Trauma Guideline Manual - SUNY Upstate Medical University

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102____________ Trauma Guideline ManualUpstate Medial University Trauma Centerc. Soil contamination or barnyard wounds: add penicillin G 4-5 million units every 4 hours.7. Tetanus prophylaxis if indicated.8. Consult orthopedics.a. Surgical irrigation and debridement within 6 hours of injury. Early fixation according toorthopedic protocols.b. Repeat surgical debridements every 24-36 hours until wound clean or all devitalizedtissue removed.c. Formal wound closure when wound is stable by whatever method necessary (delayedprimary closure, STSG, rotational or free tissue transfer).d. For Grade IIIC injuries with pulseless distal part, perform emergent surgicalintervention with intra-op angiogram if limb salvage is planned. Use of the MESSScore may help in these decisions. Scores >7 have a greater than 95% predictivevalue of amputation.http://www.mdcalc.com/mangled-extremity-severity-score-mess-score/
Trauma Guideline Manual______________Upstate Medical University Trauma Center103PRACTICE GUIDELINES: PENETRATING INJURIES OF THE EXTREMITYOBJECTIVES:1. Define suggested diagnostic approaches to penetrating extremity trauma.2. Define suggested treatment approaches to penetrating extremity trauma.GUIDELINES:1. Follow the ABC’s.2. Control exsanguinating hemorrhage by direct pressure.3. Perform rapid physical exam, noting nature of distal pulses and neurologic findings.4. Rapidly obtain X-ray of extremity, including entry and exit wounds; use wound markers.5. Take the patient immediately to surgery for the following findings:a. Exsanguinating or uncontrolled hemorrhage from the injury.b. Rapidly expanding hematoma.c. Rapidly developing compartment syndrome.6. Obtain angiogram, duplex scan or CT angiogram for::a. Diminished or absent distal pulses.b. ABI 20 mmHg when upper extremityinjury is suspected.d. Continued bleeding from wounds.e. Major nerve injury.f. Bruit or thrill.g. Proximity to a major vessel7. If neurologic deficit is present:a. Document level of deficit.b. Obtain orthopedic or neurosurgical consult.8. Penetrating injuries with an absence of vascular injury on diagnostic studies and noneurologic injury can have the wound locally treated and be discharged.9. Administer one dose of cefazolin intravenously for stab wounds. GSW without clothingcontamination do not require antibiotics. NOTE: foreign mater must be debrided. Administertetanus IM as needed.10. Debride wound edges and close or treat with dressings depending on clinical conditions.11. Splint joints above and below the injury with a bulky dressing.
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Trauma Guideline Manual - SUNY Upstate Medical University

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