blood available for the patient. With Class IV hemorrhage, you will have confusion, hypotension, rapid heart rate, and narrow pulse pressure. Class IV is a life threatening situation and you will need to do rapid blood transfusion. If you find an unstable patient with a pelvic fracture with a Class IV hemorrhage, you will need to resuscitate the patient and give the patient a blood transfusion. You will give O negative blood. There is no time for type and cross-matching blood. You will give the patient a pelvic binder to decrease the pelvic volume. The mortality rate in pelvic fractures correlates with shock on presentation. Shock due to hemorrhage could be reversible. In compensated shock, the patient has a low blood volume, but the patient is still able to maintain blood pressure and organ perfusion by increasing the heart rate and constricting the blood vessels. In decompensated shock, the body is unable to keep up with the loss of blood. The scapulothoracic dissociation is a significant injury. It’s like closed forequarter amputation where the scapula and the upper extremity moves laterally, like it is disconnected from the chest, and there can be neurovascular deficit involved with this injury with possible disruption of one of the major vessels of the upper extremity. You need to apply the ATLS protocol and the functional outcome of the patient depends on the neurovascular status of the patient. If the patient’s condition is bad before surgery or the patient’s condition sig bad during surgery, you are going to do external fixator for the femurs, especially if it is bilateral. When talking about fracture of the femur, in the operating room if the patient becomes unstable and has hypoxia, resuscitate the patient and use external fixators. You only do IM rodding of the femur after normalizing the lactic levels and the base deficit.