Extremity Trauma and Amputation
- Type of injury
- Time of injury
- Open vs. closed wound/fracture
- Wound contamination
- Medical history
- Tetanus history
- Altered sensation/motor function
- Diminished pulse/capillary refill
- Decreased extremity temperature
- Assess for pulse, sensory, and motor functions
- 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 ?
- 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
- 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
- Apply direct pressure and elevate
Bleeding controlled ?
- Notify receiving facility or contact Medical Control
- 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!