Muskuloskeletal trauma for General Practitioners
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- The document provides guidance on treating musculoskeletal trauma as a general practitioner at the scene of a road traffic accident. It emphasizes assessing the ABCDE (airway, breathing, circulation, disability, exposure) before treating any fractures. For a patient with severe leg pain and an open wound exposing bone, the priorities are to control bleeding with 1-2L of crystalloid fluids, reduce and stabilize fractures using traction, manipulation and splinting/slabbing, and arrange transfer to the hospital after initial first aid care. Open fractures should receive antibiotics, tetanus prophylaxis, irrigation, and a saline dressing before transfer.
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Muskuloskeletal trauma for General Practitioners
- 1. Muskuloskeletal Trauma for General Practitioners By Kareem Hamimy Resident of Orthopedics and Traumatology Cairo University, Student’s Hospital
- 2. Case Scenario • You are In your GP Clinic, and a Road Traffic Accident happened infront of your clinic, you heard Shouts “ Doctor, Doctor, Help us ”, • You got out of your clinic, you see a 25 years old man, fully conscious, with severe Pain in both legs, one leg has a 10 cm wound, where you can see bone edges • What are you going to do ??
- 3. Transfer • Transfer the Patient, that is the Perfect Decision, but before Transfer
- 4. Set Priorities • Care for yourself First • Take care of the scene first, try to transfer the patient to a safer area in the street, we don’t need more victims • Wear Protective equipment if available, ( gloves, Mask )
- 5. Set Priorities • ABCDE • Don’t get distracted by the open leg wound, and don’t get pushed by the crowd into managing open wound first • ABCDE is way more Important • Life before Limb
- 6. C • Musculoskeletal Trauma affect mainly the C • Pelvis Fx 2-3 L blood is lost • Femur Fx 1-1.5 L • Tibia Fx 500cc • Asses Pulse, B.P, and give 1-2L crystalloid
- 7. 2ry Survey • After Fully assessing the ABCDE • Ample History and Head to toe Examination
- 8. Fracture First aid • Any Fracture Needs Reduction and Fixation • Why ? • To protect soft tissues ( Neurovascular ) from Fractured Bony ends
- 9. Principles of Reduction • Traction and counter traction for 1 min • To decrease muscle spasm, which prevent bony alignment • For Ligamento-taxis ( the stretched soft tissue, align the bony ends • Manipulation • By pushing the bone in opposite direction of the deformity seen
- 10. Fixation • To fix the reduced bone in place, using any of Available tools • First Aid Fixation is an External Fixation using Either: • Cardboard • Slab ( Gips Slab )
- 11. Slab or Cast • Cast if done, and edema occurs, that can cause Compartment Syndrome, so Slab is better for First Aid Fixation
- 12. Open Fracture First Aid • Antibiotics ( 1.5 gm Amoxicillin clavulanic acid IM ) • Antitetanus • Antisepsis • By Copious Saline or Clear water Irrigation • 1cm 1 L Saline • The Principles of Pollution is Dilution • Covering the wound by Saline dressing
- 13. Transfer • Now you can safely Transfer the Patient to the Hospital for Definite Management