Extremity Injuries

8/18/2019 Extremity Injuries

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EXTREMITY TRAUMA

Tim Diklat IRD RSSA


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OVERVIEW

- RELATIONSHIP OF EXTREMITY TRAUMA

TO ASSESSMENT OF LIFE-THREATENING INJURY

- ASSESSMENT AND MANGEMENT OF SPESIFIC

EXTREMITY INJURIES :

- BASED UPON MECHANISM AND TYPE

- BASED UPON ANATOMIC POSITION

- BLOOD LOSS FROM FRACTURES


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FRACTURES RARELY

IMMEDIATELY FATAL

NEVER ALLOW AN OBVIOUS

EXTREMITY INJURY TO PREVENT

DIAGNOSIS OF MORE SERIOUS HEAD,

CHEST, ABDOMINAL, OR PELVIC

INJURY


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FRACTURE PRIORITIES

- FRACTURES RARELY IMMEDIATELY FATAL

- DON’T BE DISTRACTED BY OBVIOUS INJURIES- PERFORM BTLS PRIMARY SURVEY TO IDENTIFY

LIFE THREATENING INJURIES


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TYPES OF FRACRURES

- OPEN

- BONE ENDS PROTUDE FROM WOUND.

- HIGH RISK OF INFECTION

- CLOSED

- NO COMPROMISE OF SKIN INTERGRITY

- FRACTURES CAN

- DAMAGE ADJACENT NERVES AND VESSELS

- PRODUCE SEVERE BLEEDING

- BLOOD LOSS MAY NOT OBVIOUS !


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SIGNS AND SYMPTOMS

OF EXTREMITY INJURIES

PAIN

DEFORMITY SWELLING

LOSS OF MOVEMENT

CREPITUS


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DISLOCATIONS

- DEFORMITY OF JOINT MAY BE FRACTURE OR

DISLOCATIONS

- CAN CAUSE NEUROVASCULAR COMPROMISE OF

DISTAL EXTREMITY

- ASSESS

- DISTALL SENSATION

- MOTOR FUNTIONS

- PULSE AND SKIN COLOR


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AMPUTATIONS

- CONTROL BLEEDING BY DIRECT PRESSURE

- TOURNI$UET RARELY NEEDED

- LOCATE AMPUTATED PART

- DO NOT PLACE AMPUTATED PART DIRECLY IN

ICE OR WATER! :

- PLACE IN PLASTIC BAG

- PLACE BAG WITH PART IN

ICE%WATER.


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GENERAL RULES OF

SPLINTING

- VISUALI&E INJURED PART

- CHECK AND RECORD DISTAL CIRCULATION AND

SENSATION

- BEFORE AND AFTER SPLINTING!

- MAY APPLY GENTLE TRACTION- COVER OPEN WOUNDS WITH STERILE

DRESSINGS

- PAD THE SPLINT


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GENERAL RULES OF

SPLINTING'()

-IMMOBILI&E THE JOINT ABOVE AND BELOW SITE

OF INJURY

- DO NOT PUSH BONE ENDS BACK UNDER THE SKIN

- MAY APPLY SPLINTS ENROUTE TO THE HOSPITAL

- IF IN DOUBT, SPLINT IT.


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NEVER DELAY TRANSPORT OFCRITICAL PATIENT TO PERFORM

SPLINTING OF MINOR FRACTURES


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IMPALED OBJECTS

- STABILI&E INPOSITION

- REMOVE MAYBE CAUSE UNCOTROLLABLE

BLEEDING

- EXCEPTIONS

- OBJECT IN CHEEK CAUSING AIRWAY

COMPROMISE

- OBJECT IN CHEST PREVENT CPR.

- CANNOT CONTROL SEVERE BLEEDING


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ASSESSMENT

- MECHANICAL OF INJURY

- MAY HAVE ASSOCIATED INJURIES FROM

TRANSMITTED FORCES

- HISTORY

- OBTAINT IN SECONDARY SURVEY


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ASSESSMENT

DURING SECONDARY SURVEY CHECK FOR :

- DEFORMITY * SWELLING

- TENDERNESS *CREPITUS

JOINT PAIN AND MOVEMENT

- DISTAL PULSE AND SENSATION

- MOTOR FUNCTION


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MANAGEMENT

- SPLINTING

- DECREASES PAIN

- PREVENTS FURTHER INJURY

- DECREASES BLOOD LOSS


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MANAGEMENT OF

SPECIFIC INJURY

SPINAL IMMOBILI&ATION:

- LONG SPINE BOARD

- CERVICAL COLLAR

- HEAD IMMOBILI&ER


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CLAVICLE FRACTURES

- COMMON INJURY

- APPLY SLING AND SWATHE


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SHOULDER INJURIES

- ACROMIO-CLAVICULAR SEPARATION

- SLING AND SWATHE

- SHOUDER DISLOCATION

- USE PILLOW WITH SLING

AND SWATHE

- FRACTURE

- USE SLING AND SWATHE


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ELBOW INJURY

- FRACTURE OR DISLACATION

MAY CAUSE NEUROVASCULARAR INJURY

- SPLINT IN POSITION FOUND

- TRANSPORT PROMPTLY


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FORE ARM % WRIST INJURY

- RIGID SPLINT

- KEEP HAND IN +POSITION OF FUNCTION

-AIR SPLINT

- MAY BE HARD TO REASSESS CIRCULATION

- PILLOW


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GAMBAR


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HIP FRACTURES

- COMMON IN ELDERY PATIENTS

- MAY BE ABLE TO SUPPORT WEIGT

- ABILITY TO WALK DOES NOT RULE OUT

FRACTURE

- LEG OFTEN EXTERNALLY ROTATED

- MAY REFFER PAIN TO KNEE

- USE OTHER LEG FOR SPLINT

- USE VACCUM MATTRESS IF AVAILABLE


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HIP DISLOCATION

- ORTHOPEDIC EMERGENCY!

- USUALLY CAUSED BY AUTO ACCIDENT

- POSTERIOR DISLOCATION MOST COMMON

-HIP FLEXED AND LEG ROTATED INTERNALLY

- SEVERE PAIN ON ATTEMPT TO STRAIGHTEN


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HIP DISLOCTION

MANAGEMENT

- SPLINT IN MOST COMFORTABLE POSITION

- DOCUMENT SENSATION AND PULSE

- PROMPT TRANSPORT

- BE ALERT FOR ASSOCIATED KNEE INJURIES

OR FRACTURES


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FEMUR FRACTURES

- HIGH FORCE INJURY !

- HIGH POTENTIAL FOR HEMORRHAGIC SHOCK

- MAY USE TRACTION SPLINT

- MAST OR AIR SPLINT MAY GIVE ADE$UATE

STABILI&ATION


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KNEE FRACTURE OR DISLOCATION

- ORTHOPEDIC EMERGENCY!

- FRE$UENTLY CAUSES VASCULAR INJURY

- DISLOCATION OFTEN CAUSES VASCULAR INJURY

LEADING TO AMPUTATION


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KNEE FRACTURE OR DISLOCATION

MANAGEMENT- OBVIOUS DISLOCATION WITHOUT DISTAL PULSE

- APPLY GENTLE TRACTION

- IF GENTLE TRACTION DOES NOT RESTORE PULSE

- SPLINT IN PLACE

- PROMPT TRANSPORT


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TIBIA - FIBULA INJURY

- FREGUENTLY OPEN FRACTURES

- SIGNIFICANT HEMORRHAGE POSSIBLE

- DRESS OPEN WOUNDS

- DEPENDING ON LEVEL OF FRACTURE USE :

- RIGID SPLINT

- AIR SPLINT

- PILLOW


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FOOT AND HAND INJURY

- COMMON INDUSTRIAL ACCIDENT

- OFTEN DISABLING

- RARELY LIFE THREATENING

- SPLINT FOOT WITH PILLOW

- MANAGE ANKLE INJURIES THIS WAY

- SPLINT HAND IN POSITION OF FUNCTION


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COMPARTMENT

SYNDROME

• Early

– Pai

– Par!"t#!"ia"

• $at!

– P%l"!l!""!"" – Pall&r

– Paraly"i"

Pathophysiology

Signs andsymptoms


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COMPARTMENT

SYNDROME

Compartment atcruris

Compartment atforearm


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SUMMARY

- NOTE MECHANISM OF INJURY

- REMEMBER PRIORITIES

- ABC FIRST

- TREAT FOR HEMORRHAGIC SHOCK

- VISUALI&E INJURIES AREA

- CHEK AND RECORD PULSE AND SENSATION


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SUMMARY

- CRITICAL PATIENTS

- DON’T WASTE TIME ON MINOR SPLINTING

- IMMOBIL&E SPINE

- APLLY OTHER SPLINTS ENROUTE

- IMMOBILI&E JOINT ABOVE AND BELOW

- IF DOUBT, SPLINT PATENTIAL FRACTURE


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THANK YOU

Documents

Extremity Injuries