Extremity Trauma and Amputation

 

History:

 

  • Type of injury
  • Mechanism
  • Crush
  • Penetrating
  • Amputation
  • Time of injury
  • Open vs. closed wound/fracture
  • Wound contamination
  • Medical history
  • Medications
  • Tetanus history

 

Significant Findings:

 

  • Pain
  • Swelling
  • Deformity
  • Altered sensation/motor function
  • Diminished pulse/capillary refill
  • Decreased extremity temperature

 

Differential:

 

  • Abrasion
  • Contusion
  • Laceration
  • Sprain
  • Dislocation
  • Fracture
  • Amputation

 

Treatment:

 

  • Assess for pulse, sensory, and motor functions

 

  • Oxygen

 

  • Initiate IV; treat for signs of poor perfusion

 

  • if BP > 90  Morphine 0.1 mg/kg IV/IM; may repeat once every 5 mins to a  max 10 mg

 

Fracture or Dislocation ?

 

  • Yes

 

    • if extremity is pulseless, attempt gentle manipulation to place in normal anatomic position to restore circulation
    • Hip fracture/dislocations should be stabilized with the use of a scoop stretcher if full spinal immobilization is not required

 

Amputation ?

 

  • Yes

 

    • Clean amputated part
    • Wrap part in sterile dressing soaked in Normal Saline and place in airtight container (sealed bag)
    • Place container on ice if available

 

Hemorrhage ?

 

  • Yes

 

    • Apply direct pressure and elevate

 

Bleeding controlled ?

 

  • Yes

 

    • Notify receiving facility or contact Medical Control

 

  • No

 

 

 

    • Consider hemostatic agent if unable to apply CAT® due to location of injury

 

PEARLS:

 

  • Peripheral neurovascular status is important.
  • In amputations, time is critical. Transport and notify (Medical Control) immediately so that the appropriate destination can be determined.
  • Hip dislocations and knee and elbow fracture/dislocations, have a high incidence of vascular compromise.
  • Urgently transport any injury with vascular compromise.
  • Blood loss may be concealed or not apparent with extremity injuries.
  • Lacerations must be evaluated for repair within 6 hours from the time of injury.
  • Splint injured extremities in the position found unless the extremity is pulseless or manipulation is required for extrication.
  • Femur fractures should be managed with a traction splint unless hip fracture or shock is present and emergent transport is required.
  • Pressure points and elevation are inadequate in controlling severe bleeding.  Utilize a tourniquet if direct pressure to the wound fails to control extremity hemorrhage.
  • For uncontrolled hemorrhage in shoulder and groin notify SWAT for hemostatic agent use. Apply direct pressure and DON'T LET GO!

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