Emergency

LIMB THREATENING

Life saving before limb

saving

LIFE THREATENING

ATLS

A irway with cervical spine control

B reathing
C irculation with control of hemorrage
D isability (neurological state)
E xposure (take the patient clothes off)

CLINICAL FEATURES
CLINICAL FEATURES

LOCAL SIGN
Look :
Any swelling, bruising, or deformity?
Is skin intact ?
How about posture of distal extremity ?
How about colour of skin ?

LOCAL SIGN
CLINICAL FEATURES
Feel :
Palpate local tenderness ?
Any Associated injury ?
Any Vascular/Nerve abnormality ?

CLINICAL FEATURES

LOCAL SIGN
Move :
Abnormal movement
Crepitation

X-RAY
RULE oF TWO :
1.
Two Views
2.
Two Joints
3.
Two Limbs
4.
Two Injuries
5.
Two Occasions

Gustillo
Anderson
Classification
of Open
Fracture

Wound size
Level Contamination
Soft tissue Injury
Bone Injury
Vascular Injury

Grd I
Open Fracture grade 2

Grd II
Open Fracture grade 1

Grd IIIA
Open Fracture grade 3A

Grd III B
Open Fracture grade 3B

Grd III C

Open Fracture
grade 3C

Principles of
treatment

ATS
Antibiotic prophylaxis
Wound irrigation
Debridement
Fractures stabilization
Early wound coverage

Antibiotic prophylaxis
OPEN FRACTURE
GRADE

1 : CEPHALOSPORIN generasi 1
GRADE 2 : CEPHALOSPORIN generasi 1
GRADE 3 : CEPHALOSPORIN generasi 1
+ AMINOGLYCOSIDE
FARM INJURY + PENICCILIN PROCAIN

Not proper initial management

TERIMA
KASIH