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

Drill of the Month2 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 List management, assessment, and care for upper extremity fractures Review Hand/upper Extremity Trauma Protocol Review Hand/upper Extremity Trauma Protocol Describe and demonstrate methods of splinting fractures of the upper extremities: 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 Month3 Trauma Basics: Managing Upper Extremity Fractures Overview Management, Assessment, and Care Management, Assessment, and Care Hand/upper Extremity Trauma Protocol Hand/upper Extremity Trauma Protocol Splinting Upper Extremity Fractures Splinting Upper Extremity Fractures

Drill of the Month4 Trauma Basics: Managing Upper Extremity Fractures Management Management –Review Protocols for general patient care –Review trauma patient assessment  Initial assessment  Vital signs, SAMPLE  Focused history and physical exam

Drill of the Month5 Trauma Basics: Managing Upper Extremity Fractures Management Management –Review purpose of splinting  Immobilize  Minimize movement  Prevent further tissue damage  Prevent closed fracture from becoming open  Control bleeding

Drill of the Month6 Trauma Basics: Managing Upper Extremity Fractures Management 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 Month7 Trauma Basics: Managing Upper Extremity Fractures Management 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 Month8 Trauma Basics: Managing Upper Extremity Fractures Assessment 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 Month9 Trauma Basics: Managing Upper Extremity Fractures Assessment 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 Month10 Trauma Basics: Managing Upper Extremity Fractures Assessment 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 Month11 Trauma Basics: Managing Upper Extremity Fractures Care (general) Care (general) –BSI precautions –Initial Assessment –Rapid Trauma Exam  Cervical collar for suspected spine injury –Life-threatening injuries

Drill of the Month12 Trauma Basics: Managing Upper Extremity Fractures Care (general) 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 Month13 Trauma Basics: Managing Upper Extremity Fractures Care (general) 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 Month14 Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol 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 Month15 Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol Hand/Upper Extremity Trauma Protocol –Referral  Adults: Curtis National Hand Center at Union Memorial Hospital  Pediatrics (have not reached 15 th brithday): Pediatric Trauma Center  Stable patients with isolated injury at or below mid-humerus: Hand Center or nearest appropriate trauma center

Drill of the Month16 Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol 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 Month17 Trauma Basics: Managing Upper Extremity Fractures Hand/Upper Extremity Trauma Protocol 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 Month18 Trauma Basics: Managing Upper Extremity Fractures Splinting 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 Month19 Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Humerus: General Care 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 Month20 Trauma Basics: Managing Upper Extremity Fractures Splinting Upper Extremity Fractures Humerus: Specific Care 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 Month21 Trauma Basics: Managing Upper Extremity Fractures Splinting 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 Month22 Trauma Basics: Managing Upper Extremity Fractures Splinting 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 Month23 Trauma Basics: Managing Upper Extremity Fractures Splinting 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 Month24 Trauma Basics: Managing Upper Extremity Fractures Splinting 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 Month25 Trauma Basics: Managing Upper Extremity Fractures Splinting 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 Month26 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 List management, assessment, and care for upper extremity fractures Review Hand/upper Extremity Trauma Protocol Review Hand/upper Extremity Trauma Protocol Describe and demonstrate methods of splinting fractures of the upper extremities: 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 Month27 Trauma Basics: Managing Upper Extremity Fractures Review Management, Assessment, Care 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 Month28 Trauma Basics: Managing Upper Extremity Fractures Review Hand/upper Extremity Trauma Protocol 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 Month29 Trauma Basics: Managing Upper Extremity Fractures Review Splinting Upper Extremity Fractures Splinting Upper Extremity Fractures –List care steps for immobilizing each of the following fractures  Shoulder, collar bone  Humerus  Elbow  Forearm, wrist, hand  Fingers