EXTREMITY TRAUMA

Created 1-25-2010

DESIGNATION OF CONDITION

Signs and symptoms may include any or all of the following: pain, tenderness, deformity, loss of use, swelling, crepitus, discoloration, exposed bone ends, absent distal pulses with associated extremity trauma.

EMPHASIS ON PATIENT CARE

Control of hemorrhage, immobilization, maintain adequate perfusion.

First Responder & BASIC PRE-HOSPITAL MANAGEMENT
1. Initial Management - Assess airway, breathing and circulation and manage as indicated.
a. Mid-shaft fractures should be splinted in an anatomical position unless crepitus or resistance is encountered. (First Responders: Medical Direction Approval required for femoral traction splinting).
b. Fractures within three inches of the joint or dislocations should be splinted in the position found.
c. If the patient is hypotensive, transport immediately and splint enroute, if possible.
2. Transport the patient to an appropriate medical facility. If multiple trauma consider field Air-Evac to trauma center with on-line Medical Control orders.
3. Focused H&P - History, physical exam, vital signs.

INTERMEDIATE AND PARAMEDIC PRE-HOSPITAL MANAGEMENT

4. If the fracture is located in humerus, pelvis, hip, femur, ribs or multiple fractures are suspected, en-route, initiate a large bore IV of an isotonic solution and infuse at a flow rate to maintain adequate vital signs.
5. If a solitary, isolated long bone fracture in a stable patient experiencing severe pain and systolic BP > 90 consider use of narcotic analgesics, see Pain Management Protocols.

Note: If in doubt, splint.