1. 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 2007 WWW.SPLINTS.COM 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.

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

3. “SAVING LIFE AND LIMB”

4. SAVING LIFE AND SAVING LIMB’S, TOO ”

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

7. 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

8. Open Fractures

9. Long Bone Fracture

10. DislocationsDislocations

11. Gun Shot Wounds

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

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

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

17. LACK of UNDERSTANDING LACK of APPRECIATION LACK of EQUIPMENT

18. “Knee Anatomy”

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

20. Peroneal Nerve & Popliteal Artery Common Peroneal Nerve Popliteal Artery

21. Peroneal Nerve & Popliteal Artery

22. Entrapment…Compression Tractioned or Stretched

23. Compartment Syndromes

24. 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)

25. 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

26. 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

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

28. “MORBIDITY ISSUES”

29. 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

30. The “Perfect Splint” for the job

31. Extrication Management Strap Architecture Repositioning Traction Capability

32. “Tactical System… Perfect traction too”

33. The changes can be expressed in a matter of degrees