Orthopaedic Trauma

Orthopaedic Orthopaedic TraumaTrauma

ObjectivesObjectives

Identify significant findings for Identify significant findings for emergent and urgent care of emergent and urgent care of orthopaedic trauma patientsorthopaedic trauma patients

Discuss at least 4 methods of Discuss at least 4 methods of fracture fixationfracture fixation

List nursing interventions typical List nursing interventions typical to trauma patientsto trauma patients

Question AQuestion A

Dan is a 26-year old who presents in the Dan is a 26-year old who presents in the ED with an open fracture of the left ED with an open fracture of the left femur following an ATV accident. What femur following an ATV accident. What would be the initial treatment?would be the initial treatment?

a. Irrigate the wound and initiate a. Irrigate the wound and initiate antibiotic antibiotic

therapy.therapy.

b. Administer tetanus prophylaxis.b. Administer tetanus prophylaxis.

c. Check the ABCc. Check the ABC’’s and maintain c-spine s and maintain c-spine

immobilization.immobilization.

d. Prepare patient for transfer to the d. Prepare patient for transfer to the OR.OR.

Answer # AAnswer # A

Dan is a 26-year old who presents Dan is a 26-year old who presents in the ED with an open fracture in the ED with an open fracture of the left femur following an of the left femur following an ATV accident. What would be the ATV accident. What would be the initial treatment?initial treatment?

c. Check the ABCc. Check the ABC’’s and maintain s and maintain

c-spine immobilization.c-spine immobilization.

Trauma Statistics Trauma Statistics

Every 6 minutes, Every 6 minutes, someone in America someone in America dies from trauma: dies from trauma:

Motor vehiclesMotor vehicles

FarmFarm

FallsFalls

Gunshot woundsGunshot wounds

Trauma StatisticsTrauma Statistics 5th leading cause 5th leading cause of deathof death

Leading killer of Leading killer of Americans < 45 yrs Americans < 45 yrs of ageof age

1 in 4 (59 Million) 1 in 4 (59 Million) Americans injured Americans injured annuallyannually

36 Million ED 36 Million ED visits visits

Bimodal distributionBimodal distribution High energy High energy injuries in 16-35 injuries in 16-35 y.o.y.o.

Low energy Low energy injuries in injuries in elderly 70 + y.o.elderly 70 + y.o.

Following head Following head injuries, pelvic injuries, pelvic fractures are most fractures are most common cause of common cause of traumatic deathtraumatic death

Mechanism of Injury:Mechanism of Injury:Energy ExchangeEnergy Exchange

Kinetic/Kinetic/MechanicalMechanical

ThermalThermal

ChemicalChemical

ElectricalElectrical

RadiantRadiant

Oxygen deprivationOxygen deprivation

Mechanism of InjuryMechanism of Injury

Penetrating TraumaPenetrating Trauma

High velocity missiles (bullets) = High velocity missiles (bullets) = crush/stretchcrush/stretch

Low velocity stab wounds = Low velocity stab wounds = shearing/stretchshearing/stretch

High pressure injection = High pressure injection = explosion/tearingexplosion/tearing

Mechanism of InjuryMechanism of Injury

Blunt TraumaBlunt Trauma

Compression/impact= compressed/shortenCompression/impact= compressed/shorten

Shearing=tearing/Shearing=tearing/ dissectiondissection

Torsion/twisting= dislocation/Torsion/twisting= dislocation/subluxationsubluxation

Tensile/traction= stretching/tearingTensile/traction= stretching/tearing

Mechanism of InjuryMechanism of Injury Motor vehicle accidentsMotor vehicle accidents

FallsFalls

Pedestrian/Bikes/Skateboards/ScootersPedestrian/Bikes/Skateboards/Scooters

Non-accidental; self-inflictedNon-accidental; self-inflicted

Shaken babyShaken baby

DivingDiving

Gun Shot WoundsGun Shot Wounds

SubluxationSubluxation

Displacement of bone from its normal Displacement of bone from its normal joint position to the extent that joint position to the extent that articulating surfaces partially articulating surfaces partially loose contactloose contact

Commonly due to direct blow, Commonly due to direct blow, indirect force or severe twisting, indirect force or severe twisting,

Subluxation: Subluxation: InterventionsInterventions

Immediate closed Immediate closed reduction by reduction by trained trained personnelpersonnel

Question # 1Question # 1

The partial disruption of The partial disruption of articulating surfaces is articulating surfaces is known as:known as:

c. subluxationc. subluxation

DislocationDislocation

Complete separation or displacement Complete separation or displacement of articulating surfaces:of articulating surfaces: Urgent reduction required Urgent reduction required Blood supply to boneBlood supply to bone Nerve or vessel injuryNerve or vessel injury

Dislocation: Dislocation: InterventionsInterventions

Reduction (return to normal anatomic Reduction (return to normal anatomic alignment)alignment) ManuallyManually Regional block Regional block General anesthesiaGeneral anesthesia

Open Reduction Internal FixationOpen Reduction Internal Fixation

Radial Head DislocationRadial Head Dislocation

Radial dislocation Radial dislocation may be caused by a may be caused by a sudden pull on a sudden pull on a child's arm or child's arm or hand. For first hand. For first aid, immobilize aid, immobilize the arm and take the arm and take the child to the the child to the doctor's office or doctor's office or emergency room. emergency room.

Subluxation & Subluxation & Dislocation: Nursing Dislocation: Nursing

DiagnosisDiagnosis Peripheral Peripheral neurovascular neurovascular dysfunction, risk fordysfunction, risk for

Injury, risk forInjury, risk for

Tissue perfusion, Tissue perfusion, ineffective; ineffective; peripheralperipheral

Physical mobility, Physical mobility, impaired impaired


A comminuted fracture may be classified A comminuted fracture may be classified as an injury in which:as an injury in which:

a. bone protrudes through the skin a. bone protrudes through the skin

surfacesurface

b. tendons and ligaments are disruptedb. tendons and ligaments are disrupted

c. the ends of bone are impacted into c. the ends of bone are impacted into one one

anotheranother

d. bone is fractured into two or more d. bone is fractured into two or more

fragments.fragments.

Answer # 2Answer # 2

A comminuted fracture may be A comminuted fracture may be classified as an injury in which:classified as an injury in which:

d. bone is fractured into two or d. bone is fractured into two or more more


FracturesFractures

A break or A break or disruption disruption in the in the continuity continuity of a boneof a bone

Fractures: Fractures: Clinical ManifestationsClinical Manifestations

PainPain EdemaEdema DiscolorationDiscoloration Inability to Inability to functionfunction

Obvious deformityObvious deformity CrepitusCrepitus Muscle spasm Muscle spasm Protruding bone Protruding bone

Fractures: Fractures: DiagnosticsDiagnostics

Radiologic examsRadiologic exams Plane filmsPlane films

X-ray a joint X-ray a joint above and below above and below injuryinjury

CT scanCT scan

MRIMRI

FracturesFractures

Predisposing factors:Predisposing factors: OsteoporosisOsteoporosis Risk-taking behaviorsRisk-taking behaviors

Mechanical overload to bone Mechanical overload to bone

Simplest method of classification is based Simplest method of classification is based on boneon bone’’s relationship to the environment:s relationship to the environment: OpenOpen ClosedClosed

Fractures: Fractures: ClassificationsClassifications


ComminutedComminuted Displaced/Non-Displaced/Non-displaceddisplaced

Complete/Complete/

IncompleteIncomplete AvulsionAvulsion CompressionCompression BuckleBuckle ButterflyButterfly

PathologicPathologic ArticularArticular TransverseTransverse ObliqueOblique SpiralSpiral Stellate Stellate Fatigue/StressFatigue/Stress SegmentalSegmental




Fractures : Fractures : Classification by Joint Classification by Joint

InvolvementInvolvement Intraarticular: fracture extends Intraarticular: fracture extends into the jointinto the joint

Intracapsular: fracture within joint Intracapsular: fracture within joint capsulecapsule

Extracapsular: fracture extends Extracapsular: fracture extends outside capsuleoutside capsule

Supracondylar: above condyle(s)Supracondylar: above condyle(s)

Fractures: Fractures: GradingGrading

Grade I Grade I wound < 1cm; minimal contaminationwound < 1cm; minimal contamination

Grade IIGrade II wound > 1 cm; moderate wound > 1 cm; moderate contaminationcontamination

Grade III Grade III wound > 6-8 cm; extensive damage to wound > 6-8 cm; extensive damage to soft tissue, nerve, and tendon; soft tissue, nerve, and tendon; high degree of contamination high degree of contamination

Question # 3 Question # 3

Andrew has sustained an open book Andrew has sustained an open book fracture of the pelvis after being fracture of the pelvis after being pinned under his tractor. What life-pinned under his tractor. What life-threatening situation is causing his threatening situation is causing his unstable BP?unstable BP?

a. Compartment syndromea. Compartment syndrome

b. Overinflation of MAST trousersb. Overinflation of MAST trousers

c. Incorrect application of c. Incorrect application of external fixationexternal fixation

d. Retroperitoneal hemorrhage d. Retroperitoneal hemorrhage


Andrew has sustained an open Andrew has sustained an open book fracture of the pelvis book fracture of the pelvis after being pinned under his after being pinned under his tractor. What life-threatening tractor. What life-threatening situation is causing his situation is causing his unstable BP?unstable BP?


Fractures: Emergency Fractures: Emergency ManagementManagement

Primary assessment for potentially Primary assessment for potentially life-threatening injurieslife-threatening injuries

Fracture management often secondaryFracture management often secondary Most fractures not life threateningMost fractures not life threatening Stabilize extremityStabilize extremity Cover wounds, open fractures with Cover wounds, open fractures with sterile saline dressingsterile saline dressing

Principles of Open Principles of Open Fracture ManagementFracture Management

Treat open fractures as emergenciesTreat open fractures as emergencies

Culture wounds prior to cleansingCulture wounds prior to cleansing

Remove particulate matter in open fracture Remove particulate matter in open fracture by copious lavage and debridementby copious lavage and debridement

Cover exposed fracture fragments with a Cover exposed fracture fragments with a sterile dressingsterile dressing

Debride devitalized tissueDebride devitalized tissue

Principles of Open Principles of Open Fracture Management Fracture Management

(cont.)(cont.) Obtain x-rays of affected and Obtain x-rays of affected and amputated partsamputated parts

Stabilize fractures with appropriate Stabilize fractures with appropriate materialsmaterials

Provide adequate soft tissue coverageProvide adequate soft tissue coverage

Administer antibiotic coverage and Administer antibiotic coverage and tetanus prophylaxistetanus prophylaxis

Orthopaedic EmergenciesOrthopaedic Emergencies

Spine fracturesSpine fractures

Open book pelvic Open book pelvic fracturesfractures

Dislocated jointDislocated joint ElbowElbow KneeKnee

Fracture Management: Fracture Management: GoalsGoals

Prevent complicationsPrevent complications

Return to maximal functionReturn to maximal function

Achieve best possible cosmetic resultAchieve best possible cosmetic result

Remember ABCRemember ABC’’ss

C-spine precautionsC-spine precautions

AssessmentAssessmentRadiographic Radiographic AssessmentAssessment

C-spineC-spine ChestChest PelvisPelvis

Neurovascular Neurovascular AssessmentAssessment

Upper extremityUpper extremity RadialRadial MedianMedian UlnarUlnar

Lower extremityLower extremity PeronealPeroneal TibialTibial

Occult InjuriesOccult Injuries Head injury- thoracic injuryHead injury- thoracic injury Facial fractures- neck injury & Facial fractures- neck injury & airway occlusionairway occlusion

Rib fracture - pleural injuryRib fracture - pleural injury Sternal bruise-cardiac Sternal bruise-cardiac contusion, aortic tearcontusion, aortic tear

Lap belt injuries- spine Lap belt injuries- spine

and abdominal injuryand abdominal injury

Occult Injuries (cont.)Occult Injuries (cont.)

Extremity injury- compartment Extremity injury- compartment syndromesyndrome

Open book pelvic injuryOpen book pelvic injury Benign to life-threatening (hemorrhage)Benign to life-threatening (hemorrhage) Urgent external fixationUrgent external fixation Nerve damageNerve damage Bladder ruptureBladder rupture

Spine fracture-ileus, neuro deficitSpine fracture-ileus, neuro deficit

Fracture HealingFracture Healing Hematoma formationHematoma formation

1 to 3 days1 to 3 days Granulation Granulation

3 days to 2 weeks3 days to 2 weeks Callus formationCallus formation

2 to 6 weeks2 to 6 weeks Consolidation/Consolidation/Ossification Ossification 3 weeks to 6 3 weeks to 6 monthsmonths

RemodelingRemodeling

WolfWolf’’s Laws Law Bone remodels in Bone remodels in response to response to stressstress

Factors Affecting Factors Affecting Fracture HealingFracture Healing

Trauma severityTrauma severity

Type of boneType of bone

ImmobilizationImmobilization

InfectionInfection

Local pathologyLocal pathology

Avascular Avascular necrosis (AVN)necrosis (AVN)

Intra-articular Intra-articular fracturefracture

Systemic factorsSystemic factors OsteoporosisOsteoporosis

Fracture ManagementFracture Management Closed ReductionClosed Reduction

Manual manipulation to restore alignment of Manual manipulation to restore alignment of bone endsbone ends

Casts/Splints/Sling/SwatheCasts/Splints/Sling/Swathe

TractionTraction

External FixationExternal Fixation

Open Reduction Internal Fixation (ORIF)Open Reduction Internal Fixation (ORIF) Surgical realignment of fragmentsSurgical realignment of fragments Internal placement of pins, wires, plates, Internal placement of pins, wires, plates, screws, intramedullary rods, nails, screws, intramedullary rods, nails,

Closed ReductionClosed Reduction CastingCasting

Immobilize and Immobilize and support injured, support injured, deformed, and deformed, and postoperative postoperative extremitiesextremities

Protect realigned Protect realigned bonebone

Promote healing and Promote healing and early weight bearingearly weight bearing

Serial casting to Serial casting to prevent or correct prevent or correct deformitiesdeformities

Closed ReductionClosed Reduction

Complications of Complications of CastsCasts Compartment Compartment syndromesyndrome

Cast syndrome Cast syndrome (superior (superior mesenteric artery mesenteric artery syndrome) syndrome)

Question #4Question #4

Nursing assessment of skin traction Nursing assessment of skin traction such as Bucksuch as Buck’’s, Russells, Russell’’s or Bryants or Bryant’’s s traction includes:traction includes:

a. neurovascular assessmenta. neurovascular assessment

b. pin careb. pin care

c. alignment of balanced suspensionc. alignment of balanced suspension

d. prevention of skin breakdownd. prevention of skin breakdown

Nursing assessment of skin Nursing assessment of skin traction such as Bucktraction such as Buck ’’s, Russels, Russelll ’’s or Bryants or Bryant’’s traction s traction includes:includes:



Answer #4Answer #4

TractionTraction

Application of a Application of a pulling force to an pulling force to an injured or diseased injured or diseased part of the body or part of the body or an extremity while an extremity while a countertraction a countertraction pulls in the pulls in the opposite directionopposite direction

Countertraction is Countertraction is usually the patienusually the patientt ’’s body s body

Traction: Types Traction: Types

ManualManual

Use of hands to exert pulling forceUse of hands to exert pulling force

SkinSkin

Pulling force directly to the skinPulling force directly to the skin

SkeletalSkeletal

Traction forces directly to the boneTraction forces directly to the bone

Traction: PurposesTraction: Purposes Reduce, realign, Reduce, realign, and promote healing and promote healing of fractured bonesof fractured bones

Decrease muscle Decrease muscle spasmspasm

ImmobilizationImmobilization

Treat deformitiesTreat deformities

Rest jointsRest joints

Treat dislocations Treat dislocations and subluxationsand subluxations

Reduce deformitiesReduce deformities

Prevent Prevent contracturescontractures

Expand joint spaceExpand joint space

Traction: Traction: ClassificationsClassifications

SkinSkin CervicalCervical

SidearmSidearm

Pelvic sling Pelvic sling

BuckBuck’’ss

Bryant (pediatrics)Bryant (pediatrics)

RussellRussell’’s s

Traction: Traction: ClassificationsClassifications

SkeletalSkeletal Halo vestHalo vest

Steinman pin or Steinman pin or Kirschner wire with Kirschner wire with balanced suspension balanced suspension (Thomas splint with (Thomas splint with Pearson attachment) Pearson attachment) or BB (Bohler or BB (Bohler Braun) frame Braun) frame

Traction PrinciplesTraction Principles

Maintain prescribed line of pullMaintain prescribed line of pull

Maintain continuous pullMaintain continuous pull

Prevent frictionPrevent friction

Identify and maintain Identify and maintain countertraction countertraction

Traction:Traction: Nursing Diagnosis Nursing Diagnosis

Activity intoleranceActivity intolerance

Breathing pattern, Breathing pattern, ineffectiveineffective

ConstipationConstipation

Disuse syndrome, high Disuse syndrome, high risk forrisk for

Diversional activity Diversional activity deficitdeficit

HopelessnessHopelessness

Impaired physical Impaired physical mobilitymobility

Loneliness, risk for Loneliness, risk for

Pain (acute or Pain (acute or chronic)chronic)

PowerlessnessPowerlessness

Traction: Nursing Traction: Nursing Diagnosis (cont.)Diagnosis (cont.)

Peripheral neurovascular dysfunction, high risk Peripheral neurovascular dysfunction, high risk forfor

Skin integrity impairment , high risk forSkin integrity impairment , high risk for

Sleep pattern disturbance Sleep pattern disturbance

Thought process alteration Thought process alteration

Tissue perfusion alteration venousTissue perfusion alteration venous

Urinary eliminationUrinary elimination

External FixationExternal Fixation

A versatile method of immobilization A versatile method of immobilization that employs percutaneous that employs percutaneous transfixing pins/wires in bone transfixing pins/wires in bone attached to a rigid external frameattached to a rigid external frame

Allows wide range of anatomic Allows wide range of anatomic correction both congenital and correction both congenital and acquiredacquired

External FixationExternal Fixation Types of fixationTypes of fixation

circular framecircular frame semicircular semicircular frameframe

unilateral frameunilateral frame bilateral bilateral quadrilateral quadrilateral frameframe

Pin care Pin care

External Fixation: External Fixation: Indications Indications

Acute trauma to bones with/without segmental Acute trauma to bones with/without segmental lossloss

Limb length discrepanciesLimb length discrepancies

Infected and non-infected long bone union and Infected and non-infected long bone union and non union; osteomyelitisnon union; osteomyelitis

Angulation and soft tissue deformitiesAngulation and soft tissue deformities

Correction of chronic or residual deformitiesCorrection of chronic or residual deformities

External Fixation:External Fixation:Complications Complications

Pin tract infections (most common)Pin tract infections (most common)

Loss of alignment or correctionLoss of alignment or correction

Joint stiffnessJoint stiffness

ContracturesContractures

Delayed healingDelayed healing non-unionnon-union mal-unionmal-union

External Fixation:External Fixation:Nursing DiagnosisNursing Diagnosis

Body image disturbanceBody image disturbance

Disuse syndrome, risk forDisuse syndrome, risk for

Impaired adjustmentImpaired adjustment

Impaired mobilityImpaired mobility

Impaired skin integrity, risk forImpaired skin integrity, risk for

External Fixation:External Fixation:Nursing Diagnosis (cont.)Nursing Diagnosis (cont.)

Infection, risk forInfection, risk for

Injury, risk forInjury, risk for

PainPain

Peripheral neurovascular Peripheral neurovascular dysfunction, risk fordysfunction, risk for

Sleep pattern disturbanceSleep pattern disturbance

ORIFORIF

ORIF: Nursing DiagnosisORIF: Nursing Diagnosis

Disuse syndrome, high risk forDisuse syndrome, high risk for

Impaired adjustmentImpaired adjustment

Impaired physical mobilityImpaired physical mobility

Impaired skin integrity, high risk forImpaired skin integrity, high risk for

Infection, high risk forInfection, high risk for

ORIF: Nursing Diagnosis ORIF: Nursing Diagnosis (cont.)(cont.)

Pain (acute or chronic)Pain (acute or chronic)

Preoperative position injury, Preoperative position injury, risk forrisk for

Peripheral neurovascular Peripheral neurovascular dysfunction, high risk for dysfunction, high risk for

Sleep pattern disturbance Sleep pattern disturbance


Fracture management requires astute Fracture management requires astute attention to infection control attention to infection control practices. Which nursing assessment practices. Which nursing assessment is paramount in determining if is paramount in determining if wound/bone sepsis is developing? wound/bone sepsis is developing?

a. vital signsa. vital signsb. restlessnessb. restlessnessc. meticulous wound carec. meticulous wound cared. maintenance of fracture d. maintenance of fracture managementmanagement


Fracture management requires Fracture management requires astute attention to infection astute attention to infection control practices. Which nursing control practices. Which nursing assessment is paramount in assessment is paramount in determining if wound/bone sepsis determining if wound/bone sepsis is developing? is developing?

a. vital signsa. vital signs

Fracture Management:Fracture Management:Nursing ConsiderationsNursing Considerations

Skin-Tissue Perfusion Skin-Tissue Perfusion Risk for peripheral neurovascular Risk for peripheral neurovascular dysfunctiondysfunction

DVTDVT PEPE SCD-LMWHSCD-LMWH Pressure ulcersPressure ulcers

Heels/Sacrum/EarsHeels/Sacrum/Ears Fracture blistersFracture blisters


NutritionNutrition Increased needsIncreased needs NPONPO Ulcer prophylaxisUlcer prophylaxis Banana bagBanana bag Consider DTConsider DT’’s s Smoking decreases healing time Smoking decreases healing time (tibias) (tibias)


MobilityMobility Prevent wrist or Prevent wrist or foot dropfoot drop

Reduce edemaReduce edema Prevent Prevent contracturescontractures

Prevent deformity Prevent deformity and disability and disability


Self-ConceptSelf-Concept Body imageBody image Limb lossLimb loss DisfigurementDisfigurement DependenceDependence


Elimination Elimination Ileus secondary to medications, Ileus secondary to medications, anesthesiaanesthesia

ConstipationConstipation UTIUTI


Infection Infection Open fracturesOpen fractures Wound contaminationWound contamination OsteomyelitisOsteomyelitis Gas GangreneGas Gangrene

Trauma PreventionTrauma Prevention

Seat belt usageSeat belt usage Child restraintsChild restraints Booster seatsBooster seats DUIDUI MADD/SADDMADD/SADD Speed limit Speed limit adherenceadherence

Home safetyHome safety


A comminuted fracture may be classified A comminuted fracture may be classified as an injury in which:as an injury in which:

a. bone protrudes through the skin a. bone protrudes through the skin

surfacesurface

b. tendons and ligaments are disruptedb. tendons and ligaments are disrupted

c. the ends of bone are impacted into c. the ends of bone are impacted into one one

anotheranother

d. bone is fractured into two or more d. bone is fractured into two or more



A comminuted fracture may be A comminuted fracture may be classified as an injury in which:classified as an injury in which:

d. bone is fractured into two or d. bone is fractured into two or more more


Question # 3 Question # 3

Andrew has sustained an open book Andrew has sustained an open book fracture of the pelvis after being fracture of the pelvis after being pinned under his tractor. What life-pinned under his tractor. What life-threatening situation is causing his threatening situation is causing his unstable BP?unstable BP?

a. Compartment syndromea. Compartment syndrome

b. Overinflation of MAST trousersb. Overinflation of MAST trousers

c. Incorrect application of c. Incorrect application of external fixationexternal fixation



Andrew has sustained an open Andrew has sustained an open book fracture of the pelvis book fracture of the pelvis after being pinned under his after being pinned under his tractor. What life-threatening tractor. What life-threatening situation is causing his situation is causing his unstable BP?unstable BP?



Nursing assessment of skin traction Nursing assessment of skin traction such as Bucksuch as Buck’’s, Russells, Russell’’s or Bryants or Bryant’’s s traction includes:traction includes:


b. pin careb. pin care

c. alignment of balanced suspensionc. alignment of balanced suspension


Nursing assessment of skin Nursing assessment of skin traction such as Bucktraction such as Buck ’’s, Russels, Russelll ’’s or Bryants or Bryant’’s traction s traction includes:includes:



Answer #4Answer #4


Fracture management requires astute Fracture management requires astute attention to infection control attention to infection control practices. Which nursing assessment practices. Which nursing assessment is paramount in determining if is paramount in determining if wound/bone sepsis is developing? wound/bone sepsis is developing?

a. vital signsa. vital signsb. restlessnessb. restlessnessc. meticulous wound carec. meticulous wound cared. maintenance of fracture d. maintenance of fracture managementmanagement


Fracture management requires Fracture management requires astute attention to infection astute attention to infection control practices. Which nursing control practices. Which nursing assessment is paramount in assessment is paramount in determining if wound/bone sepsis determining if wound/bone sepsis is developing? is developing?

a. vital signsa. vital signs

Personal measures I take to reduce the Personal measures I take to reduce the risk of trauma include:risk of trauma include:a. always wear a lap shoulder restraint when a. always wear a lap shoulder restraint when driving or riding in the front seat of a driving or riding in the front seat of a motor vehiclemotor vehicle

b. thoroughly obeying all traffic regulationsb. thoroughly obeying all traffic regulations

c. driving within the posted speed limitc. driving within the posted speed limit

d. not drinking and driving; being a d. not drinking and driving; being a designated driver in a groupdesignated driver in a group

e. taking a break every two hours when e. taking a break every two hours when drivingdriving

f. getting adequate rest and not being f. getting adequate rest and not being fatigued at the wheelfatigued at the wheel


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Orthopaedic Trauma