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
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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