1. What Happpens With a Fracture ? Pain - bone has nerves Pain - bone has nerves Bleeding - bone has blood vessels Bleeding - bone has blood vessels Damage to surrounding tissues Damage to surrounding tissues Loss of skeletal support, protection, movement Loss of skeletal support, protection, movement

2. General Splinting Guidelines BSI precautions BSI precautions Immobilize the injury – minimize motion Immobilize the injury – minimize motion If joint injury – immobilize bones above and below jointIf joint injury – immobilize bones above and below joint If bone injury, immobilize joint above and below bone (may be with sling & swath)If bone injury, immobilize joint above and below bone (may be with sling & swath) Secure and snug, but not too tight Secure and snug, but not too tight Get patient involved Get patient involved Check CMS before and after splinting Check CMS before and after splinting

3. Why Splint? Prevent further damage Prevent further damage Reduce pain Reduce pain Reduce internal bleeding, swelling, shock, etc Reduce internal bleeding, swelling, shock, etc Ease transport Ease transport

4. Key things to remember Communicate with the patient Communicate with the patient Maintain continuous support of injury  get the patient to help Maintain continuous support of injury  get the patient to help Don't make a lever Don't make a lever

5. Why and When Do We Re-align? In a resort setting – RARELY, if EVERIn a resort setting – RARELY, if EVER For 99% of all joint injuries, splint as found (reduction is NOT in our protocol]For 99% of all joint injuries, splint as found (reduction is NOT in our protocol] Perhaps reduce only if the alignment is such that it cannot be splintedPerhaps reduce only if the alignment is such that it cannot be splinted In the backcountry, if help is more than one hour away and CSM has been compromised, try alignment ONCEIn the backcountry, if help is more than one hour away and CSM has been compromised, try alignment ONCE

6. Immobilize bones and joints with SAM splint, and use additional sling and swath for securing to body Hardest joint to immobilize is elbow.. http://www.sammedical.com/ sam_splint.html Upper extremity Splinting

7. Always Remember ----- CSM before and after splinting Cardinal sin to forget!

8. Creating a Sling 2. Long edge to shoulder on uninjured side 3. Bring this edge over shoulder on injured side; If clavicle injury, go under armpit; 4. Tie ends together to side of head 1. Make initial knot in apex to form pocket; re-knot later for snugness

9. Sling & Swath No injured shoulder Injured shoulder

10. Sling & Swath Sling Knot at apex Long edge of cravat goes over shoulder on uninjured side Minimize folds (take up slack with knot) Do not knot behind head Swath Purpose – to immobilize shoulder & arm movement – up & down, in & out Best swath is wide; minimizes pressure Keep hand exposed – check CMS

11. Wrist & Hand Injuries to wrist joint, including fractures and dislocations, are common to snowboarders

12. Wrist & Hand Can also roll SAM Want top of wrist flat

13. Forearm

14. Forearm Need to immobilize the elbow and the wrist SAM does part (extends to elbow), S&S other part Caution on roller gauze over injury; jump over

15. Elbow Dislocation Fracture Injuries to nerves and blood vessels are common, which can be made worse by excessive manipulation of injured joint Assess distal CMS periodically Cold, pale hand or weak or absent pulse  get to clinic, call for ambulance; no manipulation unless in backcountry setting

16. Elbow – splint as found ! This can used if there is minimal deformity at elbow; use two roller gauze – one above and one below elbow secure with sling & swath Also fast & easy to assemble; goes to side without deformity, or outside if none; use two roller gauze – one above and one below elbow; secure with sling & swath Splint #1 Splint #2

17. Another one fast & easy to assemble; goes to side without deformity, or inside if none; use two roller gauze to secure – one around each fold; secure with sling & swath Elbow – splint as found ! Splint #3 Secure with roller gauze

18. Elbow – splint as found ! Perhaps the most secure; definitely use with deformity; Single SAM as sugar tongs, or use two; wrap above and below elbow; Splint #4 Sling with cravat supporting at the wrist only, and then swath, but going under the injured arm and the around chest.

19. Elbow – splint as found ! If victim presents with arm almost straight, DO NOT bend to apply one of these splints; secure the arm to the body with cravats, and transport.

20. Humerus – As with elbow, do not align unless in backcountry setting; there is likely neurovascular compromise (entrapment of radial nerve); Always check CMS

21. Humerus – splint as found ! Goes to outside of arm; use roller gauze to secure; start wrap on forearm, then going under splint, then wrap arm (avoid fracture), and go over top to stabilize splint; finish with sling & swath Splint #1

22. Humerus – splint as found ! Apply the splint so that there is about 2 fingers worth of space under the elbow. Make certain the SAM is rigid by making aggressive folds on the “sugar tongs”. Splint #2

23. Remember the Old Adage If you do not know what you are doing… at least be neat If you do not know what you are doing… at least be neat

24. Humerus – splint as found ! Get to the top of the splint which is covering the joint as quickly as possible. To do this, you will NOT be over-wrapping the bandage as you go up. Leave gaps. Start on wrist

25. Humerus – splint as found ! Once you reach the top of the splint, go over it with the roller gauze and start back down again..

26. Humerus – splint as found ! Once over top, start down again; fill in holes in wrap; use 2 nd roller gauze to complete (capture top again). Tie off when complete. Sling & Swath; CMS