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Pelvic fx & fat emboli

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cdunbar4's version from 2017-03-10 17:58

Pelvic Fracture

Question Answer
physical examination characteristicslocal swelling, tenderness, deformity, unusual pelvic movement, ecchymosis on abdomen
assessmentneurovascular status of lower extremities
diagnosis of pelvic fractures by way ofxray & CT scan
tx of stable, nondisplaced fracturesrequires limited intervention & early mobilization. Bed rest few days-6wks.
tx of more complex fracturespelvic sling traction, skeletal traction, hip spica casts, external fixation, open reduction or a combination of these methods
how to provide back care for bed bound patientwhile patient is raised from bed either by trapeze or with adequate assistance
open-book pelvis fracture front of the pelvis opens like a book. This injury results in tears of the strong pelvic ligaments that hold the pelvis bones together
complications of open-book pelvis fractureLarge arteries pass near these ligaments and can get torn resulting in massive blood loss & pelvic bleeds. This requires an emergency intervention to stop the blood loss.
vertical shear pelvisThis is when one half of the pelvis shifts upwards. Like an open book, tears in the pelvic ligaments, as well as in the sacral ligaments can result in massive blood loss.
lateral crush injuryhalf of the pelvis is crushed either inward or outward, again, resulting in damage to surrounding vessels and structures.
s/s depend on artery being blockedcentral nervous system dysfunction that may progress to coma or death, irregularities in the heartbeat, respiratory distress, and fever.
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Fat Emboli

Question Answer
FES (Fat Embolism Syndrome)systemic fat globules from fractures that are distributed into tissues & organs after skeletal injury. Causes many deaths after fractures.
Long bones are usually the culprits. (3)ribs, tibia, and pelvis
FES has been known to follow what other traumatic events?total joint replacement, spinal fusion, liposuction, crush injuries & bone marrow transplantation
one theory of fat embolismsfat emboli form from damaged bone, enters circulation and occludes other organs, such as the brain.
2nd theory of fat embolisms (r/t lungs)a biochemical change initiated by injury, sets up inflammatory response → biochemical injury to lung parenchyma → tissues of lungs, brain, heart, kidneys & skin are most affected.
Early recognition of clinical manis is key to prevent fatal outcomes. What is the timeframe that most patients manifest symptoms post injury?24-48 hours
fat globules that get transported to lungs cause interstitial pneumonitis that produces s/s of?ARDS: chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia and ↓ PaO2
Clinical course is rapid and acute, although some Dx abnormalities may present. What changes would you see in the following labs: fat cells present where?; PaO2; ECG; platelet count, Hct & prothrombin time?fat cells in blood, urine or sputum; ↓ of PaO2 to <60mmHg; ST segment changes on ECG; ↓ in platelet count & Hct levels; prolonged prothrombin time.
Why does petechiae appear?d/t intravascular thromboses caused by ↓ oxygenation
What is the "white-out" effect?chest x-ray revealing areas of pulmonary infiltrate or multiple areas of consolidation.
collaborative care focus?tx is directed at prevention
most important factor in prevention of fat embolismcareful immobilization of long bone fracture
Management is symptom relatedfluid resuscitation to prevent hypovolemic shock, correction of acidosis & replacement of blood loss
Why should repositioning of patient be minimized prior to immobilzation?d/t danger of dislodging more fat droplets into the general circulation
O2 is usually administered, what cc intervention can occur if PaO2 is not reached with supplemental O2?intubation or positive pressure ventilation
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Rhabdomyolysis r/t ETOH abuse

Question Answer
How does rhabdomyolysis lead to acute kidney failure?myoglobinuria. D/T long-term alcohol abuse
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