Page 28 - 2026 SMOG

EXTREMITY TRAUMA
Signs/Symptoms Signs/Symptoms
• Pain/swelling • Abrasion
• Deformity • Contusion
• Altered sensation/function • Polytrauma
• Diminished pulse/capillary refill • Fracture
• Decreased temperature • Dislocation
• Bleeding • Laceration
• Amputation • Sprain/strain
Treatment
• Heavy active bleeding
˚ Check/add tourniquet (TQ)
■ Add deliberate TQ if hasty is in place
˚ Pack and dress the wound
˚ Pressure dressing
˚
Hemostatic dressing
• Amputation
˚ Follow heavy active bleeding (above)
˚ Wrap the amputation in a sterile dressing with NS
˚ Transport the amputated limb with the patient (if able)
˚
Clean amputated limb
• Convert limb/junctional; TQ as soon as possible if:
˚ No presence of shock
˚ Able to monitor the wound closely for bleeding
˚ Not placed to control hemorrhage on the amputated extremity
˚
Make every effort to convert in less than 2 hours if the patient is not in shock
• Wound care/protection
˚ Bandage/cover injuries
˚ Immobilize extremity
Notes, Cautions, Warnings
• After bleeding is controlled:
˚ Treat for signs/symptoms of hypotension/shock
• Follow DCR protocols regarding the hierarchy of fluid administration
• Carefully evaluate and document neurovascular status in all fractures/dislocations
• Never attempt to reduce an open fracture unless you have a confirmed loss of pulse
• A pelvic binder is indicated in cases of severe lower extremity injury and may be utilized in
conjunction with a traction splint.
• Blood loss can be severe and concealed in long bone fractures, especially the femur.
• TQs should be used without hesitation to control major bleeding
• Use only CoTCCC-approved TQs
Reference: TCCC Guidelines, CPG ID #62 (Acute Traumatic Wound Management)

20 • TRAUMA