EMS World

AUG 2011

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ORTHOPEDIC TRAUMA Figure 4: A bipolar traction splint Ischial strap Sleeves Winch "S" hook Heel stand Ankle hitch Support straps "D" ring When protocol allows, consider using a traction splint (see Figure 4) to immo- bilize the femur. Applying traction pulls displaced bone ends in line and also helps prevent muscle contraction that can lead to increased bleeding. Splinting should always be assessed immediately after completion. Check distal C/S/M function. Improper splinting can often result in impaired C/S/M func- tion. Remember also that improper splinting can lead to excessive move- ment and pressure-related injuries from inadequate padding. ELEVATION AND COLD After the injury has been properly splinted, consider elevating it above the level of the heart. In theory, elevation helps decrease edema and minimizes pain. Elevate only if proper immobiliza- tion has been achieved first. Elevation without immobilization can actually aggravate an injury by causing exces- sive movement of displaced bone ends. Application of cold packs and ice to an orthopedic injury is also thought to limit edema by causing peripheral vasocon- striction. As with elevation, the reduction in edema can help minimize pain. Never REVIEW ITEMS 1. Which of the following would be a function of the musculoskeletal system impaired by a fracture? A. Structure B. Heat retention C. Fluid balance D. Insulation 2. Which of the following complications of a dislocation would indicate a critical patient? A. No distal pulse B. Pain at the dislocation site C. Deformity at the dislocation site D. Swelling in distal extremity 60 AUGUST 2011 | EMSWORLD.com 3. A pelvic fracture is most often considered life threatening because of ______________________ . A. Hemorrhage B. Pain C. Sepsis D. Vomiting 4. An unbelted driver fractures his femur as he is thrown forward into the steering wheel during a motor vehicle crash. This mechanism of injury would best be described as______________ . A. Direct force B. Indirect force C. Twisting force D. Dislocating force 5. Which of the following assessment fi ndings would indicate that splinting has been done improperly? A. Numbness in a hand following splinting B. Continued pain in the extremity following splinting C. Flushed skin in an extremity following splinting D. Inability to move the splinted extremity ORTHOPEDIC INJURIES IN SPECIAL POPULATIONS Anatomical differences in pediatric and geriatric patients require special consideration. Pediatric patients often have less-calcifi ed bones. As a result, their bones are more pliable and fl exible. Because of this anatomical difference, true fractures are less common in younger patients than they are in adults. Although children certainly break bones, often more force is required. Furthermore, because children’s bones are fl exible, often more internal damage can occur even though the protective bones remain intact. Beware of underlying injuries in children. In geriatric patients, diseases such as osteoporosis may require an alternative approach to the assessment of mecha- nism of injury. Decreased bone density, a condition common in elderly patients, can often lead to fractures with minimal force applied. A mechanism of injury that would be unlikely to break the bone of a younger person may indeed result in fractures in a person with a disease such as osteoporosis. Have a higher index of suspicion when evaluating orthopedic injuries in geriatric patients. Joseph J. Mistovich, MEd, NREMT-P, is chair of the Department of Health Professions and a professor at Youngstown State University in Youngstown, OH. He has more than 25 years of experience as an educator in emergency medical services. He is an author or coauthor of numerous EMS books and journal articles Ischial pad apply cold directly to bare skin, as this can cause cold-related injuries such as frost- bite. Always wrap the ice or cold pack in a towel or similar cloth prior to application. CLINICAL DECISION MAKING You respond to an 11-year-old girl struck by a car. Bystanders note that the child was struck and thrown 10 feet onto the road. 1. What types of injuries would you expect from this mechanism? 2. What immediate assessment steps should you take? On arrival you fi nd the patient alert and oriented, breathing rapidly, with good distal pulses. The patient is crying and complains of pain in her pelvis and left upper arm. On inspection, you note that her pelvis is unstable and her arm is angulated and obviously fractured. 3. Given the nature of her injuries, what other systems might be aff ected? 4. Assuming her airway, breathing, and circulation are adequate, how would you deal with the unstable pelvis? 5. Should you take the time to splint her arm prior to leaving the scene? 6. After the arm has been splinted, what additional steps can you take to improve care of this injury? and is a frequent presenter at national and state EMS conferences. Daniel Limmer, AS, EMT-P, has been involved in EMS for 31 years. He is active as a paramedic with Kennebunk Fire-Rescue in Kennebunk, ME. A passionate educator, Dan teaches basic, advanced and continuing educa- tion EMS courses throughout Maine. Howard A. Werman, MD, FACEP, is professor of emergency medicine at The Ohio State University. He is a teacher of medical students in the College of Medicine and the residency training program in emergency medicine at The Ohio State University Medical Center. Daniel Batsie, EMT-P, is the EMS program coordinator at Eastern Maine Community College in Bangor, ME, and clinical and education coordinator for Atlantic Partners Regional EMS.

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