Injuries of the extremities and pelvis

Lukáš Dadák, ARK
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Statistic:
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Trauma is leading cause of death up to 40 years of age. 40% of injuries occur in traffic. Limb injuries account for about 50% of all injuries. Often underestimated blood loss and pain.

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Injury = trauma
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An injury (as a wound) to living tissue is caused by an extrinsic agent / force

Limb:
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bones joints muscles, tendons nerves vessels skin

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Force
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direct indirect great force shortly low force for long time pathologic fracture = low force + sick bone

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Wounds - First Aid
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Minor injuries are disinfected and covered with a bandage. For major wounds:
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hemostasis immobilize the limb Do not extract foreign bodies from the wound. Shorten only if they prevent transport. (needle is not „foreign body“ = pull the needle) EMS transport to a medical facility.

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Glossary
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Contusion distorsion, luxation fracture

INJURY muscles, tendons, vessels, nerves joint bone

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Types of Fractures
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Closed x Open Stable x Unstable dislocated x nondislocated by origin: traumatic x pathological Considerable force is needed to break a bone unless it is diseased or old

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Open fracture
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Broken bone ends can pierce the skin surface or wound over the fracture

Closed fracture
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Skin is intact Bones may be displaced Damage to other internal tissues Internal bleeding, shock! FA – immobilize to an unaffected part of the body Transport to a hospital

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Stable fractures
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The broken bone ends do not move (incompletely broken, jammed together) Wrist Shoulder Ankle Hip

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Unstable fractures
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The broken bone ends can easily move out of position The bone is completely broken or the ligaments are torn (ruptured) Damage to blood vessels, nerves, organs!

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SIGNS AND SYMPTOMS
Some or all:
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deformity = A visibly out-of-place or misshapen limb or joint, side by side differece in circumference intense pain at the site, crepitus (heard or felt) tenderness loss of power to limb Swelling [oedema] = longer circumference Bruising [suffusion] Numbness and tingling [anaesthesia] Broken skin with bone protruding Limitation or unwillingness to move a limb associated wound and blood loss …. SHOCK nausea, pale, cool, clammy skin; rapid, weak pulse

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Fractured Patella

Crepitus - the sounds of bone ends clicking or rubbing against each other

Blood loss during fracture
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ribs - 150 ml humerus - 500 ml forearm - 250 ml pelvis - 2000 (5000!) ml femur (diaphysis) - 1500ml shinbone - 650 ml in case of a complicated fracture to double

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Evaluation of circulation
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Nail blanch test (capilary refill test) Pulses Swolen, conjested limb Blue skin, painfull stretching of skin Pale, waxy skin Tingling

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Impaired circulation
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Evaluation of circulation

radial pulse

posterior tibial pulse

Fractures - First aid
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DRsABC In open fractures sterile wound dressing Do not move with an injured leg Do not correct Do not splint if EMS is available
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lower limb = 155 upper extremity can be transported by car to the hospital.

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Do not eat, drink or smoke (fasting before possible surgery)

Injuries of the pelvis
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Large blood loss (internal bleeding) = Shock, frequent injuries of the organs of pelvis minor Call EMS Do not change position Do not try to walk

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Immobilization
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Bandages:
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Immobilization of joints Arm sling

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Splints:
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Ladder Vakuum Rolled up blankets, magazines, clubs, bars ...

Arm Sling

Support their bad arm

Check for circulation

Ladder Splint
a flexible splint consisting of two stout parallel wires with finer cross wires

RTG

Vakuum splint

How to (out door)
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immobilizing one healthy joint above and below disability Underlay protrusions of bone (heel, knee, elbow) - prevent pressure sores, nerve damage splint, bandages, scarves, improvised parts of the clothing
Underlay the splint !!!

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Upper extremity
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All fractures can be immobilized by securing the extremity to the chest.

Lower extremity
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All fractures can be immobilized by securing the injured extremity to the opposite lower extremity.

Tips and tricks – on the snow
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Unpin binding Do not remove the shoes, just allow powders Call the mountain rescue service

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Dislocation = luxation
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shoulder

Dislocated joint

Dislocation
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Joint injury = bones are partialy / completely pulled out of possition. strong force / mucle contraction Signs: deformity, severe pain, swelling, difficulty in moving. I.A.: Do not reposition. Prevent movement, Support. EMS Do not allow the person to eat (general anesthetic may be needed)

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Strains and sprains
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soft structures – ligaments, muscles, tendons. Tissues are stretched, twisted or torn by violent or sudden movements. Pain, tenderness, hematoma, difficulty moving. swelling, bruising. I.A.: Rest, Ice / cold compress Compress Elevate

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Decollmant = rolling

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Undesirable separation of two or more physiologically and functionally conjoined structures.

Based on the extent and location immediately creates a subcutaneous hematoma.
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In the early posttraumatic period still does not hurt poorly perfused skin = pale.

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Crush syndrom = backfilling

Crush syndrom
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Syndrome of backfilling; Syndrome of compression and contusion Cause: direct damage to the muscles and soft tissue = ischemia, leak of the fluid into the tissues; toxic substances from damaged tissues symptoms: soft tissue swelling, hypovolemic shock, renal failure I.A: rescue, treatment of hypovolemic shock, transport to a medical facility (EMS)

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Amputation, semiamputation
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loss of limb incomplete separation of limb Stop bleeding on the injured limb
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I.A:
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Massive bleeding = arm, thigh = turnicet Finger, forearm = pressure bandage on the stump.

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EMS transport the patient to treatment Care about body part. Do not give false hope

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Stop bleeding
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tourniquet = exceptional cases only temporarily in case you need to gain time for applying the pressure bandage - risk of explosion, fire or other danger pressure bandage

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Body part – First Aid
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Not to hurt yourself! Do not forget and do not freeze, do not soak! Rinse dirt and pat dry well. Wrap it in wet gauze (+normal saline). Store in a plastic bag and close it carefully so that air is trapped inside, get the part of the fluid, All put into another bag with water and ice cubes

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Wet gauze

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snow

Correct procedure

Replantation = after surgery

A moment of inattention ...

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Hours of operation Weeks of rehabilitation Uncertain outcome

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DO NOT forget that saving the victim's life is more important than saving a body part. DO NOT overlook other, less obvious, injuries. DO NOT attempt to push any part back into place. DO NOT decide that a body part is too small to save. DO NOT place a tourniquet, unless the bleeding is life threatening, as the entire limb may be placed in jeopardy. DO NOT raise false hopes of reattachment.

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Acute occlusion of limb arteries
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pain, limitation of sensibility / movement cold, pale skin missing pulsation extended Capilary Refill Time sit, limb below Do not eat, drink or smoke EMS

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I.A:
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Literatura
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http://www.sja.org.uk/sja/first-aid-advice/first-aid -techniques/how-to-make-an-arm-sling.aspx http://www.sja.org.uk/sja/first-aid-advice/bones-an d-muscles.aspx

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