EMT Chapter 29

Applying a rigid splint:

1. Gently support limb and get gear ready; apply steady in line traction, and maintain; 2. Place splint under, along limb; 3. place padding for even pressure and pad prominences; 4. Apply bindings; 5. CHECK, RECORD distal nervous and circulatory.

How do you apply vacuum splint?

1. Stabilize, support injury, 2. place the splint and wrap it around the injury; 3. draw air out through valve and close valve.

How do you apply zippered inflatable splint

1. Support limb, apply gentle traction, apply open, DEFLATED, SPLINT. 2. Zip it up, inflate by pump or mouth, test pressure, check/record distal.

4 main steps in fracture treatment are

1. cover open wounds with dry, sterile; apply pressure, torniquet if need be; 2. Apply splint, raise extremity 6 inches; 3. apply ice packs (but not direct on skin); Position for transport, secure injured area.

How do you apply unzippered air splint?

1. support limb, place arm though splint, and grab hand or foot, 2. gentle traction while pulling, 3. inflate.

When do you splint?

All fractures, dislocations, sprains, unless patient in immediate danger.

Treating ankle injuries

Any ankle injury that is painful, Dress open wounds; assess distal function; correct any gross deformity with traction; before releasing traction, splint. Make sure it includes entire foot and extends up leg to knee joint. OR, WEBSITE MENTIONS FIGURE OUT AROUND FOOT.

Describe when to use an inflatable splint

Applies pressure that helps with bleeding; stabilize below knee or elbow.

How do apply splint with deformity?

Apply padded board splints and secure them with soft roller bandages.

If patient is in shock (cool, clammy, etc), do you splint or attach to longboard?

Attach to longboard for faster transport.

What if extremity injuries impair circulation or nerve functions?

Careful assessment, prompt transport, frequent reassessment, tell hospital.

Most commonly fractured bone in body

Clavicle

armbones

Clavicle (bone from neck to shoulder). scapula (shoulder blade): from clavicle to humerus. humerus is upper arm. radius and ulna. two bones elbow/wrist. radius is shorter, to thumb.

What is first priority with fracture?

Determine if skin is broken; treat any injury that breaks skin as possible open fracture.

What are serious orthopedic injuries?

Displaced long bone; multiple hand/foot fractures; open long bone fractures; displaced pelvic fractures; dislocation of major joints; multiple digit amputations; laceration of major nerves or blood vessels.

Define dislocation.

Disruption of joint where bones are no longer in contact.

How do you palpate pulses in injured limbs (orthopedic)?

Distal to point of injury. Radial in upper; posterior tibial and dorsalis pedis in lower.

How to treat hip dislocation

Don't try to reduce; splint; patient supine on board; support limb with pillows; secure; transport.

Three major leg bones

Femur, top; fibula (smaller, behind) tibia (shinbone)

When splinting an injury of the wrist, the hand should be placed

Functional position.

Signs of fracture are

Guarding, deformity, tenderness, swelling, bruising, crepitus, false motion, exposed fragments, locked joint, pain...

Treating pelvic fracture

High risk of shock (bleeding, exposed organs). If stable, put on longboard, scoop stretcher "Pelvic binder"

Shoulder dislocation wisdom

Humeral head usually anteriorly. hard to stabilize due to pain. bringing arm to chest hurts. stabilize where most comfortable.

How to treat knee dislocation

If enough distal pulse, splint; transport.

When do you apply splint in deformity position?

If severe, as often with dislocations; and when resistance or extreme pain. also with joints.

How to treat fractures about the knee

If there is enough pulse and not a lot of deformity; splint with knee straight. if deformity and pulse; splint in deformed position. If no pulse, contact medical control. NEVER traction.

Define sprain

Injury to ligaments, tendons, fluids, crossing a joint.

What should you suspect with fractures?

Internal bleeding.

Dislocated hip symptoms

Lie with hip joint flexed (knee drawn in) and thigh drawn in. Severe pain in hip; no desire to move. May have nerve loss. Splint in place.

Signs of dislocation

Marked deformity, swelling, pain aggravated by motion, tenderness on palpation, near complete loss of motion, numbness, impaired circulation.

Diagnosing pelvic fracture

Often from heavy blow (fall, car accident) OR knee striking car. complaints of lower back, abdomen discomfort Best sign: Palpate illiac crest in/out.

A car injury, knee soreness indicates

Posterior hip dislocation.

How to treat strains

Rest, Ice, Compression, Elevation, (reduced weight, pain killers).

How to treat tibia or fibula fractures

Rigid, long leg splint, or air splint.

How do you treat dislocated joints?

Splint in position found.

How to treat dislocation of patella

Splint in position you find it.

How to treat knee ligament injury

Splint. Hip to ankle or so.

Define strain.

Stretching or tearing of the muscle, causing pain, swelling, bruising.

Transport patients with lower extremity injuries by

Supine, so you can raise 6 inches for swelling.

What connects skeletal muscle to bones?

Tendons

What to do with hip, pelvis maybe femur...

Think transport first for risk of significant internal injury.

If there is significant trauma, what comes first, trauma, or muscoskeletal?

Trauma

Describe knee dislocation

True emergency; ligaments torn, damaged; is position of tibia relative to femur; anterior, posterior or medial possible.

If fracture of longbone has created severe deformity

Use constant, gentle pressure; esp. if distal is cyanotic or pusleless

Describe what causes dislocation of hip and symptoms

Usually posterior; suspect in car crash and has wounds near knee; severe pain in hip; strong resistance to movement of hip; tenderness on palpation.

Treat foot injuries

Usually swelling, not dislocation; apply rigid splint, air splint, or pillow; keep toes out.

What are traction splint types and when used?

a. femur, and Hare, Sager, Reel, Kendrick.

How to treat femoral shaft fracture

beware bone fragments on nerve/blood; usual wound covering; best stabilized with traction splint.

Properties of good stabilization of ortho. injuries are:

comfortable position, maintains good distal.

If there seem to be perfusion issues

contact medical control. more extraordinary steps may be in order.

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How to treat sprains

err on side of caution; treat as fracture. But if sprain, treat as strain (rice...).

Crepitus and false motion are positive indicators of

fracture

if pulseless limb, then transport option

if more than hour, air. (or maybe this is any fracture.)

symptoms of broken clavicle are

more common in kids; pain in shoulder and hold body across arm.

How to treat wrist or hand fractures

must be confirmed with x-rays; often dislocation; anything question, splint and ED; 1. Support hand, put hand into position of function; roller bandage in hand, 2. apply padded board splint on palmar side with fingers exposed; 3. secure with roller bandages. (swathe with...).

Describe strains

no deformity, minor swelling; increased sharp pain with movement; severe weakness of muscle; extreme point tenderness.

do you need pads with vacuum, air

no.

Contrast displaced and nondisplaced fractures.

non-displaced is simple crack; displaced produces actual deformity.

Type of splints for long bone injuries

padded board, air splint, or similar device.

If pelvic injury, type of splint

pelvic binder

How to care for elbow injuries

potentially serious; transport immediately if distal circulation; check distal neuro often.

What is crush/compartment syndrome

prolonged pressure on muscles. creates swelling.

Basic principles of splinting are:

remove clothing from area; note neurovascular condition; cover wounds with dry, sterile; do not move before splinting extremity, unless in danger; pad all rigid splints; maintain manual stabilization; if you encounter resistance, splint in position; stabilize all suspected spinal in neutral, in-line; when in doubt; splint.

splinting injuries above elbow

sling

To splint clavicle, scapula

sling and swathe.

Treating knee dislocation

splint in place unless distal issues (in which case medical control says to).

Treat compartment syndrome

splint, transport. reassess often; requires surgery.

Treating crush/compartment

splint? give oxygen. paramedics give fluids.

purpose of pneumatic antishock is...

splinting for lower extremities, pelvis

If suspected injury of any bone shaft; what about joints?

stabilize joints above, below

Transporting amputated thing by...

sterile dressing,plastic bag; container with ice; don't let it freeze! treat bleeding patient first!

If orthopedic patient has no life threatening injuries, then

take the time to stabilize his/her condition.

Isolated femoral break should be

traction

If a patient has a significant MOI but condition appears stable, you should

transport immediately.

When do you NOT use traction splint:

upper extremity; near the knee; hip; pelvis; partial amputations or avulsion; lower leg, foot, ankle.

Describe dislocation of patella

usually kids; deformity patella is to lateral side.

Displaced versus nondisplaced fractures

what you think.... nondisplaced is also hairline