extremity injuries
TRANSCRIPT
-
8/18/2019 Extremity Injuries
1/43
EXTREMITY TRAUMA
Tim Diklat IRD RSSA
-
8/18/2019 Extremity Injuries
2/43
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
-
8/18/2019 Extremity Injuries
3/43
FRACTURES RARELY
IMMEDIATELY FATAL
NEVER ALLOW AN OBVIOUS
EXTREMITY INJURY TO PREVENT
DIAGNOSIS OF MORE SERIOUS HEAD,
CHEST, ABDOMINAL, OR PELVIC
INJURY
-
8/18/2019 Extremity Injuries
4/43
FRACTURE PRIORITIES
- FRACTURES RARELY IMMEDIATELY FATAL
- DON’T BE DISTRACTED BY OBVIOUS INJURIES- PERFORM BTLS PRIMARY SURVEY TO IDENTIFY
LIFE THREATENING INJURIES
-
8/18/2019 Extremity Injuries
5/43
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 !
-
8/18/2019 Extremity Injuries
6/43
-
8/18/2019 Extremity Injuries
7/43
-
8/18/2019 Extremity Injuries
8/43
SIGNS AND SYMPTOMS
OF EXTREMITY INJURIES
PAIN
DEFORMITY SWELLING
LOSS OF MOVEMENT
CREPITUS
-
8/18/2019 Extremity Injuries
9/43
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
-
8/18/2019 Extremity Injuries
10/43
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.
-
8/18/2019 Extremity Injuries
11/43
-
8/18/2019 Extremity Injuries
12/43
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
-
8/18/2019 Extremity Injuries
13/43
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.
-
8/18/2019 Extremity Injuries
14/43
-
8/18/2019 Extremity Injuries
15/43
NEVER DELAY TRANSPORT OFCRITICAL PATIENT TO PERFORM
SPLINTING OF MINOR FRACTURES
-
8/18/2019 Extremity Injuries
16/43
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
-
8/18/2019 Extremity Injuries
17/43
ASSESSMENT
- MECHANICAL OF INJURY
- MAY HAVE ASSOCIATED INJURIES FROM
TRANSMITTED FORCES
- HISTORY
- OBTAINT IN SECONDARY SURVEY
-
8/18/2019 Extremity Injuries
18/43
ASSESSMENT
DURING SECONDARY SURVEY CHECK FOR :
- DEFORMITY * SWELLING
- TENDERNESS *CREPITUS
JOINT PAIN AND MOVEMENT
- DISTAL PULSE AND SENSATION
- MOTOR FUNCTION
-
8/18/2019 Extremity Injuries
19/43
MANAGEMENT
- SPLINTING
- DECREASES PAIN
- PREVENTS FURTHER INJURY
- DECREASES BLOOD LOSS
-
8/18/2019 Extremity Injuries
20/43
-
8/18/2019 Extremity Injuries
21/43
MANAGEMENT OF
SPECIFIC INJURY
SPINAL IMMOBILI&ATION:
- LONG SPINE BOARD
- CERVICAL COLLAR
- HEAD IMMOBILI&ER
-
8/18/2019 Extremity Injuries
22/43
CLAVICLE FRACTURES
- COMMON INJURY
- APPLY SLING AND SWATHE
-
8/18/2019 Extremity Injuries
23/43
SHOULDER INJURIES
- ACROMIO-CLAVICULAR SEPARATION
- SLING AND SWATHE
- SHOUDER DISLOCATION
- USE PILLOW WITH SLING
AND SWATHE
- FRACTURE
- USE SLING AND SWATHE
-
8/18/2019 Extremity Injuries
24/43
ELBOW INJURY
- FRACTURE OR DISLACATION
MAY CAUSE NEUROVASCULARAR INJURY
- SPLINT IN POSITION FOUND
- TRANSPORT PROMPTLY
-
8/18/2019 Extremity Injuries
25/43
FORE ARM % WRIST INJURY
- RIGID SPLINT
- KEEP HAND IN +POSITION OF FUNCTION
-AIR SPLINT
- MAY BE HARD TO REASSESS CIRCULATION
- PILLOW
-
8/18/2019 Extremity Injuries
26/43
GAMBAR
-
8/18/2019 Extremity Injuries
27/43
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
-
8/18/2019 Extremity Injuries
28/43
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
-
8/18/2019 Extremity Injuries
29/43
HIP DISLOCTION
MANAGEMENT
- SPLINT IN MOST COMFORTABLE POSITION
- DOCUMENT SENSATION AND PULSE
- PROMPT TRANSPORT
- BE ALERT FOR ASSOCIATED KNEE INJURIES
OR FRACTURES
-
8/18/2019 Extremity Injuries
30/43
-
8/18/2019 Extremity Injuries
31/43
FEMUR FRACTURES
- HIGH FORCE INJURY !
- HIGH POTENTIAL FOR HEMORRHAGIC SHOCK
- MAY USE TRACTION SPLINT
- MAST OR AIR SPLINT MAY GIVE ADE$UATE
STABILI&ATION
-
8/18/2019 Extremity Injuries
32/43
KNEE FRACTURE OR DISLOCATION
- ORTHOPEDIC EMERGENCY!
- FRE$UENTLY CAUSES VASCULAR INJURY
- DISLOCATION OFTEN CAUSES VASCULAR INJURY
LEADING TO AMPUTATION
-
8/18/2019 Extremity Injuries
33/43
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
-
8/18/2019 Extremity Injuries
34/43
TIBIA - FIBULA INJURY
- FREGUENTLY OPEN FRACTURES
- SIGNIFICANT HEMORRHAGE POSSIBLE
- DRESS OPEN WOUNDS
- DEPENDING ON LEVEL OF FRACTURE USE :
- RIGID SPLINT
- AIR SPLINT
- PILLOW
-
8/18/2019 Extremity Injuries
35/43
-
8/18/2019 Extremity Injuries
36/43
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
-
8/18/2019 Extremity Injuries
37/43
-
8/18/2019 Extremity Injuries
38/43
COMPARTMENT
SYNDROME
• Early
– Pai
– Par!"t#!"ia"
• $at!
– P%l"!l!""!"" – Pall&r
– Paraly"i"
Pathophysiology
Signs andsymptoms
-
8/18/2019 Extremity Injuries
39/43
COMPARTMENT
SYNDROME
Compartment atcruris
Compartment atforearm
-
8/18/2019 Extremity Injuries
40/43
-
8/18/2019 Extremity Injuries
41/43
SUMMARY
- NOTE MECHANISM OF INJURY
- REMEMBER PRIORITIES
- ABC FIRST
- TREAT FOR HEMORRHAGIC SHOCK
- VISUALI&E INJURIES AREA
- CHEK AND RECORD PULSE AND SENSATION
-
8/18/2019 Extremity Injuries
42/43
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
-
8/18/2019 Extremity Injuries
43/43
THANK YOU