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CE ARTICLE CLASS IV >2000 >140 Decreased Decreased >35 Confused/ lethargic Crystalloid & blood of several hours is generally caused by the build-up of edema. Also evaluate the portion of the extremity distal from the injury for circulation, sensation and motion. A temperature difference or weaker pulse in comparison to the non-injured extremity suggests vascular compromise, while loss of sensation or muted pain sensation suggests nerve injury. Decreased motion may suggest nerve injury, but is also common with angulation and deformity as ligaments and muscles are already stretched around the injury. Be sure to document any defi cits that are present prior to splint application. Management When a musculoskeletal injury is identifi ed, the treatment goal is to restore and maintain bone and joint alignment to control pain, reduce motion, prevent further soft tissue injury and promote the tamponade effect of muscles on any injured vessels. This is best achieved by realigning extremities into an anatomical position as early as possible, then applying a properly sized splint to maintain the alignment and protect the site from further injury. These management goals can only be met by performing an accurate injury assessment. Realignment Traditionally, EMS classrooms teach students to splint musculoskeletal inju- ries in the position found unless there is poor distal circulation, in which case there is one attempt to reposition the extremity. However, splinting an angu- lated extremity is technically diffi cult and it is well known that the longer deformity persists, the more diffi cult it becomes to realign the extremity because muscles begin to spasm. Additionally, while splint application does reduce pain, the most signifi cant pain relief often results from the realignment of fractured bone ends, as well as the administration of analgesia. The goal of prehospital musculoskeletal injury straightening is not to perfectly realign the bone ends. Rather, it is to signifi cantly reduce pain, protect distal circulation and nerve function, and allow splinting to become easier and more effective. Straightening an angulated or long bone is fairly straight forward. Follow these simple steps: 1) Check and document distal CSM 2) Stabilize above and below the injury site 3) Apply gentle traction to the distal extremity in the direction it is facing 4) While maintaining traction, move the distal extremity back towards its anatomical position 5) STOP repositioning when there is resistance, significant increase in pain, For More Information Circle 62 on Reader Service Card EMSWORLD.com | FEBRUARY 2012 39