Arterial Pressure Index

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TRAUMA TUESDAY POD- ARTERIAL PRESSURE INDEX

INDICATIONS

  • Severe extremity injury with...

  • Proximity of injury to vascular structures

  • Major single nerve deficit

  • Reduced pulses

  • Posterior knee or anterior elbow dislocation

  • Hypotension or moderate blood loss at scene

  • Concern for vascular injury

CONTRAINDICATIONS

  • Unable to place BP Cuff around ankle or arm due to injury

EQUIPMENT

  • Manual BP Cuff

  • Handheld Doppler Instrument

  • Ultrasound Gel

PROCEDURE

  1. Measure systolic pressure in injured extremity distal to the injury (may measure radial, ulnar, brachial, dorsalis pedis, posterior tibial)

  2. Measure systolic pressure in uninjured brachial artery

  3. Perform Calculation: Injured extremity SBP/ Uninjured brachial SBP

INTERPRETATION

  • API >0.9: Vascular injury very unlikely, CT angio unnecessary

  • API <0.9: Possible vascular injury, CT angio is indicated

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Trauma Tuesday POD- Hare Traction Splint

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traction-splint.jpg

What is a Hare Traction Splint?

When to Use a Hare Traction Splint?—Midshaft femur fracture when there is no evidence of pelvic or lower leg injury.

How to apply a Hare Traction Splint?

  1. Expose the injured limb.

  2. Measure distance of splint on uninjured leg- Should be 6-8inches past ankle.

    1. Measure on opposite leg of fracture as femur fracture side can be shortened

    2. Apply ankle hitch

    3. Slide splint under injured leg.

    4. Fasten the ischial strap.

    5. Connect loop of ankle hitch to splint

    6. Tighten the ratchet so the splint holds the traction

    7. Apply the rest of the straps- avoiding the fracture site.

    8. Assess neurovascular function

Here is a link to a video to see how it is applied!

https://youtu.be/498SydRP4jg

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Trauma Tuesday POD- BOWING FRACTURE

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bowing-fracture.jpg

BOWING FRACTURES  

What is it?

  • Incomplete fracture of tubular long bones pediatric patients.

    • Commonly radius and ulna

Presentation:

  • Fall on outstretched hand. Child presenting with pain and swelling of forearm

How does it happen?

  • Pediatric bones bend because the cortex is thinner than adult bones.

Management

  • Depends on degree of angulation

    • <20degrees= splint

    • >20 degrees= reduction of bowing (call orthopedics)

      • during the reduction they are very prone to fracturing

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