UNCONTROLLED WHEN PRINTED
Quick Chart
Introduction
  • Injury occurring to one or more of the limbs, including amputations (including partial amputations), fractures, dislocations and soft tissue injury (i.e. avulsions and degloving).
Clinical Presentation
  • Localised pain or tenderness;
  • Loss of function, limitation of motion, guarding;
  • Bizarre angulations, deep lacerations or exposed bone;
  • Crepitus;
  • Presence of altered distal pulses and sensation; and
  • Full or partial amputation of limb or extremity.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • The principles of splinting involve:
    • Arrest of external haemorrhage;
    • Support of injured area;
    • Immobilisation of the joint above and below the injury; and
    • Re-evaluation of the circulatory and neurological function before and after splinting.
  • Any fracture or dislocation which threatens the neurovascular status of the limb should be treated with urgency.
  • In the pre-hospital environment, it can be difficult to differentiate between ligament sprain and a fracture. The injury should be managed as a fracture until proven otherwise.
  • Remove jewellery from affected limbs before oedema occurs.
Management
Primary Care
  • Primary Survey with c-spine consideration
  • Be aware of Trauma Management Principles
  • Haemorrhage control as required
  • Splinting (including traction) and wound dressing (as required)
  • Soft tissue injury: Rest, ice, compression and elevation (RICE)
  • Management of the amputated part includes:
    • Wrap in sterile gauze (or similar), preserving all amputated material
    • Moisten with sterile saline if available
    • Place in watertight container. Place container on ice (do not freeze or place amputated part in direct contact with ice).
  • Secondary / CNS Survey
Intermediate Care (EMT / Level 2)
  • Administer pain relief
  • Consider applying cardiac monitor if trained and authorised
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Consider cardiac monitoring
  • Establish vascular access
  • Administer pain relief
  • Metropolitan crews should consider Major Trauma Bypass as per guideline
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Fat embolism
  • Compartment syndrome; signs of ischaemia include:
    • Pain
    • Pallor
    • Paresthesia
    • Pulselessness or reduced CRT
    • Cool or cold limb.

References
References
Key Terms & Links
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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

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