Trauma Guideline Manual - SUNY Upstate Medical University

More documents

Recommendations

Info

100____________ Trauma Guideline ManualUpstate Medial University Trauma Center7. If bony injury is found or a neurologic injury is found with concomitant bony injury, perform acomplete neurological exam using the ASIA format.8. Maintain spinal precautions until cleared by the consulting service or negative MRI’s.9. Beware of ileus in patients with spinal fractures. Consider early use of NG tube.10. If fracture is noted in one area of spine, complete C/T/LS spine radiographs should beobtained to assess additional fractures. Reformatting of the chest and abdominal/pelvis CTscans to examine the spine is preferable if these CT scans have been obtained.
Trauma Guideline Manual______________Upstate Medical University Trauma Center101PRACTICE GUIDELINES: OPEN FRACTUREOBJECTIVE:1. Define the types of open fractures and prioritize injury management based on them.Gustilo open fracture ClassificationGradeDefinitionI Open fracture, clean wound, wound 1 cm in length without extensive soft-tissue damage, flaps,IIavulsionsOpen fracture with extensive soft-tissue laceration, damage, or loss or an open segmentalIII fracture. This type also includes open fractures caused by farm injuries, fracturesrequiring vascular repair, or fractures that have been open for 8 hr prior to treatmentType III fracture with adequate periosteal coverage of the fracture bone despite theIIIAextensive soft-tissue laceration or damageType III fracture with extensive soft-tissue loss and periosteal stripping and boneIIIB damage. Usually associated with massive contamination. Will often need further softtissuecoverage procedure (i.e. free or rotational flap)Type III fracture associated with an arterial injury requiring repair, irrespective of degreeIIICof soft-tissue injury.GUIDELINES:1. Follow ABC’s. Extremity fractures assume low priority in the multiply injured patient unlessthere is significant bleeding.2. When patient is stable, examine the fracture and document distal neurovascular status oflimb.3. Remove all gross contamination using sterile saline and cover all wounds with steriledressing soaked in saline only.4. Grossly align limb or reduce dislocation.a. Splint femur fractures with Speedsplint femoral traction (see guideline)b. Splint other fractures with aluminum gutter or plaster, including joint above and belowthe fracture.5. Radiographs in two planes, including joints above and below fracture.6. Antibiotics: (see EAST Guidelines) :http://www.east.org/resources/treatment-guidelines/open-fractures,-prophylactic-antibioticuse-in-%E2%80%94-updatea. Clean or Grade I or II wounds: cefazolin for 24hrs.b. Contaminated or Grade III wound: add additional Gram negative coverage (aminoglycoside NOT fluroquinalones) for 72hrs or till flap coverage in place.
Page 11 and 12:
Trauma Guideline Manual____________
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 48 and 49:
48____________ Trauma Guideline Man
Page 50 and 51: 50____________ Trauma Guideline Man
Page 102 and 103: 102____________ Trauma Guideline Ma
Page 118 and 119: 118____________ Trauma Guidelines M
Page 150 and 151:
150____________ Trauma Guidelines M
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
show all

Trauma Guideline Manual - SUNY Upstate Medical University

Create successful ePaper yourself

Delete template?

Save as template?