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Hip Fractures

Discussion in 'EMS Talk' started by skyemt, Dec 20, 2007.

  1. skyemt

    skyemt New Member

    Location:
    NY
    EMS Training:
    EMT-Basic
    Hi all...

    our community has a fairly large elderly population, and as you can imagine, hip fractures are all too common...

    i'd like to know, especially from the more experienced providers, what your preferred method of immobilization is...

    pain management is also an issue, as i've heard blood curdling screams from pt's with hip fractures...

    thanks
  2. BossyCow

    BossyCow New Member

    Location:
    Rural (no... really, really rural) Washington Stat
    EMS Training:
    EMT-Basic
    Take a look at this. I haven't actually seen one in use yet, just the promo literature, but looks wonderful to me.

    http://www.armstrongmedical.com/ami/item.cfm?sction=3&sbsection=19&itemid=2430

    We have a gianormous vacu-splint which we have used to immobilize hip fractures. Also in a pinch, a sheet can be tied firmly around the hip area and will work at least until you have them on top of of vacu-spint or other immobilization device. Also seen mast pants used for hip fx immobilization.
  3. KEVD18

    KEVD18 New Member

    Location:
    mass
    "...allows for safe application at the scene by ordinary EMS personnel."

    what exactly the hell is that supposed to mean
  4. Ridryder911

    Ridryder911 EMS Guru

    One should recall the anatomy of what is really usually breaks in hip fractures. In most cases of hip fractures, the neck of the femur is the primary source, since it is the weakest point.

    I was taught by an orthopedic surgeon many years ago the reason of severe pain was the ability of the ball and the femur had the ability to shift around.

    I have found the Sam splint very helpful in those involve more a pelvic or acetabulam (cup portion that the ball fits into). One can make an improvised one with a towel rolled and placed under the ischium of the upper thigh, and a sheet (folded into length) and tied around the waist firmly. Decreasing the proximal end is the main goal.

    For pain management, I prefer Toradol, low dose Morphine, Demerol, or Fentyl. One has to be cautious that a pelvic fracture is not involved as well. Remember, pelvic fractures usually occurs in "two's".

    R/r 911
  5. emtangie850

    emtangie850 New Member

    Location:
    I live in a small town in Western NY- South of Roc
    EMS Training:
    EMT-Basic
    Depending on the size of the patient you could use a KED.. (Obviously use it around the hip instead of being used for spinal immobilization.)

    Havn't done it myself but heard about it in my EMT class a few years ago.

    -Angie
    Last edited by a moderator: Dec 20, 2007
  6. rescuepoppy

    rescuepoppy New Member

    Location:
    north carolina
    Hip Fracture

    An inverted XP-1 works great to stabilize a hip fracture.
  7. medic001918

    medic001918 New Member

    Location:
    East Hartford, CT
    EMS Training:
    EMT-Paramedic
    I use a KED often for hip fractures with great results. It provides a good support for the injury while allowing for a decent way to grab the patient. It's my preferred method for these calls actually.

    Shane
    NREMT-P
  8. Moshi

    Moshi New Member

    EMS Training:
    Student
    I'm sorry to bump this old topic but can someone show me an example of how exactly do you immobilize hip fracture with KED?
  9. leoemt

    leoemt New Member

    Location:
    Washington State
    EMS Training:
    EMT-Basic
    Turn the KED upside down.

    A sheet slid under the patient and knoted works great, thats what we do around here. Even the hospitals do it. No special splints for us.
  10. Tigger

    Tigger Dodges Pucks Community Leader

    Location:
    CO
    Also, don't forget about the scoop stretcher to move these patients from the ground and then to the hospital bed!
  11. AnthonyM83

    AnthonyM83 New Member

    Location:
    Los Angeles
    Hmmm. I had been trained only to do this for pelvic fractures, not for hip fractures
  12. Thriceknight

    Thriceknight New Member

    Location:
    Central Valley
    Our system has "full body vacuum splint" which work very nicely. We call it the burrito bag...though don't call it that in your PCR!!! I didn't do that....my partner did! Lol ;)
  13. Sandog

    Sandog New Member

    Location:
    San Diego,Ca.
  14. Sandog

    Sandog New Member

    Location:
    San Diego,Ca.
    I would be careful using the sheets though, too tight would cause excess flexion near the pelvic region creating real pain.
  15. Jack Bode

    Jack Bode New Member

    EMS Training:
    EMT-Paramedic
    We don't "splint" hip fractures except to help stabilize the leg once the patient has been picked up and placed on the stretcher. We do offer pain relief with Morphine, 0.1 mg/kg, (can be repeated).


    I work in an urban system with relatively short transport times. I suppose a case could be made for splinting for long transports in rural areas.


    Otherwise, I see no reason to splint hip fractures.
  16. Asclepius911

    Asclepius911 New Member

    Location:
    Los Angeles
    EMS Training:
    EMT-Paramedic
    In theory the use of a pneumatic antishock garment is called for.. in actuality I've never seen one .. has anyone ever used that crazy looking sleeping bag?
  17. FunkyAnesthetic

    FunkyAnesthetic New Member

    Location:
    No Cal
    EMS Training:
    EMT-Basic
    Pasg

    My EMT-B instructor told my class that the PASG is essentially worthless because in the time that it takes to put one on a patient, he could already have the pt at the hospital.

    Having never even seen one, I don't know if that's realistic, but the Trauma Manual 4e (written and reviewed by a bunch of surgeon's and M.D.'s) states that the, "current recommendations are for use in hypotension due to suspected pelvic fracture, otherwise uncontrollable lower extremity hemorrhage, and severe traumatic hypotension" (29). FWIW, the book also suggests that in most urban settings, the short response times make the PASG less worthwhile.
  18. Of course i have.

    I am a dinosaur...
  19. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    I was certified to use them in Nebraska, 1981.
  20. DEmedic

    DEmedic Burnt Out

    EMS Training:
    EMT-Paramedic
    Used em once. Didn't help. :/

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