LO8 Extremity Trauma (Chapter 14) Flashcards
Fractures
- open or closed
- neurovascular injuries may result from broken bones
- closed fracture causes loss of 1-2L of blood
Dislocations
A joint dislocation is an extremely painful injury easy to identify because the normal join anatomies significantly distorted
Splint in position found unless no pulse then apply gentle traction to gain pulse
Neurovascular injuries
The nerves and major blood vessels generally run beside each other usually in the flexor area of the major joints
They may be injured together and loss of circulation or sensation can be due to destruction, swelling or compression by bone fragments or hematoma’s
Sprain
is a stretching or tearing of ligaments of a joint because of a sudden twist it will cause pain and swelling
strain
is a stretching or tearing of a muscle or muscle tendon unit that will cause pain and often swelling
Facia
a tough membrane that surrounds muscles and other structures
They create multiple close spaces known as compartments
Compartment syndrome
a condition in which increase tissue pressure in a muscle compartment results in decreased blood flow leading to tissue hypoxia and possible muscle, nerves and vessels impairment can be permanent if the cells die
Crush injuries and closed fractures can cause bleeding and swelling contained within muscle creating pressure in the compartment
Lower leg injuries have the greatest risk of developing compartment syndrome
Fasciotomy:
incision of the skin and underlying fascia to release the pressure
Late signs and symptoms of compartment syndrome
5 p’s Pain Pallor Pulselessness Paresthesia (numbmness and tingling) Paralysis
Crush injury and crush syndrome
Result from application of external force on the body
tHe injured tissues swell decreasing perfusion resulting in the tissue switching to anaerobic metabolism resulting in buildup of lactic acid
Most extremities can tolerate up to 4 hours of ischemia
Circulation is restored those toxic products are carried throughout the body this is known as crush syndrome
Aggressive hydration with saline is required
Splinting
decreases pain and further damage to muscles, nerves and blood vessels by preventing further motion of the broken bone ends
Perform en route unless pt is stabe then splint before moving pt
Straightening fractures to regain pulse
- Confirm loss of pulse
- Gently grasp extremity above and below break
- Apply traction steadily and smoothly
- Recheck pulse and sensation
Rigid splint
can be made from many different materials including cardboard, hard plastic, metal or wood
Rigid splint should be well padded over boney prominences and should always immobilize one joint above and one joint below the fracture
Soft splints
include pillow slings and air splints
Slings are good for immobilizing injuries to the clavicle shoulder upper arm elbow pillows or good splints for ankle or foot air splints are useful for lower arm lower leg
Traction splint:
designed to stabilize fractures of the mid femur they should not be used in the hip fractures or if there more than one fracture in the lower extremity
If there is a suspected pelvic fracture do not use splint because it can cost for the damage
a load and go situation do not apply to split until critical life-saving interventions have been completed and the patient is in the ambulance on route
Applying Hare traction splint
- Assess PMS
- Apply traction
- Adjust splint length
- Position under leg until under butt bone
- Attach very top crotch strap
- Secure ankle hitch and attack hook
- Fasten leg straps
- Re-evaluate all straps
- crank
- re-assess PMS
Hip injuries
Most often in the narrow neck of the femur
The posteriorly dislocated hip is usually flexed and the patient will not be able to tolerate having a leg straightened it will almost always be rotated toward the midline
Knee injuries
Quite serious because the blood vessels and nerves across the knee joint are often injured if the joint is in an abnormal position
If there is a loss of pulse or sensation apply gentle traction by hand if there’s resistance splint in the most comfortable position and transport
Tibia and fibula injuries
Swelling and internal haemorrhage can cause compartment syndrome
Fractures of the distal fibula can be mistaken for sprains
Fractures of the lower leg and ankle may be splinted with a rigid splint or pillow
‘Elevated extremity to reduce the risk of developing compartment syndrome and reassess distal pulses frequently
Shoulder injuries
The radial nerve travels quite closely around the humerus and may be injured and humeral fracture’s injury to the radial nerve resulting in ability of the patient to lift the hand
Scapular fracture’s may refer pain to the shoulder joint itself considerable force is required to fractured scapula evaluate for other chest injuries
Elbow injuries
Difficult to differentiate between elbow fracture and dislocation
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Most common mechanism of injury is a fall on the outstretched arm
Never time to straighten or play traction to an elbow injury due to complexity of it
