splinting rules • adequately visualize • distal pms before and after splinting • treat...
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International Trauma Life Support
International Trauma Life Support
for Prehospital Care ProvidersSixth Edition
for Prehospital Care ProvidersSixth Edition
Patricia M. Hicks, MS, NREMTPRoy Alson, PhD, MD, FACEP
Donna Hastings, EMT-PJohn Emory Campbell, MD, FACEP
and Alabama Chapter,American College of Emergency Physicians
Patricia M. Hicks, MS, NREMTPRoy Alson, PhD, MD, FACEP
Donna Hastings, EMT-PJohn Emory Campbell, MD, FACEP
and Alabama Chapter,American College of Emergency Physicians
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJwww.fisiokinesiterapia.biz
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaExtremity TraumaCourtesy of Bonnie Meneely, EMT-P
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Overview
2
• Fractures• Dislocations• Amputations• Open wounds
• Neurovascular injuries• Sprains and strains• Impaled objects• Compartment syndrome
Priority of extremity trauma
Major complications and treatment:
Estimated blood loss • Pelvic and extremity fractures
Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Overview
3
• Pelvis• Femur• Hip• Knee• Tibia/fibula
• Clavicle/shoulder• Elbow• Forearm and wrist• Hand or foot
Major mechanisms, associated trauma, potential complications, management:
Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaDistorted or wounded extremities must not distract from life-threatening injuries. • Easy to identify• Disabling but rarely immediately life-threatening
Potential danger:• Hemorrhagic shock (very few)• Neurovascular compromise
• Distal PMS
4Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaExtremity injuries• Fractures• Dislocations• Amputations• Open wounds• Neurovascular injuries• Impaled objects• Compartment syndrome
5Extremity Trauma -
Courtesy of Roy Alson, MD
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity InjuriesFractures• Open (compound)
• Communication to outside• Danger of contamination • Blood loss outside body
• Closed (simple)• No communication to outside• Danger of contamination • Blood loss inside body
6Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
FracturesHemorrhage with fracture• Closed femur fracture
• Loss of 1 liter of blood• Two closed femur fractures life-threatening
• Closed pelvic fracture• Extensive bleeding into abdomen or retroperitoneal • Usually fractures in several places • 500 cc of blood loss for each fracture• May lacerate bladder or large pelvic blood vessels
7Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity InjuriesDislocations• Neurovascular compromise
• True emergency though not life-threatening• Check PMS distal to major joint dislocations
8Extremity Trauma -
Courtesy of Roy Alson, MD
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
DislocationsManagement• No neurovascular compromise
• Splint in position found
• Neurovascular compromise• Apply only gentle traction in effort to straighten• No more than 10 pounds of force• Often best: pad and splint in most comfortable
position and rapid safe transport
9Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity InjuriesAmputations• Disabling and sometimes life-threatening • Potential for massive hemorrhage
• Most often, bleeding controlled with ordinary pressure
10Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
AmputationsManagement• Cover with damp sterile dressing, elastic wrap• Uniform reasonable pressure across stump • Tourniquet if bleeding absolutely not controlled
• Rarely needed
• Retrieve amputated part• In plastic bag, inside ice water
11Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity InjuriesOpen wounds• Remove contamination
• Gross: remove• Smaller: irrigate with normal saline
• Sterile dressing and bandage• Pressure dressing, if necessary• Pressure point• Tourniquet rare• Hemostatic agent
12Extremity Trauma -
Courtesy of Roy Alson, MD
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Open Wounds
13
Obviousexsanguinating hemorrhage—
only time can change order of ABC to CAB.
Obviousexsanguinating hemorrhage—
only time can change order of ABC to CAB.
Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity InjuriesNeurovascular injuries• Nerves and major vessels
run beside each other in flexor area of major joints
Distal PMS• Assess pulse• Assess motor function• Assess sensory
14Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity InjuriesImpaled objects• Do not remove
• Airway obstruction exception
• Apply very bulky padding
• Transport object in place
• No unnecessary movement• Motion magnified in tissues
15Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Compartment syndrome• Forearm and lower leg most common• Swelling compresses nerves and vessels
Extremity Injuries
16Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Compartment SyndromeEarly symptoms• Pain
• Paresthesia
Late symptoms• Pain• Pallor• Pulselessness • Paresthesia • Paralysis
17Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
ITLS Patient Assessment
Mechanism History Common InjuryFalls landing on feet Foot, lumbar spine
Sitting position Knee, hip
Fall onto wrist Wrist, elbow
Fall onto ankle Ankle, proximal fibula
Shoulder involved Shoulder, neck, chest
Pelvis involved Pelvis, shock
18Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaITLS Primary and Secondary Surveys• Major bleeding• DCAP-BTLS• Instability • Crepitation• Joint pain• Joint movement• Distal PMS
19Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
ManagementSplinting• Prevent motion in broken bone ends• Eliminate further damage• Decrease pain
Load-and-go patients• Temporary splinting with long backboard• Additional splinting during transport
20Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
SplintingRules• Adequately visualize• Distal PMS before and after splinting
• Treat neurovascular compromise
• Cover open wounds with sterile dressing• Immobilize one joint above and below
• Apply on side away from open wound• Pad splint well• Do not attempt to push bone ends under skin
21Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity Trauma
22
If in doubt, splint possible injury.If in doubt, splint possible injury.
Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Types of Splints
23Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaSpine
24Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaPelvis
25Extremity Trauma -
Courtesy of Sam Splints
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaFemur
26Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaHip
27Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaKnee
28Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaTibula/fibula
29Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaClavicle
30Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaShoulder
31Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaElbow
32Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaForearm and wrist
33Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Extremity TraumaHand or foot
34Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
SummaryITLS Primary Survey has priority.• Extremity trauma not usually life-threatening• Pelvic, femur fractures can be life-threatening
Proper splinting decreases further injury.
Dislocations of elbows, hips, knees:• Careful splinting and rapid reduction
to prevent severe disability to extremity
35Extremity Trauma -
Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ
Discussion
36Extremity Trauma -
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