| |
Examination must include:
| :: |
Skin
colour and temperature |
| :: |
Distal
pulse assessment |
| :: |
Grazes
and bleeding sites |
| :: |
Limb
alignment and deformities |
| :: |
Active
and passive movements |
| :: |
Unusual
movements and crepitation |
| :: |
Level
of pain caused by the injury. |
MANAGEMENT OF EXTREMITY INJURIES
Management of extremity injuries should aim to:
| :: |
Keep
blood flowing to peripheral tissues |
| :: |
Prevent
infection and skin necrosis |
| :: |
Prevent
damage to peripheral nerves. |
SPECIAL ISSUES RELATING TO LIMB TRAUMA
| 1 |
Stop
active bleeding by direct pressure, rather than by tourniquet.
Tourniquets can be left on by mistake which can result in ischaemic damage. |
| 2 |
Compartment
syndrome is caused by an increase in the internal pressure
of fascial compartments; this pressure results in a compression
of vessels and peripheral nerves situated in these regions.
Tissue perfusion is limited; the final result is ischaemic
or even necrotic muscles with restricted function. |
| 3 |
Body
parts, traumatically amputated, should be covered with
moistened sterile gauze towels and put into a sterile
plastic bag. A non-cooled amputated part may be used within
6 hours after the injury, a cooled one
as late as 18 to 20 hours. |
Bladder catheterization (with caution in pelvic injury) is important.
LIMB SUPPORT: EARLY FASCIOTOMY
The problem of compartment syndrome is often underestimated.
TISSUE DAMAGE DUE TO HYPOXAEMIA
Compartment syndromes with increased intramuscular (IM) pressures and local
circulatory collapse are common in injuries with intramuscular haematomas,
crush injuries, fractures or amputations. If the perfusion pressure (systolic
BP) is low, even a slight rise in IM pressure causes local hypoperfusion.
With normal body temperature, peripheral limb circulation starts to decrease at
a systolic BP around 80 mmHg.
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