Extremity Injuries - Joint Injury Flashcards
Primary Survey
- Stabilize head & neck, if necessary
- Assess lvl of consciousness (AVPU scale)
- Assess & manage ABC’s as required
- Expose & examine injuries
- Control any external hemorrhage with direct pressure
- Stabilize the fracture site directly above & below the injury
- Visualize & inspect fracture to determine severity
1. Inspect joint above & joint below injury site
2. Compare injured side with uninjured side
3. Palpate above & below injury, identify regions of point tenderness
4. Palpate for crepitus and instability
5. Palpate distal circulation on all extremities, with special attention to comparing injured and non-injured limbs
6. Maintain & stabilize fracture once identified - Complete RBS
- Apply O2 (standard face mask or non-rebreather mask)
- Consider the position for comfort
- Position hypotensive PTs or PTs under spinal precaution supine
- Apply cold, if appropriate
Decision Point
Findings in an unstable (RTC) PT include:
- MOI to suggest major trauma
- Signs of a limb threatening injury
- Signs or symptoms of shock
- Absent distal pulses despite realignment
Load and Transport
Transport RTC PT immediately after primary survey
Transport NRTC PT after all treatments & protocols are complete. You may assess & manage stable PT on scene if MOI indicates minor or superficial injuries. Be prepared to transport PT as RTC if situation deteriorates.
Secondary Survey
- Critical history
- PT history (SAMPLE & OPQRRRST)
- Vital signs
- Notification (ISBAR)
- Head to toe and functional inquiry
Protocol(s)
Pain management protocol (if indicated)
Treatments
- Refer to the traumatic injuries list for fracture management
- Repeat pulse, motor, & sensory (PMS) assessments should be conducted w/ any major move of PT
- Consider application of ice
Packaging of Joint Injuries - Joint Manipulation to Neutral Position
Prior to manipulating a joint injury, ALL three criteria must be present:
- Marked angulation of the joint
- Distal limb is pale, cool & pulseless
- Treatment & transportation this is > 30 mins to hospital
Packaging of Joint Injuries - Elbow & Wrist
- Ankle, wrist and elbow joints may be manipulated as a critical intervention in a single attempt to return distal circulation. Do not attempt to manipulate shoulders, hips or knee injuries
- If manipulation is required, apply gentle traction & increase flexion to 90 deg. Do not manipulate if elbow is found at angle < 90 deg.
- Cease manipulation if: radial pulse returns, you reach 90 deg of flexion, or there is resistance or marked increase in pain
- Apply a rigid splint that extends from the axilla to the end of the fingertips
- Splinted arm can be stabilized w/ a sling for additional support
Packaging of Joint Injuries - Hip
- If you suspect a hip dislocation or head of femur fracture, due to MOI and gross deformity, consider PT unstable & transport after Primary Survey
- Pad to support the limb in a position of comfort
- Secure injured limb to uninjured limb w/ zap straps & blankets
- Min amt of straps to be placed: 2 above knee & 1 below
Packaging of Joint Injuries - Knee
- Pad to support the limb in the position of comfort
- Secure injured limb to uninjured limb w/ zap straps & blankets
- Minimum straps to be placed: 1 above knee & 1 below
Packaging of Joint Injuries - Ankle
- Immobilize w/ either a pillow or plantar splint
- Do NOT place any side braces across injured side of ankle
- Utilize zap straps or triangular bandages to secure padding/splint to lower limb
