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EXTREMITY TRAUMA

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EXTREMITY TRAUMA – PowerPoint PPT presentation

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Title: EXTREMITY TRAUMA


1
EXTREMITY TRAUMA
  • Instructor Name
  • Title
  • Unit

2
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

3
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

4
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

5
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

6
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

7
SPRAINS STRAINS
  • Signs similar to fractures
  • X-rays needed to distinguish from fractures
  • Treat as if fractured

If an extremity hurts, immobilize it
8
OPEN WOUNDS
  • Control bleeding with pressure
  • Tourniquets rarely needed
  • Check distal PMS
  • Pulse
  • Motor
  • Sensory

COURTESY ROY ALSON M.D.
9
Applying Tourniquet
10
IMPALED OBJECTS
  • Stabilize in position found
  • Removal may cause uncontrollable bleeding
  • Exceptions
  • Object in cheek
  • Cannot control major bleeding with object in place

11
COMPARTMENT SYNDROME
? Pathophysiology ? Signs and symptoms
  • Early
  • Pain
  • Paresthesias
  • Late
  • Pallor
  • Pulselessness
  • Paralysis

12
SIGNS SYMPTOMS OF EXTREMITY INJURY
  • Pain
  • Deformity
  • Swelling
  • Loss of movement
  • Crepitus

COURTESY ROY ALSON, M.D.
13
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

14
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

15
DETAILED EXAMCHECK EXTREMITIES FOR
  • Deformities
  • Contusions
  • Abrasions
  • Penetrations
  • Burns
  • Tenderness
  • Lacerations
  • Swelling

ALSO CHECK FOR PMS
16
MANAGEMENT
  • SPLINTING
  • Decreases pain
  • Prevents further injury
  • Decreases blood loss

COURTESY DAVID EFFRON, M.D.
17
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

18
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

19
MANAGEMENTLOAD GO PATIENTS
  • Spinal immobilization
  • Long backboard
  • C-collar
  • Head immobilizer
  • Limit splinting until en route
  • Backboard acts as whole body splint

20
MANAGEMENTSPECIFIC INJURIES
  • CLAVICLE FRACTURES
  • Common injury
  • Apply sling swathe

21
SHOULDER INJURIES
  • AC separation
  • Sling swathe
  • Shoulder dislocation
  • Use pillow with sling swathe
  • Fracture
  • Use sling swathe

22
ELBOW INJURY
  • Fracture or dislocation may cause neurovascular
    injury
  • Splint in position found
  • Transport promptly

23
FOREARM/WRIST INJURY
  • Rigid splint
  • Keep hand in position of function
  • Air splint
  • May be difficult to reassess circulation
  • Pillow

24
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.
25
KNEE FRACTUREOR DISLOCATION
  • Orthopedic emergency
  • Frequently causes vascular injury
  • Dislocation associated with high incidence of leg
    amputation

26
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

27
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.
28
FOOT OR HANDINJURIES
  • Common industrial injury
  • Often disabling
  • Rarely life-threatening
  • Splint foot with pillow
  • Splint hand in position of function

29
SUMMARY
  • Note mechanism of injury
  • Remember priorities
  • ABCs first
  • Be prepared for shock
  • Record PMS

30
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

31
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