EXTREMITY TRAUMA

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EXTREMITY TRAUMA

• Instructor Name
• Title
• Unit

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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

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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

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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

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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

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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

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SPRAINS STRAINS

• Signs similar to fractures
• X-rays needed to distinguish from fractures
• Treat as if fractured

If an extremity hurts, immobilize it
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OPEN WOUNDS

• Control bleeding with pressure
• Tourniquets rarely needed
• Check distal PMS
• Pulse
• Motor
• Sensory

COURTESY ROY ALSON M.D.
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Applying Tourniquet
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IMPALED OBJECTS

• Stabilize in position found
• Removal may cause uncontrollable bleeding
• Exceptions
• Object in cheek
• Cannot control major bleeding with object in place

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COMPARTMENT SYNDROME
? Pathophysiology ? Signs and symptoms

• Early
• Pain
• Paresthesias

• Late
• Pallor
• Pulselessness
• Paralysis

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SIGNS SYMPTOMS OF EXTREMITY INJURY

• Pain
• Deformity
• Swelling
• Loss of movement
• Crepitus

COURTESY ROY ALSON, M.D.
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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

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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

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DETAILED EXAMCHECK EXTREMITIES FOR

• Deformities
• Contusions
• Abrasions
• Penetrations

• Burns
• Tenderness
• Lacerations
• Swelling

ALSO CHECK FOR PMS
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MANAGEMENT

• SPLINTING
• Decreases pain
• Prevents further injury
• Decreases blood loss

COURTESY DAVID EFFRON, M.D.
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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

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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

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MANAGEMENTLOAD GO PATIENTS

• Spinal immobilization
• Long backboard
• C-collar
• Head immobilizer
• Limit splinting until en route
• Backboard acts as whole body splint

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MANAGEMENTSPECIFIC INJURIES

• CLAVICLE FRACTURES
• Common injury
• Apply sling swathe

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SHOULDER INJURIES

• AC separation
• Sling swathe
• Shoulder dislocation
• Use pillow with sling swathe
• Fracture
• Use sling swathe

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ELBOW INJURY

• Fracture or dislocation may cause neurovascular
  injury
• Splint in position found
• Transport promptly

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FOREARM/WRIST INJURY

• Rigid splint
• Keep hand in position of function
• Air splint
• May be difficult to reassess circulation
• Pillow

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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.
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KNEE FRACTUREOR DISLOCATION

• Orthopedic emergency
• Frequently causes vascular injury
• Dislocation associated with high incidence of leg
  amputation

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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

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TIBIA-FIBULA FRACTURES

• Frequently open fractures
• Significant hemorrhage possible
• Dress open wounds
• Depending on level of fracture
• Upper - Rigid splint
• Lower - Air splint or pillow

COURTESY OF ROY ALSON M.D.
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FOOT OR HANDINJURIES

• Common industrial injury
• Often disabling
• Rarely life-threatening
• Splint foot with pillow
• Splint hand in position of function

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SUMMARY

• Note mechanism of injury
• Remember priorities
• ABCs first
• Be prepared for shock
• Record PMS

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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

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QUESTIONS?