The Hip

5. Escharotomy

CPT Daniel J. Stinner, M.D.   I. Introduction (see figure 3)             A. Typically performed at bedside under sterile condition with IV sedation using electrocautery             B. Can also be performed in operating room if immediate access available             C. Electrocautery has added benefit of haemostatic control, but if unavailable, scalpel can be used             D. General … Read more

3. External Fixation of Upper Extremity/Lower Extremity/Periarticular Fractures with Limited Resources (no X-ray)

CPT Jessica D. Cross CPT Daniel R. Possley I. Introduction             A. External fixation may be performed in austere environment without use of fluoroscopy             B. Ideally, pins should be placed to minimize impact on future internal fixation II. Pin Placement             A. Should be performed as follows (see femoral external fixation placement video) External Fixation – Joe … Read more

VI. Compartment Syndrome in an Austere Environment

CPT Brendan Masini, MD     A. Define compartment syndrome and describe the diagnostic limitations presented by an austere environment   I. Acute Compartment Syndrome             A. Occurs when pressure within myofascial compartment exceeds threshold perfusion gradient across capillary beds                         1. if unchecked, leads to tissue hypoxia and cell death                         2. ischemia and necrosis … Read more

VII. Extremity Burns in an Austere Environment

CPT Daniel J. Stinner, M.D. CPT Chad A. Krueger, M.D.  A. Describe the initial evaluation and management of a burn patient   I. Background             A. Types of burn injuries                         1. thermal                         2. electrical                         3. chemical                         4. cold                         5. radiation             B. Recent civilian disasters resulting in multiple burn casualties1 … Read more

VII. Extremity Burns in an Austere Environment (continued)

CPT Daniel Stinner, M.D.    B. Define early management of extremity burns    I. Early Wound Management             A. Introduction                         1. not necessary to perform immediately, but should be done within first 24 hours                         2. ensure patient receives adequate pain medicine, as wound care can be very painful             B. Goal                                    1. … Read more

VIII. Extremity Vascular Injuries in an Austere Environment

CPT David Crawford MAJ Joanna Branstetter     A. Define the initial evaluation and demonstrate appropriate evaluation techniques of a patient with an extremity vascular injury   I. Initial Evaluation             A. Initial evaluation should always follow acute trauma lifesaving support (ATLS)             B. Application of a tourniquet above the level of injury is appropriate … Read more

V. Axial Skeleton Injuries in an Austere Environment – I

CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D.     A. Describe the initial management, resuscitation, and stabilization of pelvic fractures   Pelvic Fractures I. Epidemiology             A. High energy mechanism of injury requires instantaneous deceleration of 30 mph to injure pelvic ring             B. Large association with other injuries including head, chest, abdomen, and extremity trauma … Read more

V. Axial Skeleton Injuries in an Austere Environment – II (continued)

V. Axial Skeleton Injuries in an Austere Environment (continued) CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D.     A. Describe the initial management, resuscitation, and stabilization of pelvic fractures   III. Resuscitation             A. Mortality rates as high as 40% with hemodynamic instability                         1. major cause of death in first 24 hours: exsanguinating … Read more

V. Axial Skeleton Injuries in an Austere Environment – III (continued)

V. Axial Skeleton Injuries in an Austere Environment (continued)   CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D.     A. Describe the initial management, resuscitation, and stabilization of pelvic fractures      IV. Stabilization             A. Provisional                         1. may be performed at echelon II or III                         2. sheet/binder                                     a. easy to … Read more

V. Axial Skeleton Injuries in an Austere Environment – IV (continued)

V. Axial Skeleton Injuries in an Austere Environment (continued)   CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D. B. Define the initial management, resuscitation, and stabilization of spine injuries with associated neurological injuries     Spinal Fractures with Associated Neurologic Injuries I. Epidemiology             A. Overall spine injury from Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) … Read more