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Thinking in terms of indigs:
1.Antibiotics and analgesia.
2.Brachial Plexus block
3.bp cuff above the elbow, pumped up as high as it can go (200mmHG preferably 250mmHg)
4.Start the clock, tourniquet time should be no more than 2 hours.
5.Prep the area
6.Remove the object
7.Flush the site with sterile saline
8.Explore for major vessel damage. Tie off any large vessels.
9.Deflate cuff, watch for bleeders, re inflate and flush with saline and tie off any new bleeders.
10.Repeat if necessary.
11.Dirty wound , so pack with wet to dry dressing don’t close
12.Splint and dry dressings on top
13.Be prepared for sepsis and the possibility of below elbow amputation
14.NSAID and antibiotics.
15.Dressing BID
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