Extremity Injuries - Upper & Lower Limb Injury

Question 1

Primary Survey

Answer 1

• Stabilize head & neck if necessary
• Assess lvl of consciousness (ABPU scale)
• Assess & manage ABC’s as required
• Expose & examine injuries
• Control any external hemorrhage w/ direct pressure
• Stabilize fracture site directly above & below the injury
• Visualize & inspect fracture to determine severity
  1. Inspect joint above & joint below of injury site
  2. Compare injured side w/ uninsured side
  3. Palpate above & below injury, identify regions of point tenderness
  4. Palpate for crepitus & instability
  5. Palpate distal circulation on all extremities, w/ special attention to comparing all limbs
  6. Maintain stabilization of fracture once identified
• Complete RBS
• Apply O2 (standard face mask or non-rebreather mask)
• Considerthe position for comfort
• Position hypotensive PTs or PTs under spinal precautions supine
• Apply cold pack if appropriate

Question 2

Decision Point

Answer 2

Findings in an unstable PT include:
- MOI to suggest major trauma
- Absent distal circulation despite realignment of grossly angulated limb
- PT w/ 2 or more proximal long bone fractures
- Signs or symptoms of shock
- Bleeding requiring the application of a tourniquet
- Unstable pelvis
- Hip fracture/dislocation
- Knee dislocation
- Elbow dislocation

Question 3

Load & Transport

Answer 3

Transport RTC PT immediately after primary survey

Transport NRTC PT after all treatments & protocols are complete. You may assess & manage a stable PT on scene if MOI indicates minor or superficial injuries. Be prepared to immediately package & transport PT if situation deteriorates

Question 4

Secondary Survey

Answer 4

• Critical history
• Patient History (SAMPLE & OPQRRRST)
• Vital signs
• Notification (ISBAR)
• Head to toe & functional inquiry

Question 5

Protocol(s)

Answer 5

Pain management protocol (if indicated)

Question 6

Treatments

Answer 6

• Repeat pulse, motor and sensory PMS assessments should be conducted with any major move to the PT
• Splinting is intended to immobilize the injury, decrease the pain, and reduce the risk of further damage to the muscles, nerves, blood vessels, and skin
• Always consider the application of ice