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Combat extremity Wounds

Combat extremity Wounds. Combat Extremity Wounds.

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Combat extremity Wounds

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  1. Combat extremity Wounds Combat Extremity Wounds

  2. Improvements in body armor have reduced axial trauma, but the overall percentage of skeletal trauma on the modern battlefield has increased. The severity of the wounds and the amount of energy absorbed by the limbs with modern battlefield injuries cannot be overemphasized.” . “ Journal of Orthopedic Trauma

  3. TLO • Action : The soldier will identify combat extremity wounds and determine the correct interventions for these patients • Conditions: Classroom environment with PowerPoint presentation • Standard: Soldiers will complete a 10 question written exam in less than 5 mins

  4. ELOs • ELO #1: Factors effecting extremity wounds • ELO #2: Early management of extremity wounds • ElO #3: Interventions for extremity wounds

  5. Safety Requirements • Be aware of your environment • Maintain professional behavior at all times ( No running with scissors)

  6. Risk factors • LOW

  7. Environmental considerations • Indoor Classroom • No opposing force

  8. Evaluation • The Solider will be evaluated using a 10 question exam. The solider will complete the exam in less than 5 minutes with a minimal score of 80%

  9. Instructional lead in This block of instruction will take place in a classroom setting, using a PowerPoint presentation and reference materials. In actual combat the solider would encounter enemy fire ,hostile terrain and host of environmental factors while weighed down weapons and equipment

  10. Target This presentation is designed for • Line medics/ corpsman • W56, Nurses and physicians attached to BAS, Forward surgical teams or Shock platoons.

  11. SAFTY • In the combat zone the provider will need to conscious of hostile fire, and environmental factors. • Scene safety and BSI should be observed at all times

  12. ELO #1: Factors effecting extremity wounds • Action: Determine factors effecting extremity wounds. • Condition: same as TLO • Standards: Same as TLO

  13. ELO#1Factors affecting Extremity wounds

  14. ELO#1Factors affecting Extremity wounds • Energy level (height of a fall / speed of car / caliber of bullet) • Degree of contamination (soil, broken glass, shrapnel) • Degree soft tissue injury (crushed / avulsed) • Complexity of fracture pattern (number of bony pieces) • Vascular injury

  15. High Energy • High-energy sources produce wounds characterized by violenttissue destruction. Violent tissue destruction and contaminationrequires radical débridement

  16. Compound Fracture • A compound fracture, also called a open fracture, is an injury that occurs when there is a break in the skin around a broken bone. Compound fractures are generally treated with surgery to clean the site of injury and stabilize the fracture

  17. Fracture types

  18. Complexity of fracture pattern

  19. Compound Fracture Compound Fracture

  20. Compound Fractures

  21. Traumatic Amputations • Though amputations are visually dramatic, attention must be focused on the frequently associated life-threatening injuries. • Most commonly due to explosive munitions, with penetration and blast effects or Parachute Injuries.

  22. Compartment syndrome • Caused especially by crush injuries, electrical burns, circumferential scars, tight casts, hematoma in compartment, snake bites, and anything else that can increase pressure in a compartment.

  23. Compartment SyndromeSigns and symptoms • Severe, constant pain in affected limb, pain on muscle palpation, passive stretch, and active contraction, paresthesia loss of distal pulses are late signs and indicate poor outcome

  24. Compartment syndrome

  25. Check on learning • High-energy sources produce wounds characterized by violenttissue destruction • Though amputations are visually dramatic, attention must be focused on the frequently associated life-threatening injuries • Severe, constant pain in affected limb, pain on muscle palpation, passive stretch, and active contraction, paresthesia loss of distal pulses are late signs and indicate poor outcome • A compound fracture, also called a open fracture, is an injury that occurs when there is a break in the skin around a broken bone.

  26. ELO #2Early Management of Extremity wounds • Action: Determine the management techniques for extremity wounds • Conditions: Same as TLO • Standards: Same as TLO

  27. "There is no good reason why wounded soldiers are continuing to die on the battlefield from extremity bleeding.“ Capt. Michael J. Tarpey, Battalion surgeon ,3rd Infantry Division's 1-15 Infantry

  28. Early Management of Extremity wounds • Control of hemorrhage • Temporary splinting • IV antibiotics • Tetanus prophylaxis

  29. The Tourniquet • Designed for one-handed application, the tourniquet allows a soldier to apply the tourniquet to himself if needed and replaces the Army's field-expedient method, where a soldier would use a bandage and a stick to stop blood flow from a wound

  30. “There is no pre-hospital device deployed in this war that has saved more lives than tourniquets.” Col. Holcom , 10th CSH

  31. The Special Operations Forces Tactical Tourniquet

  32. IMMBOLISATION • It is essential for the provider to immobilize any fractures prior to CASVAC • Failure to immobilize all fractured extremities could lead to vascular injuries or compartment syndrome

  33. Transportation cast

  34. ElO #3:Interventions for extremity wounds • Action: Determine interventions for extremity wounds • Conditions: Same • Standards: Same

  35. Treatment of fractures • Débridement • Reduction • Fixation • Evacuation

  36. Wound Management

  37. Compound Fractures Wound Management Treat by irrigation and Debridement as soon as feasible to prevent infection. Neurovascular status of the extremity should be documented and checked repeatedly. Biplanar radiographs should be obtained.

  38. PULSE LAVAGE PULSE LAVAGE

  39. PULSE LAVAGE High Pressure Irrigation • Irrigation can remove enough wound bacteria to render the wound non-contaminated but only if the irrigant is delivered with sufficiently high pressure ( <7 PSI) to mechanically remove bacteria from the wound surface

  40. Antibiotic beads and spacers

  41. Antibiotic beads and spacers • After fracture stabilization has been completed, bone defects may be filled with antibiotic-impregnated methacrylate beads. these beads provide local depot administration of antibiotic and maintain space for subsequent bone graft

  42. Internal fixation • Internal fixation is the definitive treatment for compound fracture. • This procedure is not performed in theater

  43. INTERNAL FIXATION (ORIF)

  44. EXTERNAL FIXATION

  45. Advantages of external fixation Technically easy to perform No soft tissue stripping; Ease of removing hardware

  46. Disadvantages of external fixation • Pin tract infections, • Delayed union • Non union , and Mal-union

  47. Technique of Amputation • Tourniquet control is mandatory. • Surgical preparation of the entire limb, because • planes of injury may be much higher than initially • evident. • If a tourniquet was placed in the prehospital • setting for hemorrhage control, it is prepped • entirely within the surgical field.

  48. Fasciotomy

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