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Extremity Trauma, Penetrating, Emergency Medicine

Gary M. Vilke Reviewed 06/2017
 


Basics

Description

Penetrating injury to extremity 

Etiology

  • Stab or puncture

  • Gunshot

  • Laceration

  • Bite

  • High-pressure injection injury

Diagnosis

Signs and Symptoms

  • Entry and exit wound (if present), lacerations

  • High-muzzle–velocity gunshot wounds:

    • Produce shock wave that results in significant tissue injury

    • Often exit wound demonstrates ...

Treatment

Pre-Hospital

Cautions: 
  • Control hemorrhage with direct pressure over site.

  • Elevate extremity.

  • Evaluate neurovascular status.

  • Leave impaled objects in place and stabilize in current position.

  • Pain ...

Follow-Up

Disposition

Admission Criteria

  • Emergent surgical consultation and admission are required for any penetrating wounds with potential for vascular compromise, associated compartment syndrome, and...

Pearls and Pitfalls

  • Presence of distal pulse does not exclude proximal vascular injury.

  • High-pressure injuries of hand may have wounds that appear trivial on surface but track up tendon sheaths into mo...

Additional Reading

  • Bekler  H, Gokce  A, Beyzadeoglu  T, et al. The surgical treatment and outcomes of high-pressure injection injuries of the hand. J Hand Surg Eur Vol.  2007;32(4):394–399.

  • Belin ...

Codes

ICD9

  • 884.0 Multiple and unspecified open wound of upper limb, without mention of complication

  • 894.0 Multiple and unspecified open wound of lower limb, without mention of complication

  • 928.9 Crushing...

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