Question on traction spints

[DwayneEMTP]

I wasn't sure which forum was most appropriate so decided maybe other basics could learn from this.

I have a feeling these are dorky questions...but couldn't find an answer elsewhere....so here goes.

Disclaimer (So we don't tie up the thread with how unfair it is to judge others, I don't have much info and will just post what I do have as it relates to the question. This is not meant to be a fair representaion of this call and I have no idea how this turned out!) Thank you.

Disclaimer II (Though disclaimers such as the one above seem to be becoming necessary, I think it sucks and am not going to do it again. I'm leaving this one in the hopes of making a point.) Thank you.

Man shot multiple times, hand, arm, femur. All on the right side. As they load him up his leg twists mid-femur (I'm not positive that mid-femur is the only injury to this area but am going to assume it is for the question) You can see the skin twist like taffy, I'm not sure how to describe it.

As this injury came from a gunshot and not a fall is there a greater possibility that it is not a clean break but perhaps the bone is shattered...?

If it is shattered, only in the mid-femur area, is this still called a fracture or is there another name for it?

Again assuming it is slightly shattered (restricted to a small area. I don't have the language I need for this) would a traction splint be useful? Is it still applicable if you don't have well defined bone ends or would this be a contraindication?

Both my brain cells are screaming that I should know these answers, or they should have been easily found...neither seems to be the case. So if I boneheaded this I'll take my beating...

Thanks all...Have a great day or night!

Dwayne

[Ridryder 911]

Chances are it is a comminuted fracture. basically splintered due to the velocity and awl of the bullets and pellets. If it is mid shaft primary) than yes, a traction. if it appears other than such ..no. Puling traction on femur fractures, that located more proximal, or even distal condyles can actually cause more damage. As well, if it a GSW, with more than that isolated case, I would b more worried of vascular damage and other potential injuries and be using more simplistic and rapid devices. Since this is multiple GSW, I myself would not be waisting time with a traction, and be focusing on more possible injuries, if the victim was struck multiple times.. if the patient had no distal pulses in the leg,.. and traction worked, of course placed one.. but again, look at the whole picture.

R/r 911

[AZCEP]

Ditto Rid.

The multiple GSW patient tends to not be stable enough to tolerate the time it will take to correctly apply a traction splint. If you can secure the extremity so that motion is limited without it, then that may be a better way to go.

I've got to ask, did you have a scenario like this in class? I will guess not. If you never get placed in these types of situations, how are you supposed to know how to manage it? Kudos for wanting the information, and asking for it.

[canuckEMT]

Well how much more could one add to what has already been said? The only way I would apply a traction over a B splint in this scenario is if I had enough people in the back of the bus to help. I would definately not be wasting time on scene applying a Sager.

[Dustdevil]

Well how much more could one add to what has already been said?

How about, "what is a B splint?" :?

And suppose you are in a remote situation, not a transporting unit, and awaiting a helo from 20 minutes away? Now what do you do? Traction or no traction?

[DwayneEMTP]

Thanks for the response guys...Thanks for making me look at the bigger picture.

You know what's funny...is the further I go in my education the more the simple questions start to grow teeth.

Basic academy: Mid-shaft femur fracture without contraindications = traction splint. Patient = leg.

Real life: Patient = whole person, vitals, moi, history, time to hospital, etc, etc, etc (all the etcs being stuff I'm sure I don't know yet).

I'm beginning to believe that my school did a disservice by convincing me I actually had a handle on some things...

I'm not bashing Basics. I went to the basic academy because I saw a woman get hit by a cab and didn't know what to do. I would be much more help to her now than before..(for instance I would now want to know if she was alive before freaking out over her broken arms and legs... :roll: )

It seems that each class I complete creates a bunch of "what ifs" for things that I was taught were pretty black and white. It's getting easier and easier to see the issues involved in giving 'simple' meds as a basic.

I felt much more competent after my first 3 weeks of basic training than I do now after bio-chem and a little A&P.

I'm not speaking for other basics...Even when both brain cells are firing I can't speak on the same level as most here....this is just my experience....

Perhaps the biggest benefit of my becoming a basic (me...no one else) is I'll be a much better source of information for 911 when calling for a paramedic.

Thanks again for your help!!

Dwayne

[canuckEMT]

How about, "what is a B splint?" :?

A rigid splint with velcro closures. Sorry should have used a little different terminology.

[Lucky~13]

Aren't open femor wounds conterindications to using traction splints? :?

[becksdad]

I know the oldtimers answered this, just a few more thoughts. As they have said, this patient is a candidate for rapid transport. But good to know also - any exit wounds? where are they? Could the arm or hand shots have exited and entered elsewhere in the body? Did the femoral shot exit? It could have travelled upwards into the pelvis. If the femoral shot was enough to shatter a femur, but the wound is not hemorrhaging excessively, and the leg has no PMS compromise distal, maybe the arm is actually the more severe wound. Seems like a load that shatters a femur would be enough to blow an arm clean off. You would be re-assessing very frequently with this patient. So my first impression with this scenario would be no traction splint - no time

Also in this thread - I don't see where this open femoral injury would be a contraindication to traction splinting. Especially if there was neurovascular compromise, and traction restored any PMS function at all. The traction would alleviate the muscle spasms in this strong musculature, possibly protecting from further damage, and almost certainly reducing pain level. Ultimately, to traction or not to traction would be a decision based on assessments, time, assistance, etc. I certainly wouldn't delay transport for it.

[Lucky~13]

I know the oldtimers answered this, just a few more thoughts. As they have said, this patient is a candidate for rapid transport. But good to know also - any exit wounds? where are they? Could the arm or hand shots have exited and entered elsewhere in the body? Did the femoral shot exit? It could have travelled upwards into the pelvis. If the femoral shot was enough to shatter a femur, but the wound is not hemorrhaging excessively, and the leg has no PMS compromise distal, maybe the arm is actually the more severe wound. Seems like a load that shatters a femur would be enough to blow an arm clean off. You would be re-assessing very frequently with this patient. So my first impression with this scenario would be no traction splint - no time

Also in this thread - I don't see where this open femoral injury would be a contraindication to traction splinting. Especially if there was neurovascular compromise, and traction restored any PMS function at all. The traction would alleviate the muscle spasms in this strong musculature, possibly protecting from further damage, and almost certainly reducing pain level. Ultimately, to traction or not to traction would be a decision based on assessments, time, assistance, etc. I certainly wouldn't delay transport for it.

I'm just a basic student, so I'm by no means an expert. But our book said that open injuries to the thigh is a counterindication to traction splinting. It can further aggrevate the wound by tearing it open more, destroy clots, rip open more blood vessels, etc.

Unless I'm missing something here, I wouldn't traction splint the leg at all in this scenario.