ISE Trauma 5 (trauma to extremities) Flashcards
most commonly injured vessels in trauma to the extremities
femoral and popliteal vessels
hard signs of extremity vascular trauma
absent or diminished distal pulses
obvious arterial bleeding
large expanding or pulsatile hematoma
audible bruit
palpable bruit
distal ischemia
-pain
-pallor
-paralysis
-paresthesias
-coolness
prsence of any hard sign, consult vascular surgery immediately
soft signs of extremity vascular trauma
small, stable hematoma
injury to anatomically related nerve
proximity of injury to major vascular structures
unexplained hypotension
history of hemorrhage
complex fracture
remarks on ABI
ABI <0.9, do CT angiography
4 types of fractures associated with low-energy gunshots
- drill-hole track pattern
- unicortical fractures
- comminuted fractures
- distal spiral fracture
most common fracture associated with low-energy gunshots
drill-hole wound track pattern
most common in
distal femur
pelvis
proximal humerus
unicorticacl fractures
appear in metaphyses of long bones
comminuted fractures
diaphyseal bone
distal spiral fracture
femur
remarks on ultrasound in extremity trauma
doppler:
normal triphasic arterial flow in both the dorsalis pedis artery and posterior tibial artery had a sensitivity and specificity of 100% in ruling out arterial lesions in lower-limb penetrating trauma
most important component of wound management in extremity trauma
irrigation with saline or tap water (500-1000mL) at high pressures (15-20 pounds per square inch)
antiseptic solution does not decrease infection rate and may actually be harmful
when is delayed closure of wound indicated
delay of 72-96 hours
“BCD”
retained foreign Bodies
Contamination
major tissue Destruction
remarks on bullet in extremities
a bullet generally should not be removed unless the bullet has potential to migrate into surrounding vital structures or if it is in the joint capsule
disposition in penetrating extremity trauma
hard signs —> immediiate surgical consult
all other patients with penetrating extremity trauma: a minimum of 24hours is reasonable
return precaution:
-increasing pain
-numbness
-weakness
-redness
-pus discharge