FIRST AID IN FIRST AID IN TRAUMATOLOGY OF TRAUMATOLOGY OF

LOCOMOTIV LOCOMOTIV APPARATUSAPPARATUS

1.1. INJURY OF LIMBSINJURY OF LIMBS

MUDr. Ježek JakubMUDr. Ježek Jakub

Injury of limbs generallyInjury of limbs generally

5% of all injury5% of all injury differ: isolated injury or part of differ: isolated injury or part of

polytraumapolytrauma for polytrauma intensify importance for polytrauma intensify importance

of general conditionof general condition for global aspect is important for global aspect is important

quantity of blood loss quantity of blood loss assessment of blood lossassessment of blood loss

Assessment of blood lossAssessment of blood loss

is important especially for multiple is important especially for multiple limbs injurylimbs injury

close injuryclose injury arm 100 – 800 mlarm 100 – 800 ml forearm 50 – 400 mlforearm 50 – 400 ml femur 300 – 2000 mlfemur 300 – 2000 ml shank 100 – 1000 mlshank 100 – 1000 ml pelvis 500 – 3000 mlpelvis 500 – 3000 ml

Assessment of blood lossAssessment of blood loss

open injuryopen injury assessment is very incorectassessment is very incorect conclusive is evaluation of general conclusive is evaluation of general

conditioncondition

Isolated injury of limbs Isolated injury of limbs

composed most of injuries of composed most of injuries of locomotiv aparatuslocomotiv aparatus

minimal alteration of general minimal alteration of general condition condition

luxation, fractures, small injuriesluxation, fractures, small injuries BUT: denger of injury of nerves and BUT: denger of injury of nerves and

vesselsvessels importans: restauration axis of the importans: restauration axis of the

limblimb

Types of injury of limbsTypes of injury of limbs

injury – injury – bonesbones jointsjoints tendonstendons injury of neurovascular bundleinjury of neurovascular bundle injury of skin and subcutaneous coatinjury of skin and subcutaneous coat

open X closedopen X closed isolated X associatedisolated X associated

A. fracturesA. fractures

diaphyseal x area of articulars ends of diaphyseal x area of articulars ends of bone – dg.bone – dg.

certain symptoms of fracture – certain symptoms of fracture – patologic movments, crepitatio, patologic movments, crepitatio, unphysiological position, (X-ray)unphysiological position, (X-ray)

uncertain symptoms – pain, swelling, uncertain symptoms – pain, swelling, hematoma, dysfunctionhematoma, dysfunction

for diaphyseal fr. is simplier diagnosticfor diaphyseal fr. is simplier diagnostic at intraarticular fr. differ injury of at intraarticular fr. differ injury of

ligament‘s apparatus of jointsligament‘s apparatus of joints

B. injury of jointsB. injury of joints

a lot of kinds of injury a lot of kinds of injury injury of ligamentsinjury of ligaments

mikrorupturemikrorupture distension of ligamentdistension of ligament rupture – total or subtotal. Can leads to rupture – total or subtotal. Can leads to

luxation or subluxation of joint.luxation or subluxation of joint. luxation‘s fractures – very important luxation‘s fractures – very important

injuriesinjuries

C. injury of muscles and C. injury of muscles and tendoonstendoons

direct force – contusiondirect force – contusion complete or incoplete rupture (most complete or incoplete rupture (most

common Achilles tendoon)common Achilles tendoon) open injuryopen injury kompartment syndromkompartment syndrom

during a few hoursduring a few hours shank, forearm, arm, femurshank, forearm, arm, femur increase of pressure in fascial increase of pressure in fascial

compartment (ground)compartment (ground)

D. injury of neurovascular D. injury of neurovascular bundlebundle

direct accident force – we don‘t direct accident force – we don‘t influensinfluens

undirect by compression of bone undirect by compression of bone fragments, by dislocation, swelling – fragments, by dislocation, swelling – we can influenswe can influens

it is necessary examine periphery of it is necessary examine periphery of limb at every injurylimb at every injury

D. injury of neurovascular D. injury of neurovascular bundlebundle

E. injury of skin and E. injury of skin and subcutaneous coatsubcutaneous coat

penetrating and loss – making injurypenetrating and loss – making injury too contusion and decolemant tootoo contusion and decolemant too closed x openclosed x open – according to violation – according to violation

of skin integrityof skin integrity importance of injury according to importance of injury according to

destruction of soft tissues, not destruction of soft tissues, not according to extension of skin woundaccording to extension of skin wound

sharp object x blunt with high energysharp object x blunt with high energy

E. injury of skin and E. injury of skin and subcutaneous coatsubcutaneous coat

closedclosed: no perforation of skin and : no perforation of skin and no comunication between deeper no comunication between deeper coat and exteriorcoat and exterior

crush syndromcrush syndrom blast syndromblast syndrom

water – abdominal organswater – abdominal organs air – thoracic organsair – thoracic organs multiple fractures and contusion of soft multiple fractures and contusion of soft

tissuestissues

Open injuriesOpen injuries

perforation of skin and comunication perforation of skin and comunication between deeper coat and exteriorbetween deeper coat and exterior

possibilities of high blood losspossibilities of high blood loss all types of wounds, open fractures, all types of wounds, open fractures,

amputationsamputations direct or undirect forcedirect or undirect force low energy x high energy traumalow energy x high energy trauma it is importance of good description of it is importance of good description of

soft tissue injury soft tissue injury

Open injuriesOpen injuries

Primary diagnosticsPrimary diagnostics

at firts aid is most important at firts aid is most important evaluation of general status, evaluation of general status, importance of single injury importance of single injury

before hospital care we have limit before hospital care we have limit conditions for diagnosticconditions for diagnostic

anamnesisanamnesis aspection, palpation, motionaspection, palpation, motion fractures – desaxiation, swelling, fractures – desaxiation, swelling,

deformity, crepitation, restriction of deformity, crepitation, restriction of motion in joints neer fracturemotion in joints neer fracture

Primary treatmentPrimary treatment

remove abrasive dirtinessremove abrasive dirtiness steril coversteril cover correction of axis of the limbcorrection of axis of the limb imobilisation imobilisation compression of vesselscompression of vessels stabilisation of general statusstabilisation of general status

Injury of the upper limbInjury of the upper limb

injury of the shoulderinjury of the shoulder fractures of the claviculafractures of the clavicula acromioclavicular luxationacromioclavicular luxation luxation of the shoulder luxation of the shoulder fractures of the proximal humerusfractures of the proximal humerus

firs aid: firs aid: hanging scarf, analgetics, control of hanging scarf, analgetics, control of

periferiyperiferiy

Injury of the upper limbInjury of the upper limb injury of the arminjury of the arm fr. diaphysis of humerus, cave: injury of radial fr. diaphysis of humerus, cave: injury of radial

nervnerv FA: axial reposition, imobilisation by LU splint, FA: axial reposition, imobilisation by LU splint,

scarfscarf luxation of the elbow and fractures neer elbow luxation of the elbow and fractures neer elbow

FA: we try to make good axis and flexion 70 dg., FA: we try to make good axis and flexion 70 dg., imobilisation with splintimobilisation with splint

fractures of the forearmfractures of the forearm FA: axial reposition, imobilisationFA: axial reposition, imobilisation

injury of the hand and wristinjury of the hand and wrist FA: imobilisationFA: imobilisation

Injury of the lower limbInjury of the lower limb

injury of the hip joint – luxation or injury of the hip joint – luxation or fractures of the proximal femurfractures of the proximal femur FA: analgetics, transport, vacuum mattresFA: analgetics, transport, vacuum mattres no reposition, no axial reposition !!!no reposition, no axial reposition !!!

injury of the femur (attention – great injury of the femur (attention – great blood loss)blood loss) FA: axial reposition, imobilisation (Thomas FA: axial reposition, imobilisation (Thomas

splint, vacuum splint or matters)splint, vacuum splint or matters) Crammer‘s splints – two, boath from illiac Crammer‘s splints – two, boath from illiac

cristcrist

Injury of the lower limbInjury of the lower limb injury of the kneeinjury of the knee ligaments, extensor aparatusligaments, extensor aparatus

FA: imobilisation, by luxation of the patela FA: imobilisation, by luxation of the patela extenzion of the kneeextenzion of the knee

fractures of the distal femurfractures of the distal femur danger of injury a. poplitea by osseous danger of injury a. poplitea by osseous

fragment – cool down the limb, transport to fragment – cool down the limb, transport to hospital with AGhospital with AG

restauration of axis of the limb, imobilizationrestauration of axis of the limb, imobilization fractures of the proximal tibiafractures of the proximal tibia

FA: axialy reposition, imobilisationFA: axialy reposition, imobilisation

Injury of the lower limbInjury of the lower limb injury of the shankinjury of the shank

FA: restauration of the axis !!! imobilisation FA: restauration of the axis !!! imobilisation CAVE: compartment syndromCAVE: compartment syndrom

injury of the ankle injury of the ankle if it is possible, axialy reposition, or not, if it is possible, axialy reposition, or not,

imobilisationimobilisation injury of the foot – fr. of the calcaneus, injury of the foot – fr. of the calcaneus,

metatarsal bones, forefoot, fingersmetatarsal bones, forefoot, fingers distorsion x important luxotion‘s fracturesdistorsion x important luxotion‘s fractures

FIRST AID IN FIRST AID IN TRAUMATOLOGY OF TRAUMATOLOGY OF

LOCOMOTIV LOCOMOTIV APPARATUSAPPARATUS2. SPINAL INJURY2. SPINAL INJURY

Spinal injury Spinal injury

spinal column x spinal cord – all combinationsspinal column x spinal cord – all combinations mostly closed injurymostly closed injury cervical, thoracolumbal spinecervical, thoracolumbal spine different importance of demage (compressive different importance of demage (compressive

fractures, distorsion of cervical spine, luxation fractures, distorsion of cervical spine, luxation fractures)fractures)

it is possible present neurological handicapit is possible present neurological handicap Etiol: car accidents, water sports, jumps, fallsEtiol: car accidents, water sports, jumps, falls often by polytrauma – limitid diagnosticoften by polytrauma – limitid diagnostic

Injury of the cervical Injury of the cervical spinespine

whip-slash – distorsionwhip-slash – distorsion fractures, luxations – various fractures, luxations – various

appearancesappearances fatal injury often leeds to stop fatal injury often leeds to stop

breathingbreathing FA: imobilisation, FA: imobilisation, transport !!!transport !!!

attention by rescue (from car…)attention by rescue (from car…) Philadelphia collar, vacuum matters, Philadelphia collar, vacuum matters,

combinationcombination

Injury of the thoracic and Injury of the thoracic and lumbal spinelumbal spine

contusioncontusion compression fractures (patological compression fractures (patological

also)also) severe injury (burst, luxation severe injury (burst, luxation

fractures, flection-distraction fractures, flection-distraction fractures, translation…)fractures, translation…)

neurological leasionneurological leasion FA: transport at lying positionFA: transport at lying position

Spinal injurySpinal injury

examinationexamination we don‘t assess exact diagnosis but we don‘t assess exact diagnosis but

necessity adequate imobilisationnecessity adequate imobilisation the patient is speekingthe patient is speeking

anamnesis, inspection, palpation, neurostatusanamnesis, inspection, palpation, neurostatus the patientv is in comathe patientv is in coma

witnessis, inspection, palpation, neurostatus (deepth witnessis, inspection, palpation, neurostatus (deepth of coma, defens reactions, tonus of muscles)of coma, defens reactions, tonus of muscles)

suspition for spinal column with or suspition for spinal column with or without demage of neurological strucreswithout demage of neurological strucres

FIRST AID IN FIRST AID IN TRAUMATOLOGY OF TRAUMATOLOGY OF

LOCOMOTIV LOCOMOTIV APPARATUSAPPARATUS

3. INJURY OF THE PELVIS3. INJURY OF THE PELVIS

Injury of the pelvisInjury of the pelvis

low – energy traumalow – energy trauma old people, falls, often by osteoporosisold people, falls, often by osteoporosis fractures of ramus superior et inferior fractures of ramus superior et inferior

of os pubis, isolated fr. of the pelvic of os pubis, isolated fr. of the pelvic ring, fr. of acetabulumring, fr. of acetabulum

FA: transport in lying position, FA: transport in lying position, analgeticsanalgetics

Injury of the pelvisInjury of the pelvis

high – energy traumahigh – energy trauma symptoms: swelling, haematoma, painful symptoms: swelling, haematoma, painful

palpation, restriction of movements of the palpation, restriction of movements of the hip, enhanced abdomen, peritoneal hip, enhanced abdomen, peritoneal symptoms, shortening of the limb, external symptoms, shortening of the limb, external rotation position of the limbrotation position of the limb

evaluation of the general condition evaluation of the general condition stabilisation of vital functionstabilisation of vital function vacuum mattres, transportvacuum mattres, transport CAVE: blood lossCAVE: blood loss