Boast guidelines

Question 1

What do the BOAST guidelines say about managing arterial injuries associated with fractures?

Answer 1

Assessment and early management
* control haemorrhage with direct pressure or tourniquet - not clamping
* realign pulseless limbs
* warm ischaemia - > 3hrs results in irreversible tissue damage and increased risk of amputation
* imaging - duplex, angiography, CT angio and on-table angio

operative management
* early amputation - 2 consultant decision and patient warned of the risk
* sequence of surgical interventions:
1. temporary shunt
2. assess viability
3. skeletal stabilisation
4. reconstruction with autologous vein grafts
- peripheral nerve injuries identified either repaired or referred
- low threshold for fasciotomies - preserve perforating vessels

Question 2

What do BOAST guidelines say about managing nerve injuries

Answer 2

Assessment
- document pre and post surgery peripheral nerve function - if nerve at risk
- document NV status for injuries and after initial treatment

treatment
- reduce fractures or dislocations with nerve injuries
- document nerve position in relation to internal fixation

Referral to PN unit
- immediately - nerve damaged during surgery
- within 24hrs - after a laceration or penetrating injury or when op not needed for associated fracture