Drill of the Month Developed by Gloria Bizjak Trauma Basics: Managing Upper Extremity Fractures

Trauma Basics: Managing Upper Extremity Fractures Student Performance Objective: Given information and resources, splinting materials, demonstration, and time to practice EMTs will be able to: List management, assessment, and care for upper extremity fractures Review Hand/upper Extremity Trauma Protocol Describe and demonstrate methods of splinting fractures of the upper extremities: Shoulder (scapula) and collar bone (clavicle) humerus (arm) elbow forearm (forearm), wrist (carpals), and hand (metacarpals) fingers (phalanges) EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Overview Management, Assessment, and Care Hand/upper Extremity Trauma Protocol Splinting Upper Extremity Fractures Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Management Review Protocols for general patient care Review trauma patient assessment Initial assessment Vital signs, SAMPLE Focused history and physical exam Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Management Review purpose of splinting Immobilize Minimize movement Prevent further tissue damage Prevent closed fracture from becoming open Control bleeding Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Management Review purpose of repositioning Effective splinting Restore circulation Aide patient comfort Prevent closed fracture from becoming open Prevent further tissue damage Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Management Review management of joint injuries Splint in position found; reposition If circulation is absent If the attempt meets o resistance To establish a pulse Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Assessment Patient complains of pain, tenderness Guards injury site Describes injury Points to site Care provider examines site Looks for deformity or angulation (compare to uninjured side) Looks for other injured areas Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Assessment Patient complains of grating sensation or sound (crepitis) or a pins-and-needles sensation Care provider looks for: Swelling and/or deformity or angulation Bruising Exposed bone Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Assessment Patient complains of inability to move joint Care provider checks for joints locked in unusual position (dislocation) Care provider checks for distal pulse, motor function, sensation Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Care (general) BSI precautions Initial Assessment Rapid Trauma Exam Cervical collar for suspected spine injury Life-threatening injuries Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Care (general) Painful, swollen, deformed extremities Low-priority, stable patient Splint individual injuries High-priority, unstable patient Immobilize on long board Load and go Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Care (general) Stabilize injury site Check distal pulse, motor function, sensation Cover open wounds, elevate while splinting Measure, select, position splint Stabilize until splint is secured; not too tight/loose Recheck distal p-m-s Apply cold pack Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol Injuries Complete/incomplete hand/upper extremity amputations Partial/complete finger/thumb amputations Crushing, degloving, devascularization injuries High-pressure injection injuries Loss of perfusion Nerve injury (compartment syndrome) Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol Referral Adults: Curtis National Hand Center at Union Memorial Hospital Pediatrics (have not reached 15th brithday): Pediatric Trauma Center Stable patients with isolated injury at or below mid-humerus: Hand Center or nearest appropriate trauma center Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol Contraindications for referral to specialty center Unstable/abnormal vital signs: to trauma center Major/multiple system trauma: to trauma center Partial/complete toe amputation: to medical facility Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol Care for amputated part Keep dry Place in sealed plastic bag Place on top of ice Do not freeze Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Shoulder and collar bone Stabilize and check distal p-m-s Use sling and swathe: Position sling, secure w/forearm elevated across chest Position knot to side of spine; pad knot Secure point of sling Stabilize arm with cravat across chest Recheck distal p-m-s Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Humerus: General Care Stabilize extremity Check distal p-m-s Place hand in position of function Immobilize w/board and/or sling and swathe Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Humerus: Specific Care Proximal fracture: use sling and swathe Distal fracture: use narrow sling to support wrist, leave elbow exposed; stabilize with swathe Mid-shaft: measure and secure padded board splint, fingertips exposed; support with swathe Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Elbow: General Care Check distal p-m-s With distal pulse, stabilize and splint in position found With no distal pulse, attempt to reposition to obtain pulse Hand in position of function Immobilize Recheck distal p-m-s Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Elbow: Specific Care Straight position Measure, secure padded board splint Leave fingertips exposed Pad between patient and splinted arm Secure arm to torso Bent position Place padded board splint over angle of arm Secure with cravats Apply wrist sling, keeping forearm elevated Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Radius/Ulna, wrist, hand: General Care Stabilize Check distal p-m-s Hand in position of function Immobilize Recheck distal p-m-s Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Radius/Ulna, wrist, hand: Specific Care Measure, apply splint from elbow to fingertips Secure splint with roller gauze Wrap distal to proximal Leave fingertips exposed Apply sling, keeping forearm elevated against chest Stabilize with cravat Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Fingers Splint injured finger to uninjured finger with tape OR Splint injured finger with tongue depressor Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Student Performance Objective: Given information and resources, splinting materials, demonstration, and time to practice EMTs will be able to: List management, assessment, and care for upper extremity fractures Review Hand/upper Extremity Trauma Protocol Describe and demonstrate methods of splinting fractures of the upper extremities: Shoulder (scapula) and collar bone (clavicle) humerus (arm) elbow forearm (forearm), wrist (carpals), and hand (metacarpals) fingers (phalanges) EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Review Management, Assessment, Care List MIEMSS Protocols for General Patient Care List purposes of splinting List management steps of joint injuries List assessment steps for a trauma patient List general care steps for a trauma patient Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Review Hand/upper Extremity Trauma Protocol State MIEMSS Trauma Protocol for Hand/Upper Extemity Trauma List indications for transport to specialty centers for adults and peds List contra indications for transport to specialty center Drill of the Month

Trauma Basics: Managing Upper Extremity Fractures Review Splinting Upper Extremity Fractures List care steps for immobilizing each of the following fractures Shoulder, collar bone Humerus Elbow Forearm, wrist, hand Fingers Drill of the Month