Evaluation and Management of Peripheral
Vascular Injury
Part 1

Annotation for Point A

Bleeding from an injured extremity affects “Circulation” during the Primary Survey of Advanced Trauma Life
Support and should be managed with direct pressure or a compressive dressing and ongoing resuscitation. In the absence of bleeding, the injured extremity is assessed during the Secondary Survey of Advanced Trauma Life Support. The assessment for a possible arterial injury is dependent on the presence of normal versus diminished or absent pulses on physical examination or use of the Doppler device. Therefore, a fracture or dislocation of a joint in the injured extremity should be realigned or relocated, respectively, should first palpation of distal pulses during the Secondary Survey document a difference between the injured and a contralateral uninjured extremity in the hemodynamically stable patient.16,17