1. IED Blast Injury Right Femur Fracture and Left Lower Leg Amputation Skills Practicum

2. You Are working in the ER as a nurse.

3. Patient 20 year old Male arrived at Emergency Room by Helicopter Was on patrol when an IED went off and he was thrown 10 meters No loss of consciousness Accident was 60 minutes ago

4. What do you do?

5. Initial vitals: Temperature: 37.2 °C Respirations: 26 Blood Pressure: 118/72 Pulse: 110 Pulse Oximetry: 88% room air

6. What you see Right leg deformity with discoloration and edema 4 second capillary refill Right foot Left lower leg amputation

7. What do you see - Left Leg

8. What do you see - Right leg

9. X-Ray – Right leg

10. Initial Treatments

11. Initial treatments (cont)

12. Assessment “Blood Sweep” Primary Survey Secondary Survey

13. What you hear

14. Assessment Findings Alert and oriented Pupils equal and reactive to light, brisk Left leg amputation but bleeding controlled Airway open, breathing on his own, lungs clear, heart sounds normal Grating sounds present with palpation of injured Right Let Capillary Refill 4 seconds Right leg Patient has Pale, cool, clammy skin Bowel sounds are present

15. Vitals on monitor 10 minutes later (repeated vitals) Temperature: 37.2 C Respirations: 26 Blood Pressure: 100/62 Pulse: 125 Pulse Oximetry: 94% on Oxygen (high flow)

16. What’s Happening? What do you think is wrong with the patient? What treatment should he receive? What complications might he have in the next 8 hours? How can you prevent complications?

17. Continued Care and Concerns Short term Risks and concerns No circulation Loss of sensation Bleeding Mid and Long term risks and concerns Infection Compartment syndrome