Musculoskeletal Injuries: Management Chapter 20, Section 3 Musculoskeletal Injuries: Management Discussion Points: You will likely spend many hours practicing the skills that accompany this topic – far more time than you will spend talking about them. This set of slides is only a brief overview.

Objectives 20.3.1 Explain the general management of a patient with an MS injury. 20.3.2 List and demonstrate the use of the following types of splints: sling and swathe Quick Splint soft splint rigid splint traction splint continued

Objectives 20.3.3 Demonstrate how to care for specific injuries to the arm or leg. 20.3.4 Demonstrate how to remove a boot, including a ski boot. 20.3.5 Describe and demonstrate placing a patient in the anatomical position using the principles of “jams and pretzels.”

Topics Management Boot Removal Chapter Summary

Management Deal with life threats General care has common steps Use BSI Plan of action to include help, equipment, and transport needed Expose injury to observe for bleeding, deformity, discoloration, swelling Control bleeding, bandage wounds Discussion Points: Note that these are general principles. Most have been covered in previous chapters or courses. continued

Management General care has common steps Immobilize as needed – check CMS Ice for swelling Transport to aid room, monitor patient comfort Reassess for CMS and bleeding, adjust treatment as needed O2 as needed Transfer to higher level of care Discussion Point: Emphasize reassessment, since a situation can change as the patient is brought in, or as they warm up in the first aid area.

Splinting Splint to: Decrease movement of broken bone ends Allow clotting, prevent further blood loss Decrease pain at injury site Help with muscle spasms, place in anatomic position Prevent closed fracture bone ends from penetrating the skin Discussion Point: Mention each as this is mostly straightforward material. continued

Splinting continued Copyright Edward McNamara Some examples of the many different types of commercial splints. Copyright Edward McNamara continued

Splinting Splint to: Prevent further tissue damage Allow easier transport Prevent paralysis in spinal injuries Discussion Point: Mention each as this is mostly straightforward material.

Types of Splints Soft splints Sling and swathe Air splint Vacuum splint Blanket roll/pillow splint Pelvic binders Discussion Points: Have on hand the splints available at your area. Note the splints that are only found in your toboggans, or only in the aid room. continued

Types of Splints continued Copyright Edward McNamara A sling and swathe is used primarily to immobilize injured upper extremities. continued Copyright Edward McNamara

Types of Splints A vacuum splint in use on an injured arm. continued

Types of Splints continued A pillow splint can be used on wrist and hand injuries when rigid splints are not available. continued

Types of Splints continued Copyright Candace Horgen A SAM™ pelvic sling. continued Copyright Candace Horgen

Types of Splints Rigid splints Cardboard Wood Quick splint Airplane splint Malleable metal splints Traction splint continued

Types of Splints An example of a rigid splint. continued

Types of Splints continued Copyright Edward McNamara A cardboard splint. Copyright Edward McNamara continued

Types of Splints continued Copyright Edward McNamara An airplane splint being applied. continued Copyright Edward McNamara

Types of Splints A SAM™ splint. continued Copyright John Dobson, M.D.

Types of Splints Commercially available traction splints. continued

Types of Splints Commercially available traction splints. continued

Types of Splints Improvised splints i.e., Popsicle™ stick for finger splint Only use if the one commonly used is unavailable Discussion Points: Improvised splints may have to be used if a limb cannot be aligned; show students the materials available for them to use. Mention improvised splints for “civilian” situations in which convenient toboggan or aid room supplies are unavailable.

Types of Splints The use of a magazine as a splint.

Types of Splints A variety of items can be used as splints.

Principles of Splinting Splint before moving patient Check CMS before and after Manually stabilize injured area Use correct type/size, pad as needed Position, move limb carefully, and secure If shock is significant, work quickly and transport Discussion Points: The information on the next three slides will become much of the mantra of your practice sessions, as well as the backbone of the treatment of many of your patients: Checking CMS Manual stabilization Correct size and type of splint Care in moving injured limbs All of the above are second nature to OEC techs, and applies to your students as well. Note the last bullet: When a patient’s general condition is deteriorating, it may be more important to transport than to spend time splinting MS injuries. continued

Principles of Splinting If deformity is present with fracture, align if possible If alignment is not possible, secure in best position for stability/comfort Open fracture Severely angulated or “locked” Dislocations and/or fracture at joint Patient who will not allow movement Injury with impaled object Discussion Points: Alignment is mentioned several times in the chapter: In relation to straightening a long bone fracture before splinting (efficiency and improving patient comfort) To re-establish distal CMS Joint splinting in position found (if CMS is compromised AND a 2+ hour wait for hospital care) Increased pain and resistance may be cause to abandon alignment of a long bone and splint in position found (improvised splinting) continued

Principles of Splinting Splint an injured knee in the position found. continued

Principles of Splinting Do not attempt to reduce fractures or force bone ends back into skin Remove jewelry before swelling occurs – account for it Immobilize above and below injury site (bones for joint injury, joints for bone injury) Advise patient to seek follow-up care Discussion Points: Ensure students understand the difference between aligning and reducing a fracture. The chapter mentions that bones may pull back into the skin with alignment, especially in relation to traction splinting. This is different from forcing the bone ends back in. If jewelry is removed, ensure that the patient has it with them when they leave to avoid accusations of theft related to our care. The last two bullets on the slide are not mentioned specifically in the principles of splinting section of the chapter, but appear in the various descriptions of splinting specific injuries.

Caring for Specific Extremity Injuries Upper Extremity Injuries Shoulder, clavicle, scapula Sling and swathe Figure eight splint option for clavicle Blanket roll Posterior sternoclavicular dislocation Reduce if vascular/respiratory life threat Humerus Splint, sling and swathe Discussion Points: Note that the chapter includes many details regarding the methods and variations used for splinting each of the various upper extremity parts. The basics are listed here as these are primarily practical skills. Encourage students to use the chapter descriptions and skill guides to practice the various splinting methods. As such, no additional discussion points will be added to most of the next several slides. continued

Caring for Specific Extremity Injuries To align the humerus, place the patient in a supine position and apply gentle longitudinal tension. continued Copyright Edward McNamara

Caring for Specific Extremity Injuries Upper Extremity Injuries Elbow Sling and swathe in position found Stabilize above and below the joint Option to use malleable / rigid splint If CMS compromise AND care is 2+ hours away, may attempt 1 axial alignment If elbow I straight, secure arm to body with swathes continued

Caring for Specific Extremity Injuries Splint elbow injuries in children in the position the injury was found. continued

Caring for Specific Extremity Injuries Application of a splint for a straight arm in a child. continued

Caring for Specific Extremity Injuries Application of a splint for a straight arm in an adult. continued

Caring for Specific Extremity Injuries Upper Extremity Injuries Forearm Immobilize elbow and wrist Prevent rotation at the elbow Wrist, hand, fingers Position of function/comfort Immobilize forearm Digits may use tongue blade Secure impaled objects Send amputated parts with patient continued