Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
ABCDE of trauma
Airway management
Airway management techniques
Ventilation (breathing) management
Circulatory management
Circulatory resuscitation measures
Secondary surgery
Chest trauma
Abdominal trauma
Head trauma
Spinal trauma
Neurological trauma
Limb trauma
Special trauma cases
Transport of critically ill patients
Trauma response
Activation plan for trauma team
Primary Trauma Care Manual | Limb trauma
 

 

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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