[shadowflyer]

1. BP of 90 and above for the systolic will get you a palpable radial pulse.


2. DCAP-BTLS is memory aid for assessment we are learning in medic school.

D - deformities
C - contusions/crepitation
A - abrasions
P - penetrations/paradoxical movement
B - burns
T - tenderness
L - lacerations
S - swelling


3. Shock Mgmt--What---2 18G IV NS
When---Signs of shock warrant it.
How much---Still digging for that. I do know that 1500cc blood loss is not uncommon for hip fractures.

3. 3 types of pelvic fractures--

A. Femoral neck fractures
B. Intertrochanteric fractures
C. Subtrochanteric fractures


4. TX/DX of Pelvic fractures-- (I had to dig for this) Since I dont know it off the top of my head ...yet.

In patients who experienced trauma, perform a primary survey and stabilize as needed.

Take a detailed secondary survey because of the high likelihood of other associated injuries. As many as 69% of patients with femoral head fracture-dislocations had major associated injuries, including other extremity injuries, intraabdominal or intrapelvic injuries, neck injuries, and head injuries.

Pay particular attention to vital signs and secondary manifestations of shock such as changes in skin, mental status, and urine output. Hip fractures are associated with blood volume losses of up to 1500 cc.


Inspect and palpate for deformity, hematoma formation, laceration, and asymmetry.

Observe the natural position of the extremity, as this alone often indicates the type of injury the patient has sustained.

Femoral head fracture: Most often, this occurs as a result of hip dislocation; therefore, the position of the extremity is abduction, external rotation, and flexion or extension for anterior dislocation. With posterior dislocation (most common type), the extremity is held in an adducted and internally rotated position.


Femoral neck fracture: Extremity is held in a slightly shortened, abducted, and externally rotated position, unless the fracture is only a stress fracture or severely impacted. In this case, the hip is held in a natural position.


Intertrochanteric fracture: Extremity is held in a markedly shortened and externally rotated position.


Subtrochanteric fracture: Proximal femur usually is held in a flexed and externally rotated position.

Trochanteric fracture
No deformities are noted on observation.
Apply lateral to medial pressure on hips through greater trochanters.


In assessing range of motion (ROM), first test external and internal rotation with extremity in extension. If the patient has a fracture, especially a displaced one, the remainder of ROM exam is extremely painful, of limited diagnostic use, and potentially dangerous. If the patient has pain with the initial ROM exam, obtain x-ray prior to completing.


Perform a detailed distal neurovascular exam.


If patient is a trauma victim, assess for pelvic fracture by stressing pelvis anteriorly to posteriorly through iliac crests and symphysis pubis, and laterally to medially through iliac crests.