Extremity Trauma

Causes

Mostly injuries are secondary to acts of violence involving gunshot. Vascular injuries usually are caused by penetrating trauma from knives, bullets, and glass. Motor vehicle accidents, heavy machinery-related injuries, and falls cause a small proportion of blunt vascular injuries secondary to decelerating or crushing forces.

Signs

• Deformity
• Hematoma
• Lacerations
• Abrasions
• Pulselessness
• Pain
• Paralysis, paresthesia
• Bruit
• Thrill

Treatment

Upper extremity vascular injuries require early surgical treatment to minimize the risk of developing limb ischemia and to regain adequate extremity function. The initial management of patients begins with hemodynamic stabilization with a balanced salt solution. Sufficient amounts of blood are typed and cross-matched when operative blood loss may be significant.

Emergency Care:

• As with all traumas, maintain ABCs as the first priority.
• Conduct a more detailed secondary evaluation to assess for vascular injury.
• If penetrating injuries, particularly high-velocity injuries, are near major vascular structures, assume damage to those structures. Approximately 20% of such patients have occult arterial injuries.
• Control hemorrhage with direct pressure. Don't blindly attempt to clamp a vessel.