Forum Presentation: DCMT (Directorate of Combat Medic Training) U.S. Army Whiskey, 2007 Instructor Training Breakout Sessions, Ft. Sam Houston, TX RR and D, Inc., © May References: Heightman, MPA, EMT-P JEMS “Articulated Injuries”, Auerbach, MD Annals of Emergency Medicine, “Experience…” Monchik, MD, NREMT-P Compression Syndrome Warwick and Williams, Gray’s Anatomy, Lopez and Antunez, “Atlas of Human Anatomy”, SBC Yellow Pages Phone Book, “Survival Guide”, Marvel Circa’ 1968 product page.

TOPIC: EMERGING ISSUES IN THE FIELD TREATMENT OF LOWER EXTREMITY FRACTURES AND DISLOCATIONS… TOPIC:

“SAVING LIFE AND LIMB”

SAVING LIFE AND SAVING LIMB’S, TOO ”

“Discussion of: Types, Basic Anatomy, Causes…”

Orthopedic Emergencies Open fractures Open fractures Long Bone Fractures Long Bone Fractures Dislocations Dislocations Extremities with neurological or vascular compromise (GSW) Extremities with neurological or vascular compromise (GSW) Compartment syndromes Compartment syndromes

Open Fractures

Long Bone Fracture

DislocationsDislocations

Gun Shot Wounds

“Immobilizing injuries in the position found.” “Immobilizing injuries in the position found.” “Immobilizing the joints above and below the injury site”

Help to prevent further injury… Help to Relieve pain… Help to Determine Mechanism of injury…

The Knee and Ankle are always in play and must be frozen in place

LACK of UNDERSTANDING LACK of APPRECIATION LACK of EQUIPMENT

“Knee Anatomy”

The “TWO P’s” in the knee. Peroneal Nerve, Popliteal Artery

Peroneal Nerve & Popliteal Artery Common Peroneal Nerve Popliteal Artery

Peroneal Nerve & Popliteal Artery

Entrapment…Compression Tractioned or Stretched

Compartment Syndromes

Compartment Syndrome Definition Elevated tissue pressure within a closed fascial space Reduces tissue perfusion Results in cell death Pathogenesis Too much inflow (edema, hemorrhage) Decreased outflow (venous obstruction, tight dressing/cast)

Compartment Syndrome Etiology Fractures-closed and open Fractures-closed and open Blunt trauma Blunt trauma Temp vascular occlusion Temp vascular occlusion Cast/dressing Cast/dressing Closure of fascial defects Closure of fascial defects Burns/electrical Burns/electrical GSW IV/A-lines Snake bite Arterial injury

Compartment Syndrome Tissue Survival Muscle Muscle 3-4 hours - reversible changes 3-4 hours - reversible changes 6 hours - variable damage 6 hours - variable damage 8 hours - irreversible changes 8 hours - irreversible changes Nerve Nerve 2 hours - looses nerve conduction 2 hours - looses nerve conduction 4 hours - neuropraxia 4 hours - neuropraxia 8 hours - irreversible changes 8 hours - irreversible changes

Compartment Syndrome Diagnosis Pain out of proportion Palpably tense compartment Pain with passive stretch Paralysis Pulselessness/pallor

“MORBIDITY ISSUES”

1. Foot drop 2. Ankle and Foot Palsy 3. Gaiting difficulties 4. Loss of sensation 5. Toe Dragging 6. Loss of muscle tone 7. Long term health effects 8. Psychological

The “Perfect Splint” for the job

Extrication Management Strap Architecture Repositioning Traction Capability

“Tactical System… Perfect traction too”

The changes can be expressed in a matter of degrees