MEDSURG | Ortho Trauma & More
STAT Stitch Deep Dive Podcast Beyond The Bedside · Regular Guy
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Show Notes
🩺 Med-Surg Review: Musculoskeletal Trauma (High-Yield, <2800 chars)
1) Acute Soft-Tissue Injuries — Sprain/Strain/Dislocation • Sprain: ligament tear/stretch. • Strain: muscle/tendon tear/stretch. • Dislocation: complete joint surface separation → risk neurovascular injury & avascular necrosis. Meds: NSAIDs (GI bleed risk), analgesics (opioid constipation/resp depression). Team: MD (X-ray, reduction/cast or surgery); RN: RICE (Rest-Ice-Compression-Elevation), immobilize; PT: gradual ROM/strength; Dietitian: Ca/Vit D. Critical signs: obvious deformity (dislocation), neurovascular compromise. Common: pain, swelling, bruising, ↓ function. RN priorities: • Neurovascular checks distal: color, temp, cap refill, pulses, sensation, motor. • Immobilize as found; do NOT reduce. • Ice 20–30 min on, 20 off for 24–48 h; elevate above heart. Quick cues: Neurovascular first; immobilize; RICE; watch for avascular necrosis (hip/shoulder).
2) Fracture Complications — Compartment Syndrome (CS) & Fat Embolism Syndrome (FES)
A) Compartment Syndrome Patho: ↑ pressure in closed muscle space → ↓ perfusion → ischemia/necrosis (4–8 h) → amputation risk. Key sign: Pain out of proportion & with passive stretch, not relieved by opioids. Six Ps: Pain*, Paresthesia*, Pallor, Paralysis (late), Pulselessness (late), Pressure (*=early/critical). RN actions: Hourly neurovascular checks; do NOT elevate above heart; keep level; loosen/bivalve cast per order; notify MD STAT; prep for fasciotomy. Quick: Pain unrelieved by opioids = red flag.
B) Fat Embolism Syndrome (24–48 h post long-bone/pelvis fractures) Triad: Resp distress (tachypnea, hypoxemia, chest pain, cyanosis), Neuro changes (confusion, HA), Petechiae(neck/chest/axilla/conjunctiva). Mgmt: Prompt immobilization of fracture; O2/ventilation to keep PaO₂ >60; IV fluids; consider steroids (controversial). Team: MD (airway/hemodynamics, VTE ppx), RN (monitor resp/neuro, fluids), RT (O₂/vent). Quick: Timing 24–48 h; long bones; triad present → escalate.
3) Total Hip Arthroplasty (THA) / Hip Fracture Risks: VTE (DVT/PE); post-op dislocation (sudden severe pain, lump buttock, limb shortening, external rotation). Meds: Anticoagulants (LMWH, Xa-inhibitors, warfarin/INR, aspirin) → bleed watch; opioids (constipation); pre-op antibiotics. RN: VTE ppx (TED/SCD, ankle pumps), early ambulation, pain control, bowel regimen. Hip precautions: No flexion >90°, no adduction/crossing legs, no internal rotation; keep abduction wedge, neutral rotation; raised chairs/toilet. Quick: Positioning + precautions prevent dislocation; teach DVT/PE symptoms.