What is the management for a patient bruised in an ATV accident?

Management of Bruising from ATV Accidents

For patients with bruising from ATV accidents, immediate assessment of injury severity using an established grading system is essential, followed by appropriate interventions based on the extent of bleeding and hemodynamic stability. 1

Initial Assessment

• Assess vital signs immediately: pulse rate, blood pressure, respiratory rate, and mental status to classify hemorrhage severity 1

• Evaluate for signs of hemodynamic instability:

  • Tachycardia (>100 beats/minute)
  • Hypotension
  • Decreased pulse pressure
  • Tachypnea
  • Decreased urine output
  • Altered mental status 1

• Thoroughly examine all anatomical areas, as ATV accidents commonly cause injuries to multiple sites:

  • Upper extremities (73% involve fractures/dislocations) 2
  • Chest (potential cardiac valve injuries) 3
  • Head (leading cause of death in ATV accidents) 4

Management Algorithm Based on Severity

For Hemodynamically Stable Patients (Class I-II Hemorrhage)

1. Apply direct pressure to bruised areas for 3-5 minutes 5
2. Elevate injured extremities
3. Apply cold compresses to reduce swelling and pain
4. Consider oral analgesics for pain management
5. Monitor for progression of symptoms
6. Consider imaging (CT) for high-risk mechanisms of injury 1

For Hemodynamically Unstable Patients (Class III-IV Hemorrhage)

1. Secure airway and ensure adequate ventilation (avoid hyperventilation) 1
2. Establish IV access and begin fluid resuscitation:
   • Start with crystalloids 1
   • Target systolic BP of 80-100 mmHg until major bleeding is controlled 1, 5
3. Identify source of bleeding:
   • Perform FAST examination for suspected torso trauma 1
   • Obtain chest and pelvic X-rays 1
4. For significant free intra-abdominal fluid with hemodynamic instability, proceed to urgent intervention 1
5. For identified sources of bleeding, implement immediate bleeding control procedures 1
6. Monitor serum lactate and base deficit to assess extent of bleeding and shock 1, 5

Special Considerations

• For bone bruising or bleeding:

  • Apply direct pressure
  • Consider bone wax for cancellous bone bleeding if pressure is insufficient 5
  • For severe bleeding, consider systemic antifibrinolytic agents: tranexamic acid 10-15 mg/kg IV followed by infusion of 1-5 mg/kg/h 1, 5

• For suspected internal organ bruising:

  • Perform FAST examination 1
  • For stable patients with suspected torso trauma, obtain CT imaging 1
  • Monitor hemoglobin/hematocrit to detect ongoing bleeding 5

• For head injuries (common in ATV accidents):

  • Maintain higher systolic BP targets (>100 mmHg) 1, 5
  • Consider neurosurgical consultation for severe cases

Prevention of Complications

• Avoid excessive positive end-expiratory pressure in severely hypovolemic patients 1
• Minimize time between injury identification and bleeding control 5
• Consider damage control approach for severe, ongoing bleeding with coagulopathy, hypothermia, or acidosis 5
• For patients on anticoagulants, consult with the prescribing physician regarding temporary discontinuation 5

Follow-up Care

• Educate patients on signs of worsening bruising or internal bleeding requiring immediate medical attention
• Recommend helmet use and safety equipment for future ATV use, as only 15% of fatal ATV accident victims were known to have worn helmets 6
• Screen for alcohol use, as it was detected in 50% of fatal ATV crashes 6