ATLS (limb injury).ppt final

ATLS : 

4/20/2009 1 ATLS Advanced Trauma Life Support (limb injury)

Limb injury in ATLS recievers : 

4/20/2009 2 Limb injury in ATLS recievers Incidence: 50% of ATLS recievers having Extremity injury And most common Cause is RTA and Upper limb most Commonly affected.

Immediate measures at the scene of accident : 

4/20/2009 3 Immediate measures at the scene of accident After immediate resuscitation by: Clearing of airway. Maintaining ventilation. Opening of I/V channel. Starting of I/V fluid. Control of bleeding.

Control of bleeding : 

4/20/2009 4 Control of bleeding Free haemorrhage from accesible surface wound is usually obvious and can be controlled by : - Local pressure . - Elevation of bleeding point. - Application of torniquette if above measures fails.

Immobilization of limb : 

4/20/2009 5 Immobilization of limb Recognition and splinting of major fractures and immobilization of all injured parts before transportation are essential. Temporary splint can be given by : Upper limb – 1. Collar and calf sling. 2. Broad arm sling. Lower limb - 1. Splint. 2. Wooden block. 3. Tie with opposite healthy limb.

Pre-hospital transportation : 

4/20/2009 6 Pre-hospital transportation Patient should be transported as early as possible in the nearest hospital Ideally the transportation time should not exceed 30 minutes. Resuscitation should be continued during transportation

Hospital Management : 

4/20/2009 7 Hospital Management Primary survey and resuscitation. Secondary survey. Definitive treatment.

Clinical Examination : 

(a) General examination (b) Examination of the extremities - Sites of injury - Size of injury - Shape of injury - Active bleeding - Contamination (c) Examination of distal neurovascular structure. Clinical Examination 4/20/2009 8

Investigations : 

4/20/2009 9 Investigations Imaging: - X-ray of the affected limb - Doppler study - Duplex scan - Per-operative angiography. Culture and sensitivity of the wound swab.

Treatment : 

4/20/2009 10 Treatment Treatment priorities (a) Unless there is associated vascular injury with threatened ischemia of the limb, fracture of the long bones can be splinted and treated on urgent basis. (b) Open contaminated wound should be cleaned and debrided as soon as possible. (c) Tetanus prophylaxis should be given in all instance of open contaminated wound.

Tetanus Prophylaxis : 

Tetanus Prophylaxis 4/20/2009 11

Repair of The Wound : 

Repair of The Wound

Repair of the wound : 

4/20/2009 13 Repair of the wound Clean wound <6 hours – Primary closure. Grossly contaminated wound < 6 hours - Should not be closed first. - Wound cleaned and debried and stitch . - Should be covered with gauge and bandage . - Examination after 24-48 hours , if oozing and edema subsides. Closure by delayed primary closure.

Repair of the wound : 

4/20/2009 14 Repair of the wound Infected wound >12 hours -Must be kept open under dressing. -Closed by secondary suture.