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Trauma

EXTREMITY TRAUMA

Signs and Symptoms: Differential Diagnosis:
• Pain / Swelling • Abrasion
• Deformity • Contusion
• Altered Sensation / Function • Multi-trauma
• Diminished Pulse / Cap • Fracture
Refill • Dislocation
• Decreased Temperature • Laceration
• Bleeding • Sprain / Strain
• Amputation
Continued From:
Tactical Evacuation Guideline
HEMORRHAGE CONTROL YES Multiple Trauma
• Check / Add Tourniquet Multiple Injury Sites Guideline
(Add DELIBERATE NO
tourniquet if HASTY YES
tourniquets only in place ) Heavy Active Bleeding?
• Pack and Dress Wound NO
• Pressure Dressing
• Hemostatic Dressing IV / IO Guideline After Bleeding Controlled:
If Hypotensive or showing signs /
symptoms of hypotension or shock
Pain Control Guideline Move immediately to:
Fluid Resuscitation HYPOTENSION / SHOCK
• Whole Blood (if available) Wound Care / Protection Guideline
• pRBCs and plasma (if • Bandage and Cover Injuries
available) • Immobilize Extremity
• Platelets (If authorized) • Ice (if available) for Edema
• Crystalloid (LR/NS)
• PlasmaLyte A Was it Amputated?
• Clean amputated part
• Wrap in sterile dressing damp with Normal Saline
• Place in plastic bag / air tight container
• Place limb in sealed container in ice bath slurry if
available
• Transport with Patient
• Pelvic Binder for Explosive Mechanisms
Pearls:
• Evaluate and document neurovascular status in all fractures / dislocations.
• Never attempt to reduce an open fracture unless you have a confirmed loss of pulse.
• Blood loss can be severe and concealed in long bone fractures – especially the femur.
• Tourniquets should be used without hesitation to control major bleeding. Use only CoTCCC
Approved Tourniquets!
• Limb and junctional tourniquets should be converted to hemostatic or pressure dressings as
soon as possible if three criteria are met: the casualty is not in shock; it is possible to monitor
the wound closely for bleeding; and the tourniquet is not being used to control bleeding from an
amputated extremity. Every effort should be made to convert tourniquets in less than 2 hours if
bleeding can be controlled with other means.

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