BonnerCountyEMS System Patient Care Treatment Guidelines-Trauma and Environmental Emergencies

Trauma Guidelines: Major Extremity Trauma - 6014

major extremity Trauma

Prehospital Management of Extremity Trauma

History
  • Time and Mechanism of Injury (Crush/ penetrating/ amputation)
  • Open vs. closed wound/fracture
  • Wound contamination
  • Past medical history
  • Medications, Allergies
  • Loss of consciousness
  • Loss of sensation
/ Signs and Symptoms
  • Pain and tenderness, Swelling
  • Deformities, Bruising, Bleeding
  • Exposed bone
  • Altered sensation/ motor function
  • Diminished pulse/ capillary refill
  • Decreased extremity temperature
  • Immobility of joint or extremity
/ ASSESSMENT
  • Abrasion
  • Contusion
  • Laceration
  • Sprain
  • Dislocation
  • Fracture
  • Amputation
  • Crush injury
  • Vascular compromise

TREATMENT GUIDELINES

R-EMR / E – EMT / A-AEMT / P-PARAMEDIC / **M-Medical Control **

***Higher level of providers are responsible for lower level treatments***

  • Initial Patient Contact (2000). Oxygen Administration (9000).
  • Wound Care (9080). Do not intentionally replace any bone fragments.
  • Immobilize and Splint Fractures or possible fractures (9063). Immobilize dislocations in the position found. Position extremities from crush injury at level of heart.
  • Control hemorrhage with pressure. Apply cold pack to injured area with edema.
  • If hemorrhage cannot be controlled with pressure, consider Hemostatic Agent (9081). If hemorrhage is life-threatening, consider Trauma Tourniquet Procedure (9083).
  • Apply gentle traction to a distal extremity found to have severe deformity, lacking pulse or with cyanosis prior to splinting.
/ R
  • Spinal Immobilization if indicated (9062).1
  • Monitor vitals every 10 min;(3-5 if critical). Assist ALS with Cardiac Monitor if indicated.
  • Pulse Oximetry (9001) if oxygen is needed.
  • Stabilize suspected femur fractures with Traction Splint (9063).
  • If distal extremity pulses are absent with signs of decreased circulation, or vitals suggest shock, transport expeditiously and complete assessment en-route.
  • For stable vital signs, complete assessment. Transport to appropriate facility.
/ E
  • Establish IV with NS, draw labs; do not delay transport for IV access.2
  • Administer NS bolus of 10-20 cc/kg IV for Hypotension (5003) and reassess.2
/ A
  • ALS required for Major Extremity Trauma, loss of pulses or Hypotension.
  • Reassess and treat volume status for major trauma and crush injuries.
  • Administer Analgesia as needed for Pain Control (2060).
/ P
  • **Call Medical Control for extremities lacking pulses despite traction or reduction. Consider facilitated transport to an appropriate receiving trauma hospital.**
/ M

1EMR, and 2EMTproviders may perform these procedures if credentialed with the appropriate OM.

Pearls:

Check pulses, motor and sensory (PMS) before, during and after splinting, and after moving patient.

Clean amputated parts in sterile dressing soaked in NS, place in sealed bag, in iced air-tight container.

Hip dislocations, knee and elbow fractures/dislocations have a high incidence of vascular compromise.

Blood loss may be hidden with extremity injuries. Associated lacerations must be treated within 6 hrs.

______

BCEMS Medical Director

Effective: 04/01/14final10/4/2018 page 1of 1