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International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Extremity Trauma 14.

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Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Extremity Trauma 14."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Extremity Trauma 14

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma © Pearson

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Priority of extremity trauma Major complications and treatment: –Fractures –Dislocations –Amputations –Open wounds

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Major complications and treatment (cont.): –Neurovascular injuries –Sprains and strains –Impaled objects –Compartment syndrome Estimated blood loss –Pelvic and extremity fractures

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Major mechanisms, associated trauma, potential complications, management: –Pelvis –Femur –Hip –Knee –Tibia/fibula

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Major mechanisms, associated trauma, potential complications, management: –Clavicle/shoulder –Elbow –Forearm and wrist –Hand or foot

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Distorted or wounded extremities must not distract from life-threatening injuries. –Easy to identify –Disabling but rarely immediately life- threatening Potential danger: –Hemorrhagic shock (very few) –Neurovascular compromise  Distal PMS

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Extremity injuries –Fractures –Dislocations –Open wounds –Amputations –Neurovascular injuries –Sprains & strains –Impaled objects –Compartment syndrome –Crush injury Courtesy of Roy Alson, MD

9 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Fractures –Open (compound)  Communication to outside  Danger of contamination  Blood loss outside body –Closed (simple)  No communication to outside  No danger of contamination  Blood loss inside body (Photo courtesy of Roy Alson, MD)

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Fractures Hemorrhage with fracture –Closed femur fracture  Loss of 1 liter of blood  Two closed femur fractures life-threatening (Courtesy of ®E. M. Singletary, MD)

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Fractures Hemorrhage with fracture –Closed pelvic fracture  Extensive bleeding into abdomen or retroperitoneal  Usually fractures in several places  500 cc of blood loss for each fracture  May lacerate bladder or large pelvic blood vessels (Courtesy of Sabina Braithwaite, MD)

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Dislocations –Neurovascular compromise  True emergency though not life-threatening  Check PMS distal to major joint dislocations Courtesy of Roy Alson, MD© Pearson

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Dislocations Management –No neurovascular compromise  Splint in position found –Neurovascular compromise  Apply only gentle traction in effort to straighten  Often best: pad and splint in most comfortable position and rapid safe transport

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Open wounds –Remove contamination  Gross: remove  Smaller: irrigate with normal saline –Sterile dressing and bandage  Pressure dressing, if necessary  Pressure point  Tourniquet rare  Hemostatic agent (Courtesy of 2010 North American Rescue, LLC)

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Open Wounds Obvious exsanguinating hemorrhage— only time can change order of ABC to CABC.

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Amputations –Disabling and sometimes life-threatening –Potential for massive hemorrhage  Most often, bleeding controlled with direct pressure © Edward T. Dickinson, MD

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Amputation Management –Cover with damp sterile dressing, elastic wrap –Uniform reasonable pressure across stump –Tourniquet if bleeding absolutely not controlled  Rarely needed –Retrieve amputated part  In plastic bag, inside ice water (Courtesy of Stanley Cooper, EMT-P)

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Neurovascular injuries –Nerves and major vessels run beside each other in flexor area of major joints Distal PMS –Assess pulse –Assess motor function –Assess sensory Courtesy of Louis B. Mallory, MBA, REMT-P

19 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Sprain –Injury to ligaments of a joint –Pain & swelling –Treat like a fracture Strain –Injury of musculotendinous unit –Pain & swelling –Treat like a fracture

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Impaled objects –Do not remove  Airway obstruction exception –Apply very bulky padding –Transport object in place –No unnecessary movement  Motion magnified in tissues © Pearson

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Compartment syndrome –Forearm and lower leg most common –Swelling compresses nerves and vessels

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Compartment Syndrome Early symptoms –Pain –Paresthesia Late symptoms –Pain –Pallor –Pulselessness –Paresthesia –Paralysis

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Injuries Crush injury –Pressure on extremities for extended time  Anaerobic metabolism –Pressure released  Blood flow to crushed tissue reinstated  Toxins distributed throughout entire body a.k.a. “Crush or Compression Syndrome”

24 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Patient Assessment Mechanism history –Falls landing on feet –Sitting position –Fall onto wrist –Fall onto ankle –Shoulder involved –Pelvis involved Common injury –Foot, lumbar spine –Knee, hip –Wrist, elbow –Ankle, proximal fibula –Shoulder, neck, chest –Pelvis, shock

25 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma ITLS Primary and Secondary Surveys –Major bleeding –DCAP-BLS-TIC –Instability –Crepitation –Joint pain –Joint movement –Distal PMS © Pearson

26 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Management Splinting –Prevent motion in broken bone ends –Eliminate further damage –Decrease pain Load-and-go patients –Temporary splinting with long backboard –Additional splinting during transport

27 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Splinting Rules –Adequately visualize –Distal PMS before and after splinting  Treat neurovascular compromise –Cover open wounds with sterile dressing –Immobilize one joint above and below  Apply on side away from open wound  Pad splint well  Do not attempt to push bone ends under skin

28 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma If in doubt, splint possible injury.

29 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Types of Splints (Courtesy of Eduardo Romero Hicks, MD)

30 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Tourniquets Common in military and tactical settings Regaining use in civilian use Not without complications Label patients who have tourniquets (Courtesy of 2010 North American Rescue, LLC)

31 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Hemostatic Agents For uncontrollable bleeding Promote clot formation Used in conjunction with direct pressure

32 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Spine Courtesy of Louis B. Mallory, MBA, REMT-P

33 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Pelvis Courtesy of Louis B. Mallory, MBA, REMT-P

34 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Femur Courtesy of Louis B. Mallory, MBA, REMT-P

35 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Hip © Pearson

36 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Knee Courtesy of Louis B. Mallory, MBA, REMT-P

37 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Tibia/fibula © Pearson

38 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Clavicle © Pearson

39 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Shoulder © Pearson

40 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Elbow Courtesy of Louis B. Mallory, MBA, REMT-P

41 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Forearm and wrist Courtesy of Louis B. Mallory, MBA, REMT-P

42 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Extremity Trauma Hand or foot Courtesy of Louis B. Mallory, MBA, REMT-P

43 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Crush Injuries –Frequent ongoing exams –Alkalizing the blood  Fluid resuscitation  NaCO 3 infusion  Osmotic diuretics –Tourniquet use –Contact Medical Command early

44 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Summary ITLS Primary Survey has priority –Extremity trauma not usually life-threatening –Pelvic, femur fractures can be life-threatening Proper splinting decreases further injury Dislocations of elbows, hips, knees: –Careful splinting and rapid reduction to prevent severe disability to extremity


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