กลับไปหน้า CPG Trauma Fast Track

แนวทาง Extremity Trauma

Hard signs and Soft signs for Extremity trauma

Hard Signs Soft Signs
Absent or diminished distal pulse Small, stable hematoma
Obvious arterial bleeding Injury to anatomically related nerve
Large expanding or pulsatile hematoma Unexplained hypotension
Audible bruit History of hemorrhage
Palpable thrill Complex fracture
Distal ischemia
(Pain, Pallor, Paralysis, Paresthesia, Coolness)
Proximity of injury to major vascular structures

Mangled Extremity Severity Score (MESS)

Criteria Characteristics Details Point
Skeletal/Soft tissue injury
A Low energy Stab, Simple fracture, Pistol gunshot wound 1
B Medium energy Open or multiple fracture/dislocation 2
C High energy High speed motor vehicle accident, Rifle gunshot wound 3
D Very high energy High speed trauma with gross contamination 4
Shock
A Normotension Systolic BP ≥90 mmHg 0
B Transiently hypotensive Systolic BP <90 mmHg 1
C Persistent hypotension In OR 2
Limb ischemia
A Mild Pulse reduced or absent, but perfusion normal 1
B Moderate Pulseless, Paresthesia, Diminished capillary refill 2
C Advanced Cool, Paralyzed, Insensate, Numb 3
Age
A <30 years 0
B 30-50 years 1
C >50 years 2