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 |
Last update มิถุนายน 2568