8. Hypovolaemic Shock
Commonest cause for death
Pelvis(2 lts) & Long Bone(1.5lts) #’s
External Hemorrhage
eg: Open fracture, vascular Injury
Internal Hemorrhage
eg: Chest/Abdominal bleeding
9. Hypovolaemic shock-Management
Follow the BLS/ATLS protocols
Eg: No 14 IV cannula + 2lts of
crystalloids/colloids/blood, Localize the site of
bleeding, needle aspiration, Inv - X-ray,
Ultrasound
Avoid movements at the Fracture
Stabilize the fracture eg : External
Fixator for Pelvis, Splints for long bones
10. ARDS –Adult Respiratory Distress
Syndrome
Cause – Trauma & Shock
Release of Inflammatory mediators
Disruption of Pulmonary
microvasculature
Onset in 24 hrs
Tachypnoea & laboured breathing
11. ARDS - Management
Chest X-ray: diffuse Pulm infiltrate
Arterial PO2 <50
100% Oxygen
Assisted ventilation
Chest clears in 4 to 7 days
Not treated – CardioPulmonary failure -
Death
12. Fat Embolism
Occlusion of Small vessels by fat globules
Bone Marrow/Adipose tissue
Polytrauma of long major bones
Release of free fatty acids(Lipases action) –
toxic vasculitis – Platelet fibrin thrombosis
Obstruction of Pulm vessels by fat
13. Fat Embolism – clinical features
Develops in 24 to 72hrs
Cerebral type – drowsy, restless,
disoriented, coma
Pulmonary type – tachypnoea, tachycardia
Patechial rash- neck, axillary fold, chest,
conjunctiva
Respiratory failure - Death
15. Fat Embolism - treatment
Respiratory support
Heparinisation, IV Low molecular wt
dextran, corticosteriods
16. Deep Vein Thrombosis (DVT)
& Pulmonary Embolism (PE)
Lower limb & Spinal Injuries
Cause: Immobilization – venous stasis –
thrombosis of veins
DVT proximal to knee is Dangerous
DVT in 48 hrs – PE in 4 to 5 days
17. DVT & PE – Clinical Feature
High index of suspicion
Elderly & Obese pts
Leg swelling & calf tenderness
Calf tenderness on passive dorsiflexion
of Ankle ( Homan’s sign)
Venography/Doppler Ultrasound
PE – tachypnoea, dyspnoea, chest
pain, hemoptysis
18. DVT & PE - treatment
DVT : Elevation of limb, Elastic
bandage, active mobilization after early
fracture stabilization, anticoagulation
PE : Respiratory support,
Anticoagulation therapy
19. Crush syndrome
Massive crushing of Muscles
Release of Myohaemoglobin
Precipitates in Renal tubules
Acute renal tubular necrosis
Treated as for Acute renal failure
26. Compartment syndrome
Rise in Pressure in closed compartment
of the limb
Jeopardize the Muscle & nerve blood
supply
Injury & oedma to muscles
Fracture hematoma
Ischemia leading to muscle oedema
29. Compartmental syndrome -
Diagnosis
Excessive Pain
High risk injuries
eg:Supracondylar # humerus,
Forearm bones #,
Closed Tibial #,
Crush injuries to leg & forearm
30. Compartmental syndrome -
Diagnosis
Stretch test – earliest sign
Tense compartment
Hypoaesthesia of involved nerves
Muscle weakness
Compartmental pressure of >40 mm of
H2O
31. Compartmental syndrome - Treatment
Early prevention – limb elevation, active
finger mobilization
Early surgical decompression eg:
fasciotomy
32. Delayed & Non-union
More than the usual time to unite
Fracture healing has stopped (not
before six months)
33. Delayed & Non-union
Causes related to the patients
Age – common in old age
Asso Systemic illness eg:Malignancy,
Osteomalacia
34. Delayed & Non-union
Causes related to fracture
Distraction at fracture site
Muscle pulling eg:Patella & Olecranon #
Gravity eg: # shaft of humerus
Soft tissue interposition eg: # shaft
humerus, femur
Bone loss at the # site
45. Malunion - Treatment
Osteoclasis
Corrective osteotomy
No treatment – Remodelling
Children,
5 to 10 deg of Angulation,
Angulation in the plane of movement,
#’s near joints
46. Avascular Necrosis
Blood supply is jeopardized
Head of Femur eg: # neck of femur,
dislocation hip
Proximal pole of scaphoid, Body of
Talus