Scenario Regarding Traction

[SwissEMT]

Imagine this:

You arrive on scene to a dispatch for a Pedestrian struck, the pt presents with a Femur Fx requiring traction, unfortunately, you also find that the patient also has a fractured ankle on the same leg. You find no distal pulse.

How do apply traction to the leg?

 

[m33kr0b]

mast pants

 

[MedicPrincess]

You don't. Traction is for isolated femur fractures. you cant pull traction on that fractured ankle.

Call the helicopter, get'em to surgery.

 

[DT4EMS]

mast pants

That's what I would do to splint it. Traction would be very limited. The missing distal pulse could be from the Fx to the ankle. MAST/PASG or an air splint would be great.

 

[Pablo the Pirate]

mast pants

WOW you guys still carry those? anyhoo I would LSB and haul *** or call a chopper. Also you could try realigning the injury to restore pulse.

 

[Ridryder911]

Why the chopper ? .. I would attempt slight manual traction, to see if I could regain a pulse then splint appropiate either anatomically or pillow-padded.
PASG level does not go above and below the joint as well increasing pressure onto the femur will cause an increase in pain distally.

Patient has upto over an hour of lack of circulation.. nothing to waste time, but not necessary an isolated need for a helicopter, or need of $10,000 flight bill.

R/r 911

 

[MedicPrincess]

Why the chopper ?
R/r 911

Due to the limitations of the hospitals in our area. The biggest hospital, while they have a bang up Cardiac Center, is not the place to take a femur fx.

Also, Pedestrian struck, with fx in our area will go to trauma center d/t possiblity of other "not so obvious" injuries. Unless weather prohibits, patients to the trauma centers....fly.

 

[HorseHauler]

With the only injury being a femur fx and ankle fx, I too would have a hard time calling the bird. I also would try manual stablization to try to regain that pulse, if needed have someone maintain it the whole ride. just my .02

 

[KEVD18]

they were concious right?

press hard, three copies.

 

[MedicPrincess]

With the only injury being a femur fx and ankle fx, I too would have a hard time calling the bird.

How can you be certain they only have the femur/ankle fx? Are you not suspicious of additional injuries d/t MOI?

 

[Ridryder911]

You might suspect other injuries, but that is what a good thorough examination is for. Are we suspecting pelvis ? Is there signs of such, what was the speed ? Other related injuries? ..

R/r 911

 

[SwissEMT]

Sorry about the lack of details. I was simply looking for some ideas as to applying traction when the ankle is affected.

 

[Ridryder911]

One should not apply traction splint (at least Hare or Sager) since the traction device is composed of an ankle hitch that pulls traction. Now, with that saying, I would pull in-line traction if there were no pulse present one time; per just below the femur area and see if there was a reconstitution of a pulse.

I was just asking if one was considering pelvic fracture, which one might if it was not isolated to a lower femur area. This as well would change treatment modality, with the potential loss of blood in a pelvic region of large porous bone and high vasculature regions.

R/r 911

 

[BossyCow]

There's a dandy little telescoping splint we use in SAR for wilderness that would work. It fastens to the leg itself above and below the suspected fx site and then telescopes out. There's research about the Hare and Sagar being a problem in the long pack out time in wilderness rescue.

 

[Jon]

Well... you can't traction with a fx. ankle... just splint the fractures (Boy Scout skills time - with the Bored Splints).

Around here, depeneding on MOI, that patient may well fly... we don't have a trauma center. If the patient meets trauma criteria, espicially with a long-bone fracture... they are geting a helicopter ride.