Download - Fracture Management
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Refresher 2003Refresher 2003
Common Outdoor Common Outdoor Injury ManagementInjury Management
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InstructorsThis PowerPoint was developed to
be used as an instructor- aid for the 2003 OEC Fall Refresher. Please
MODIFY its contents to meet your patrol’s needs. A mini-presentation
is a good teaching style for this exercise. Your review should not
take more than 30 minutes – maximum!
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Refresher 2003Refresher 2003
Common Outdoor Common Outdoor Injury ManagementInjury Management
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Common Outdoor Common Outdoor Injury ManagementInjury Management
ObjectivesObjectives Review mechanisms and patterns Review mechanisms and patterns
of traumatic injuryof traumatic injury Illustrate the types of injury that Illustrate the types of injury that
occur to the skeleton, soft tissue, occur to the skeleton, soft tissue, and skeletal support structuresand skeletal support structures
Explain the general principles of Explain the general principles of wound care and the emergency wound care and the emergency care for musculoskeletal injuriescare for musculoskeletal injuries
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Mechanism of InjuryMechanism of Injury
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending Trauma
HyperflexionHyperflexion
HyperextensionHyperextension
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Nail in Index FingerNail in Index Finger
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending TraumaHyperflexionHyperflexionHyperextensionHyperextension
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Severe Contusion of FootSevere Contusion of Foot
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending Trauma
HyperflexionHyperflexion
HyperextensionHyperextension
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CervicalCervical(C5-C6) (C5-C6) Fracture Fracture
DislocatioDislocationn
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending Trauma
HyperflexionHyperflexion
HyperextensionHyperextension
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Dorsal Dorsal DislocationDislocation
, Long , Long Finger Finger Middle Middle JointJoint
(PIP Joint)(PIP Joint)
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
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Normal Normal Tibia Tibia Left Left
SpiralSpiral
FractureFracture
Tibia Tibia
RightRight
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
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Dislocation of Right Dislocation of Right ShoulderShoulder
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
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Train Crush Injury, LegTrain Crush Injury, Leg
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
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Deceleration TraumaDeceleration Trauma
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Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
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Car struck from behind Car struck from behind “accelerates” passengers, “accelerates” passengers,
producing an extension injury producing an extension injury to the neck!to the neck!
Acceleration Acceleration TraumaTrauma
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Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
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Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
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DirectDirectMid-Shaft Fracture, Mid-Shaft Fracture,
FemurFemur
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Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
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IndirectIndirectPosterior Dislocation, Posterior Dislocation,
ElbowElbow
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Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
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TwistingTwistingSubtalar Dislocation, Subtalar Dislocation,
AnkleAnkle
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Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
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High EnergyHigh EnergyFractured PelvisFractured Pelvis
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Types of InjuryTypes of Injury
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Types of InjuryTypes of InjuryFractureFracture
• Any break in the Any break in the continuity of a bonecontinuity of a bone
• May vary from a simple May vary from a simple crack to a completely crack to a completely
shattered boneshattered bone
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Fracture ClassificationFracture Classification
Closed/OpenClosed/Open
Incomplete/CompleteIncomplete/Complete
Non-Displaced/DisplacedNon-Displaced/Displaced
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Closed Fracture,Closed Fracture,
Base of ThumbBase of Thumb ClosedClosed
Dorsally Dorsally Angulated Angulated
Forearm FractureForearm Fracture
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Open Fracture, TibiaOpen Fracture, Tibia
Open Fracture, ForearmOpen Fracture, Forearm
Open Fracture, ForearmOpen Fracture, Forearm
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Open Fractures Are Open Fractures Are More Serious!More Serious!
Blood lossBlood loss
Potential contamination Potential contamination with risk of infectionwith risk of infection
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Fracture ClassificationFracture Classification
Closed/OpenClosed/Open
Incomplete/CompleteIncomplete/Complete
Displaced/DisplacedDisplaced/Displaced
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Incomplete Fracture, Incomplete Fracture, Distal RadiusDistal Radius
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Complete Fracture, Complete Fracture, FemurFemur
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Fracture ClassificationFracture Classification
Closed/OpenClosed/Open
Incomplete/CompleteIncomplete/Complete
Non-Displaced/DisplacedNon-Displaced/Displaced
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Non-Displaced Fracture, Non-Displaced Fracture, Distal Tibia and FibulaDistal Tibia and Fibula
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Displaced Forearm Displaced Forearm FracturesFractures
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Other Types of FractureOther Types of FractureComminuted – fractured into Comminuted – fractured into more than two segmentsmore than two segments
Pathologic – fracture Pathologic – fracture through diseased bonethrough diseased bone
Epiphyseal – fracture passes Epiphyseal – fracture passes through the growth platethrough the growth plate
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Comminuted Femur Comminuted Femur FractureFracture
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Other Types of Fracture
Comminuted – fractured into more than two segments
Pathologic – fracture through diseased bone
Epiphyseal – fracture passes through the growth plate
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PathologicPathologicLytic lesion (darker = Lytic lesion (darker =
tumor) in proximal phalanx tumor) in proximal phalanx of finger, with associated of finger, with associated
transverse fracturetransverse fracture
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Other Types of Fracture
Comminuted – fractured into many pieces
Pathologic – fracture through diseased bone
Epiphyseal – fracture through the growth plate
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Epiphyseal (growth-line) Epiphyseal (growth-line) Fracture, Fracture,
Distal Femur Distal Femur
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Signs of a FractureSigns of a Fracture
TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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Fractured PatellaFractured Patella
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Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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AngulatedAngulated Fracture, Fracture, Radius and UlnaRadius and Ulna
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Seven Seven Signs of FractureSigns of Fracture
TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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CrepitusCrepitus
In a complete fracture, In a complete fracture, the the sounds of bone ends clicking sounds of bone ends clicking
or rubbing against each other;or rubbing against each other; denotes an unstable fracture!denotes an unstable fracture!
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Seven Seven Signs of FractureSigns of Fracture
TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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Open Ankle FractureOpen Ankle Fracture
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Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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False MotionFalse MotionThe unusual visual The unusual visual
sensation of observing sensation of observing motion at a long bone motion at a long bone fracture site wherefracture site where
““there is no joint!” there is no joint!”
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Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
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Fracture, Right Clavicle Fracture, Right Clavicle Right Arm ProtectedRight Arm Protected
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Seven Signs of Seven Signs of FractureFracture
The presence of The presence of
any oneany one
of the of the
seven fracture signs just listed seven fracture signs just listed
is sufficient to assess this injury!is sufficient to assess this injury!
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Types of Injury Types of Injury DislocationDislocation
Disruption of a joint such Disruption of a joint such that the bone ends are no that the bone ends are no longer in normal contactlonger in normal contact
Must have torn ligaments Must have torn ligaments and joint capsuleand joint capsule
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Signs of DislocationSigns of Dislocation
TendernessTenderness Deformity (usually Deformity (usually
marked)marked) Swelling and EcchymosisSwelling and Ecchymosis Loss of normal joint Loss of normal joint
motionmotion
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Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
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Anterior Dislocation, Right Anterior Dislocation, Right ShoulderShoulder
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Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
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Dislocation, Middle Joint Dislocation, Middle Joint (PIP Joint), Ring Finger(PIP Joint), Ring Finger
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Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
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Posterior Hip DislocationPosterior Hip Dislocation
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Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
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Posterior Elbow DislocationPosterior Elbow Dislocation
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Types of InjuryTypes of Injury Fracture-DislocationFracture-Dislocation
A combined injury with A combined injury with joint dislocation and an joint dislocation and an adjacent bone fractureadjacent bone fracture
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Fracture–Dislocation, AnkleFracture–Dislocation, Ankle
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Types of Injury Types of Injury SprainSprain
Partial or completePartial or completetemporarytemporary joint dislocationjoint dislocation
Ligaments are torn Ligaments are torn partially or completelypartially or completely
May produce as much May produce as much structural damage as a structural damage as a
dislocationdislocation
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Sprain, Left AnkleSprain, Left Ankle
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Types of InjuryTypes of InjuryStrainStrain
““Muscle Pull”Muscle Pull” Stretching or Stretching or
tearing of muscle, tearing of muscle, or muscle fascia or muscle fascia (covering)(covering)
Occurs frequently Occurs frequently in the lower back in the lower back secondary to poor secondary to poor posture and poor posture and poor abdominal muscle abdominal muscle controlcontrol
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Assessing Assessing Musculoskeletal Musculoskeletal
InjuriesInjuries MOI on ApproachMOI on Approach ABC’sABC’s Injury History (“What Injury History (“What
happened?”)happened?”) Palpation of injury site --Palpation of injury site --
“ “Take one finger and Take one finger and show me where it hurts!” show me where it hurts!”
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DCAP-BTLSDCAP-BTLS DDeformitieseformities CContusionsontusions AAbrasionsbrasions PPuncture Woundsuncture Wounds BBurnsurns TTendernessenderness LLacerationsacerations SSwellingwelling
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Evaluation of Distal Evaluation of Distal Neurovascular FunctionNeurovascular Function
(CMS)(CMS)
Pulse (circulation)Pulse (circulation) Motor FunctionMotor Function SensationSensation
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Radial Pulse Posterior Radial Pulse Posterior Tibial Tibial PulsePulse
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Evaluation of Distal Evaluation of Distal Neurovascular FunctionNeurovascular Function
(CMS)(CMS)
Pulse (circulation)Pulse (circulation) Motor FunctionMotor Function SensationSensation
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Extension Extension FlexionFlexion
Ankle Dorsiflexion Ankle Plantar Ankle Dorsiflexion Ankle Plantar FlexionFlexion
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Evaluation of Distal Evaluation of Distal Neurovascular FunctionNeurovascular Function
(CMS)(CMS)
Pulse (circulation)Pulse (circulation) Motor FunctionMotor Function SensationSensation
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Medial and Medial Foot Medial and Medial Foot Lateral FootLateral FootLateral HandLateral Hand
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Principles of Principles of Musculoskeletal Injury Musculoskeletal Injury
ManagementManagement ABC’sABC’s Evaluate distal neurovascularEvaluate distal neurovascular
functionfunction Dress all woundsDress all wounds Splint all suspected injuriesSplint all suspected injuries Prepare patient for transportPrepare patient for transport
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Injury ManagementInjury Management
All All
open woundsopen wounds
should be covered with a should be covered with a
dry sterile compression dry sterile compression dressingdressing
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Injury ManagementInjury ManagementSplinting Immobilizes Splinting Immobilizes
the Injury and:the Injury and: Reduces PainReduces Pain Facilitates TransportFacilitates Transport Prevents further damage Prevents further damage
totoblood vessels, nerves andblood vessels, nerves andskin adjacent to the injuryskin adjacent to the injury
Decreases BleedingDecreases Bleeding
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Principles of SplintingPrinciples of Splinting Check and record CMS Check and record CMS Dress all woundsDress all wounds Immobilize the joints above Immobilize the joints above
and below a suspected and below a suspected fracturefracture
With injuries at or near joints, With injuries at or near joints, immobilize the bones above immobilize the bones above and below the injuryand below the injury
Stabilize the injury site during Stabilize the injury site during splint application splint application
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Principles of SplintingPrinciples of Splinting
Use gentle in-line manual traction Use gentle in-line manual traction to realign displaced long bone to realign displaced long bone fracturesfractures
Expect to encounter increased Expect to encounter increased pain and some resistance when pain and some resistance when attempting to realign a deformed attempting to realign a deformed limblimb
Immobilize all suspected spinal Immobilize all suspected spinal injuries injuries in a neutral in-line in a neutral in-line positionposition on a spineboard on a spineboard
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Principles of SplintingPrinciples of Splinting
If the patient demonstrates If the patient demonstrates major signs of shock, align the major signs of shock, align the limb as close to its normal limb as close to its normal anatomic alignment as possible anatomic alignment as possible on a spineboard (immobilization on a spineboard (immobilization of total body), and provide of total body), and provide rapidrapid transport transport
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Total Body Total Body ImmobilizationImmobilization
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When in doubt:When in doubt:
SPLINT!SPLINT!
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Rigid SplintsRigid Splints Quick Splint Cardboard Quick Splint Cardboard SplintSplint
Ladder Splint SAM Ladder Splint SAM SplintSplint
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Soft SplintsSoft Splints Air Splint Vacuum Air Splint Vacuum SplintSplint
Sling and Swathe Blanket Sling and Swathe Blanket RollRoll
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Traction SplintTraction Splint
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When standard splints When standard splints are unavailable, are unavailable, improvisation improvisation
is better than doing is better than doing nothing!nothing!
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UPPER UPPER EXTREMITYEXTREMITY
All fractures All fractures can be can be
immobilized immobilized by securing by securing
the extremity the extremity to the chest!to the chest!
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LOWER EXTREMITYLOWER EXTREMITYAll fractures can be immobilized by All fractures can be immobilized by
securing the injured extremity to securing the injured extremity to the opposite lower extremity!the opposite lower extremity!
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The EndThe End