Page 6 - Emergency medicine for students ebook
P. 6
Broken Bones and Fractures
Symptoms:
Swelling, loss of motion, movement in unnatural direction, limb shorter/twisted/bent, grating noise/feeling, loss of strength, shock
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Pre-hospital aid:
• If open, cover with sterile dressing and apply pressure around wound to stop bleeding
• Support injured body part to stop movement ------------------------------------------------------------------------------------------------------- Hospital Treatment of compound/open fractures
• Arrange orthopaedics referral
• Treatment life threatening injuries before limb injuries
• Control haemorrhage by direct manual pressure
• Start IV fluids
• Analgesia- incremental IV opioids
• Correct severe deformities with traction and splint
• Irrigate with saline
• Cover wound with steroid moist dressing (eg saline soaked pads).
• Immobilise limb in a plaster of paris backslab and leave covered until
surgery
• Record presence/absence of distal pulses and sensation and recheck
frequently
• Drug administration
v IV antibiotics: 1.2g co-amoxiclav or 1.5g cefuroxime
o Add gentamicin or metronidazole if grossly contaminated
v Tetanus toxoid if tetanus prone (heavy contamination, devitalized tissue, infection or wounds >6hrs old, puncture wounds and animal bites)
o If patient fully immunized does not vaccine- can give 250- 500units IM HATI (Ig) if risk very high
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Types of fractures:
Stable fracture: The broken ends of the bone line up and are barely out of place.
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