Materi Kegawatan orthopedic (Emergency in Orthopaedic) secara singkat.

1. Emergency in Orthopaedic

2. Emergency inOrthopaedic
• Fat Embolism Syndrome (FES)
• Crush Injury Syndrome
• Septic Arthritis
• Open Fracture
• Dislocation
• Compartment Syndrome

3. Crush Injury Syndrome
• Crush injury is compression of extremities or other parts of the body that
causes muscle swelling and/or neurological disturbances in the affected
areas of the body, while crush syndrome is localized crush injury with
systemic manifestations

5. Clinical feature
The compromised limb is pulseless and becomes red, swollen and
blistered; sensation and muscle power may be lost
Treatment
Fasciotomy is indicated → Compartment syndrome
Excision of dead muscle must be radical to avoid sepsis
Open wound should be managed aggressively.

6. FAT EMBOLISM SYNDROME(FES)

7. Fat Emboli: Fat particles or droplets that travel
through the circulation
Fat Embolism: A process by which fat emboli passes
into the bloodstream and lodges within a blood
vessel.
Fat Embolism Syndrome (FES): serious
manifestation of fat embolism occasionally
causes multi system dysfunction, the lungs are always
involved and next is brain

8. CLINICAL FEATURES
Asymptomatic for the first 12-48 hours
Pulmonary Dysfunction
Neurological (nonspecific)
Dermatological Signs

9. Pulmonary
฀Hypoxia, rales, pleural friction rub
฀CXR usually normal early on, later may show
‘snowstorm’ pattern- diffuse bilateral infiltrates
฀CT chest: ground glass opacification with interlobular
septal thickening.

10. Neurological findings฀Usually occur after respiratory symptoms
฀Incidence- 80% patients with FES
฀Minor global dysfunction is most common-ranges from mild
delirium to coma.
฀Seizures/focal deficits
฀Transient and reversible in most cases.
฀CT Head: general edema, usually nonspecific
฀MRI brain: Low density on T1, and high intensity T2 signal, correlates
to degree of impairment.

11. Dermatological findings
฀Petechie
฀Usually on conjunctiva, neck, axilla, upper limbs.
฀Results from occlusion of dermal capillaries by fat
globules and then extravasations of RBC.
฀Resolves in 5-7 days. Usually fast resolving.
฀Pathognomic, but only present in 20-50% of patients.

12. Gurd & Wilson Criteria

13. Schonfeld FES Index
sign score
Petechial rash 5
Diffuse alveolar infiltrate 4
Hypoxemia pao2<70 mm Hg, FIO2-100% 3
confusion 1
Fever ( >100.4 F) 1
Heart rate >120 beats/min 1
Respiratory rate >30/min 1
Diagnostic Criteria

14. Lindeque's criteria
Diagnostic Criteria

15. Treatment and management
฀Immobilization and early internal fixation of
fracture.
฀Continuous pulse oximeter monitoring in high- risk
patients may help in detecting desaturation early,
allowing early institution of oxygen
฀ High dose steroid