Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)
Outline
Fractures (Open, Closed, Fat Embolus)
Definition/Etiology:
- Closed Fracture (Simple fracture) – break in the bone but the skin and surrounding tissue remain intact (CLOSED)
- Open Fracture (Compound fracture) – break in the bone but the skin and surround tissue are compromised (OPEN)
- Fat Embolism – characterized by systemic dissemination of fat emboli within the system circulation. Orthopedic trauma is the usual cause
Pathophysiology:
- Fracture – A break in the bone is usually caused by trauma/injury such as MVA, MCC, falls, etc.
- Fat embolus – Fat particles are released from the bone during the time of the fracture and enter the microcirculation, causing damage to the capillary beds.
Usually, a fracture of the long bone or pelvis.
Route of the fat embolus:
- Lungs
- Brain
- Eyes
Clinical Presentation:
- Open fractures are at increased risk of neurovascular compromise, hemorrhage and INFECTION!
- Usually occur from high velocity injuries
- Skin will be open, extremity usually deformed
- Distracting injuries so don’t forget your ABCs, then address the fracture
Collaborative Management:
Fractures:
- X-ray (of course)
- CT may be helpful if it is a joint such as an ankle.
- CTA used to identify vascular injury if pulses are diminished
- Stabilize injury (splint/pillow/cast/etc)
- Check for distal pulses and sensation for baseline neurovascular status
- Hemodynamic monitoring
- Pain management
- Lifesaving tetanus
- Open fracture – Get those antibiotics on board.
Fat Embolus:
- Diagnosis based on hx of traumatic fx and symptoms
- Symptomatic treatment
- Good Oxygenation
- Albumin binds to fatty acids
- stabilization of the fracture
Evaluation | Patient Monitoring | Education:
Closed fracture? Splint it and forget it. (Rarely requires more than outpatient follow up and pain management)
- Watch for swelling (especially after splinting) due to risk for compartment syndrome
Open fracture? Hanging out for the night
- Ortho consult, surgical consult
- Open fractures may need reduced to take pressure off open area
- Monitor for signs of infection
Linchpins: (Key Points)
- Either fracture can have neurovascular compromise
- Open fractures have higher risk of infection
- Surgical consult needed on open fractures
Fat Embolus Triad:
- Respiratory Changes (hypoxia, dyspnea)
- Neurologic Changes (Altered Mental Status)
- Dermatological Changes (Petechial Rash)
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Adeyinka, A., & Pierre, L. (2018). Fat embolism.
- Shaikh, N. (2009). Emergency management of fat embolism syndrome. Journal of Emergencies, Trauma and Shock, 2(1), 29.
- Sheehy, S. B., Hammond, B. B., & Zimmermann, P. G. (2013). Sheehy’s manual of emergency care. 7th ed. / St. Louis, Mo., Elsevier/Mosby.
- Sop, J. L., & Sop, A. (2017). Open Fracture Management.
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