Extremity Injuries

Section 6 - TRAUMA

6.06 EXTREMITY INJURIES

INITIAL TRAUMA CARE, (2.02)

SUSPECTED FRACTURE:

• Splint suspected fracture sites in most appropriate fashion:
  • Fractures may be immobilized with padded board splints, ladder splints or air splints.
  • Femur fractures may be immobilized with a traction splint or inflated MAST.
• Place cold pack on suspected fracture sites.
• If distal pulses are present and neurological function intact, immobilize apparent fractures in present position, (when possible).
• If distal pulses are diminished or absent, immobilize apparent closed fracture(s) in neutral anatomic position. Attempt to reduce severely angulated fractures with inline traction, except when a joint is involved. Note pulses distal to fracture site. Apply appropriate splinting and dressings.
• If open, (compound), fracture:
  • cover with sterile dressings and immobilize in present position. Apply appropriate splinting and dressings.
  • ANCEF 1 gm IV/IO for adults or 50 mg/kg IV/IO up to 1 gm for pediatrics

DO NOT MANIPULATE OR REDUCE OPEN FRACTURES.

• Always assess distal neurovascular status before and after application of splint.
• Refer to ANALGESIA /SEDATION PRACTICE PARAMETERS (2.04).

DIFFICULT TO CONTROL BLEED OR TRAUMATIC AMPUTATION:

• If unable to easily control bleeding, consider the following procedures:
  • Hemostatic dressing
  • Combat Action Tourniquet if extremity
  • iTClamp – not usable on trunk of body
• For amputations:
  • Splint in line with associated extremity.
  • If amputation incomplete, attempt to stabilize with bulky pressure dressing.
  • Cleanse amputated part with sterile saline. Wrap in a sterile saline soaked dressing. Place in plastic bag. Attempt to cool with cold pack during transport.
  • DO NOT APPLY DIRECTLY TO ICE
• Refer to ANALGESIA /SEDATION PRACTICE PARAMETERS (2.04).