extremity trauma instructor name: title: unit:. overview relationship of extremity trauma to...
TRANSCRIPT
EXTREMITY TRAUMA
• Instructor Name:
• Title:
• Unit:
OVERVIEW
• Relationship of extremity trauma to assessment of life-threatening injury
• Types of extremity injuries• Assessment & management
– General• Estimation of blood loss
• Splinting
– Specific injuries
FRACTURE PRIORITIES
• Fractures rarely life-threatening
• Perform BTLS Primary Survey to find life-threatening injuries– Do not be distracted by obvious but not life-
threatening extremity injuries– Be alert to major bleeding from extremity
injuries
TYPES OF FRACTURES
• Open– Bone ends protrude through the wound– High risk of infection
• Closed– No opening through the skin
• Fractures may– Damage adjacent nerves and vessels– Produce severe bleeding– Blood loss may be internal
DISLOCATIONS
• Joint deformity may be fracture or dislocation
• Can cause neurovascular compromise of distal extremity
• Always assess– Distal sensation– Distal motor function– Distal pulses and skin color
AMPUTATIONS
• Control bleeding by direct pressure– Tourniquets rarely needed
• Locate amputated part
• Do not place amputated part directly in ice or water– Place part in plastic bag– Place bag in ice-water mixture
SPRAINS & STRAINS
• Signs similar to fractures
• X-rays needed to distinguish from fractures
• Treat as if fractured
“If an extremity hurts, immobilize it”
OPEN WOUNDS
• Control bleeding with pressure– Tourniquets rarely
needed
• Check distal PMS– Pulse
– Motor
– Sensory
COURTESY ROY ALSON M.D.
Applying Tourniquet
IMPALED OBJECTS
• Stabilize in position found– Removal may cause uncontrollable
bleeding
• Exceptions– Object in cheek– Cannot control major bleeding with
object in place
COMPARTMENT SYNDROME
• Early– Pain
– Paresthesias
• Late– Pallor
– Pulselessness
– Paralysis
Pathophysiology
Signs and symptoms
SIGNS & SYMPTOMS OF EXTREMITY INJURY
• Pain
• Deformity
• Swelling
• Loss of movement
• CrepitusCOURTESY ROY ALSON,
M.D.
ASSESSMENT
• Scene Size-Up– Clues to specific injuries
• BTLS Primary Survey– Pelvic fractures or bilateral femur fractures are
Load & Go– Control major bleeding– History may suggest other injuries
BLOOD LOSS FROM FRACTURES
• Pelvis - 500cc for each break– May lacerate major vessels causing
major internal bleeding
• Femur - 1000cc
• Multiple fractures can produce life-threatening hemorrhage– May all be internal
DETAILED EXAMCHECK EXTREMITIES FOR
• Deformities
• Contusions
• Abrasions
• Penetrations
• Burns
• Tenderness
• Lacerations
• Swelling
ALSO CHECK FOR PMS
MANAGEMENT
• SPLINTING– Decreases pain– Prevents further
injury– Decreases blood
lossCOURTESY DAVID EFFRON, M.D.
GENERAL RULES OF SPLINTING
• Visualize injured part• Check and record PMS before and after
splinting• May apply gentle in-line traction• Cover open wounds with sterile
dressings• Pad the splint• Immobilize one joint above and below
the site of the injury
GENERAL RULES OF SPLINTING
• Do not push bone ends back under the skin
• May apply splints en route to the hospital
• If in doubt, splint • Never delay transport of critical
patient to perform splinting of minor fractures
MANAGEMENTLOAD & GO PATIENTS
• Spinal immobilization– Long backboard– C-collar– Head immobilizer
• Limit splinting until en route• Backboard acts as “whole body”
splint
MANAGEMENTSPECIFIC INJURIES
• CLAVICLE FRACTURES– Common injury
– Apply sling & swathe
SHOULDER INJURIES
• AC separation– Sling & swathe
• Shoulder dislocation– Use pillow with
sling & swathe
• Fracture– Use sling & swathe
ELBOW INJURY
• Fracture or dislocation may cause neurovascular injury
• Splint in position found
• Transport promptly
FOREARM/WRIST INJURY
• Rigid splint– Keep hand in
position of function
• Air splint– May be difficult
to reassess circulation
• Pillow
FEMUR FRACTURES
• High force injury• High potential for
shock• May use traction splint• PASG or air splint
may give adequate stabilization
COURTESY OF ROY ALSON M.D.
KNEE FRACTUREOR DISLOCATION
• Orthopedic emergency• Frequently causes
vascular injury• Dislocation associated
with high incidence of leg amputation
MANAGEMENT KNEE DISLOCATION
• Obvious dislocation without distal pulse– Apply gentle in-line traction
• If gentle traction does not restore the pulse– Splint in place
• Prompt transport
TIBIA-FIBULA FRACTURES
• Frequently open fractures• Significant hemorrhage
possible• Dress open wounds• Depending on level of
fracture– Upper - Rigid splint
– Lower - Air splint or pillowCOURTESY OF ROY ALSON M.D.
FOOT OR HANDINJURIES
• Common industrial injury• Often disabling• Rarely life-threatening• Splint foot with pillow• Splint hand in position of
function
SUMMARY
• Note mechanism of injury
• Remember priorities– ABCs first
• Be prepared for shock
• Record PMS
SUMMARY
• Critical patients– Do not waste time on minor splinting– Immobilize spine– Apply other splints en route
• Immobilize one joint above and below
• If in doubt, splint
QUESTIONS?