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EXTREMITY TRAUMA. OBJECTIVES. Identify and treat fractures and soft tissue injuries in a tactical environment. Open Wounds. Closed Wounds. Musculoskeletal - Causes. Overuse Acute sprains and strains Trauma. Overuse. Acute Sprains and Strains. Trauma. Compound Fracture of the Ankle.

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Objectives
OBJECTIVES

Identify and treat fractures and soft tissue injuries in a tactical environment.




Musculoskeletal causes
Musculoskeletal - Causes

  • Overuse

  • Acute sprains and strains

  • Trauma




Extremity trauma

Trauma

Compound Fracture of the Ankle


Musculoskeletal presentation
Musculoskeletal Presentation

  • Pain

  • Swelling

  • Discoloration

  • Temperature change

  • Numbness/tingling

  • Loss of function


Musculoskeletal evaluation
Musculoskeletal Evaluation

  • History

  • Physical examination

    • skin breaks

    • tenderness

    • swelling

    • discoloration

    • distal pulses

    • sensory exam

    • motor exam


Musculoskeletal treatment
Musculoskeletal Treatment

  • Prevention

  • “RICE”

  • Analgesic

    • Tylenol

  • Analgesic & Anti-inflammatory

    • Aspirin

    • Ibuprofen (Motrin/Ranger Candy)

    • Naprosyn


Fractures
Fractures

  • Any break in the continuity of a bone

  • May vary from a simple crack to a completely shattered bone

FX Femur


Extremity trauma

Open Fracture

Compound Fracture of the Ulna


Other injuries
Other Injuries

De-gloving Injury

Blast Injury


Ecchymosis
Ecchymosis

  • Discoloration caused by bleeding in tissue

  • Blood migrates toward skin and changes color with time


Joints
Joints

  • Surrounded by joint capsule and ligaments, muscles and tendons


Dislocations
Dislocations

  • Disruption of a joint such that the bone ends are no longer in contact

  • Torn ligaments and capsule


Common dislocations
Common Dislocations

  • Fingers

  • Shoulder

  • Hip

  • Elbow

  • Ankle

Dislocated Elbow


Knee joint
Knee Joint

  • Femur, Tibia, and Patella

  • Largest hinge joint in body

  • Held together by complex ligaments

  • Susceptible to injury


Knee injuries
Knee Injuries

  • Ligaments and cartilage injuries are common

  • Swelling, pain, limited ROM

  • Frequent athletic injury

  • Splint entire femur and tibia


Dislocation of the knee
Dislocation of the Knee

  • Severe deformity

  • Popliteal artery commonly injured

  • If pulse is present, splint in deformed position

  • If pulse is absent, attempt once to realign limb and splint where pulse is strongest (RGR MEDIC)



Ankle injuries
Ankle Injuries

  • Usually result from twisting, indirect force

  • Fracture, dislocations, sprains can occur

  • Swelling and deformity

  • Note circulation

  • Immobilize with padding and splint


Sprain
Sprain

  • Partial, temporary joint dislocation

  • Ligaments torn or stretched

  • May produce discoloration



Management of closed injuries
Management of Closed Injuries

  • R - Rest

  • I - Ice

  • C - Compression

  • E - Elevation

  • S - Splint (SAM Splints and cravats or ACE wraps)

  • R/O fracture


Soft tissue injuries
Soft Tissue Injuries

  • Open - Violation of overlying skin or mucous membrane


Management
Management

Stop the bleeding and bandage


Summary
Summary

  • Although quite common, rarely life threatening

  • First priority in management same for all patients ( A,B,C’s)

  • RICES for most soft tissue injuries