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

 

• Associated Pain:  See Pain Management Protocol

 

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

 

Suspected Fracture with any open wound?

 

• Yes

 

Documented or Reported PCN or cephalosporins Allergy?

 

• Yes

 

• • Notify receiving facility or contact Medical Control

 

• No

 

• • Adult - 2 g IV Rocephin; over 10 minutes
  • Pediatric - 50 mg/kg to a max dose of 1 g IV Rocephin over 10 minutes

 

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

 

 

Documented or Reported Penicillin Allergy?

 

• Yes

 

• • Notify receiving facility or contact Medical Control

 

• No

 

• • Adult - 2 g IV Rocephin; over 10 minutes
  • Pediatric - 50 mg/kg to a max dose of 1 g IV Rocephin over 10 minutes

 

Hemorrhage ?

 

• Yes

 

• • Apply direct pressure and elevate

 

Bleeding controlled ?

 

• Yes

 

• • Notify receiving facility or contact Medical Control

 

• No

 

• • Apply CAT® tourniquet

 

• • Consider wound packing 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.
• Direct Pressure 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 consider wound packing. Apply direct pressure and DON'T LET GO!