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I Think We Need Ancef...

3/27/2015

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HPI:  Middle age man s/p MCC with open fracture of right leg.  Tourniquet applied in the field.

Physical Exam:  Completely shattered tibia and fibula with 10cm open wound.  Weak but palpable DP after taking tourniquet down.  Intact sensation to light touch in superficial peroneal, deep peroneal, and tibial distributions.  Able to wiggle toes and slight dorsiflexion.
Management:  Basic Management of Open Fractures
  • Fracture management starts after initial trauma survey
  • First generation cephalosporin (we use Ancef 2 gm here) and update tetanus
  • Control bleeding with direct pressure. Do not blindly clamp or place tourniquets on damaged extremity
  • Assess soft tissue damage and perform neurovascular exam
  • Remove large debris and place sterile saline soaked gauze on wound
  • Splint Fracture
Key Points:  
  • Ortho versus Vascular taking to operating room all depends on your detailed neurovascular exam
  • Early antibiotic administration is the  most important factor in reducing infection
  • Most important predictor of eventual amputation is the severity of extremity soft tissue injury
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  • Prospective Applicants
    • 2020 MATCH
    • About CMC
    • Our Curriculum
    • Our Residents
    • Our Fellowships
    • Program Leadership
    • Explore Charlotte
    • Official Site
  • ROTATING STUDENTS
    • Prospective Visiting Students
    • UNC Students
    • Healthcare Disparities Externship
    • Current Students
  • Current Residents
    • Airway Lecture!
    • PGY - 1
    • PGY - 2
    • PGY - 3
    • Simulation Reading
    • Blogs >
      • EM GuideWire
      • CMC ECG Masters
      • Core Concepts
      • #FOAMed
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
    • Board Review
    • Journal Club
    • Resident Wellness
    • Resident Research
  • Top 20
  • Chiefs Corner
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Individualized Interactive Instruction
    • Evaluations/Interview Season
    • Contact Info
    • Resume Builder