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Extremity Trauma

Extremity Trauma is injury to muscles and bones and related tissues from violence, sports, MVA etc. Are seldom life-threatening except for the fractured femur – which may produce severe internal bleeding.

“Limb”-threatening means nerve damage or compromised circulation.

Fractures:

  • Open – break the bone and the skin
  • Closed – break the bone, not the skin
  • Closed femur fracture can be life-threatening 500-2000mL blood can be lost in the upper thigh
  • Pelvic fracture: large blood loss, disruption of vascular plexes Dislocation – separation of two bones at the joint
  • Splint in position found, check PMS
  • Compartment Syndrome: ischemia and compromised circulation from vascular injury. Pressure,
    swelling >>> cells deprived of O2 >>> anoxic >>> tissue death
  • Document position extremity found in
  • PMS, level of pain, skin color
  • Neurovascular changes

Assessment: Signs and Symptoms:

  • Deformity
  • Pain, tenderness
  • Swelling
  • Bruising
  • Exposed bone ends
  • Locked joints
  • Bleeding
    • External
    • Internal

Treatment: Goals

  • Control Bleeding
  • Direct pressure, elevation, pressure points, treat for Shock
  • O2, blanket, elevate legs, transport, IV as nec. Prevent further injury/Immobilize
  • Return limb to anatomic position (two attempts to return distal pulse)
  • Splint, PMS before and after foot/hand in position of function
  • Femur traction splint unless fractured pelvis, hip or knee injury, significant foot or ankle injury
  • Minimize permanent damage
  • Reduce Pain

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