Principle Management of Wound and Fracture in Ed Dr Tedjo
-
Upload
amber-carter -
Category
Documents
-
view
217 -
download
0
description
Transcript of Principle Management of Wound and Fracture in Ed Dr Tedjo
-
Principle Management of Wound and Fracture in Emergency Department
dr. Tedjo Rukmoyo, SpOT (K) Spine
Presented in Clinical Update Seminar January 15th 2011
-
Initial Management ATLS Procedure A : airway B : breathing C : circulation D : disabilities E : exposure
Compressive dressings for hemorrhage
Check Cervical Chest Abdoment
X ray
Head Pelvis Neurovascular
-
Wound Inspection & Palpation
Concentrate ony Hemorrhage y Locationy Sizey Border y Wound typey Exudatey Infectiony Dressed or undressed
-
Wound management Evaluate the wound NeuroVasc status Joint Movement X-RAY ! Sterile saline dressing Irrigate with NS 1 or 2 litres
Tetanus status immunity IV antibiotics Prepare minor set Needle Suture material instruments
-
Wound irrigation
Irrigate with NaCl 0,9 % 1 2 litre Brush, evacuate foreign
body Use : Povidon iodine Savlon Perhidrol
(hidrogen peroxide) Irrigate with NaCl to
cleanse
-
Debridement
Excision:y Wound Edgey Skin Abrasion y Dead Tissuey Dirty Bone
Evacuate:y Foreign body
Re-Irrigation / Spoel Irrigation Temporary
-
Primary Closure
-
Secondary closure & Packing
-
Dressing Types and Assistive Devices
Dry Dressings dry wound
Wet-to-Dry Dressings wet wound
Packing deep wound
Vacuum Assisted Closure
Compression Elastic Bandage
-
Principle Wound and Skin coverage
Without skin lossy Primary clossure
y Contraindication :
1. Contamination
2. NV injury
3. Tension
-
Principle Wound and Skin coverage
With skin loss :y Secondary intention
y Release / counter incision
y STSG, FTSG
y Flap fasciocutaneus, rotational
-
Fracture Classification
Close (simple) Openy Gustillo Anderson Grade I Grade II Grade III a Grade IIIb Grade IIIc
-
Gustillo Anderson
-
> Grade III B
Vascular disruption Arteriography If can be repaired? Possible Limb salvage Failed? amputation?
-
Debridement and Irrigation
As soon as possible Scrub and brush
wound dirt Superficial
debridement: Identify and explore
-> extend wound Excised non viable tissue
-
Debridement and Irrigation
Deep debridement : When in doubt take it out Check muscle : 4 c Color Capacity to bleed Contractility Consistency Cover by tissue or moist dressing Remove Foreign body
-
Debridement Procedure
-
Irrigation
Use NS, high volume low pressure lavage
For grade II-III : y 6 10 l
Use antiseptics, perhidrol, antibiotic, etc
-
Upper extremity ImmobilizationOn Accidental Site At the primary health care
(puskesmas or clinics)
-
Lower extremity ImmobilizationOn Accidental Site At the primary health care
(puskesmas or clinics)
-
Skeletal Stabilisation
Evaluate vascular status, limb salvage, debridement and irrigation
Stabilize the bone : Restore length Angular alignment Rotation
Will promote healing Decrease pain and
further damage
-
Method Skeletal stabilisation
Cast : y splint, circular cast
Traction : y skin, skeletal
External fixation : y steinman or K wire
-
Internal Fixation
Plate and screwy Accurate anatomicaly Mantain /w platey Various types
IM nailsy Restore alignmenty Callus healingy Minimize soft tissue damage
-
Compartment syndrome
-
Rehabilitation
Early Range of Motion Isometric, isotonic, isokinetic excercise Motor Power excercise Non weight bearing Partial weight bearing Full weight bearing Return to normal activity
-
Slide Number 1Initial ManagementWound Inspection & PalpationWound managementWound irrigationDebridementPrimary ClosureSecondary closure & Packing Dressing Types and Assistive DevicesPrinciple Wound and Skin coveragePrinciple Wound and Skin coverageFracture ClassificationGustillo Anderson > Grade III B Debridement and IrrigationDebridement and IrrigationDebridement ProcedureIrrigationUpper extremity ImmobilizationLower extremity ImmobilizationSkeletal StabilisationMethod Skeletal stabilisationInternal FixationCompartment syndromeRehabilitationSlide Number 26