Emergency Management of Severe Lower Limb Injuries

These diagrams and illustrations have been designed to help you learn, memorise and recall key information.

Primary management in the emergency department

 

Principal recommendations 


  • Initial assessment and treatment of the patient occurs simultaneously and in accordance with Advanced Trauma Life Support (ATLS®) principles. 


  • Assessment of the open tibial injury is systematic, careful and repeated in order to identify established or evolving limb-threatening conditions and to document limb status prior to manipulation or surgery. 


  • Haemorrhage control is through direct pressure or, as a last resort, application of a tourniquet. 


  • Wounds are handled only to
a. Remove gross contaminants b. Photograph for record
c. Seal from the environment. 


  • Wounds are not ‘provisionally cleaned’ either by: a. exploration
b. irrigation. 


  • Limb splintage is the most appropriate means of immobilisation available in the Emergency Department. Provisional external xators are not applied. 


  • Antibiotic and anti-tetanus prophylaxis is given. 


  • In addition to two orthogonal views of the tibia, radiographic assessment includes the knee and ankle joints. 


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© TIPS in Plastic Surgery 2016

John K Dickson