# Help With Splinting



## Mad Max (May 17, 2012)

So I find myself near the very end of my EMT-IV course with just a couple of things left to sign off on, and two of the glaring skills are those of splinting the tib/fib and the hip.  Honestly speaking, I suck at tying square knots, and yes, in hindsight, perhaps I shouldn't have left these two skills until the end, but I digress.  I'm looking for any tips you guys might have on putting on simple board splints, especially with getting the triangular bandage cravats super tight.  I've asked the instructors in class about this, to which I receive a, "Just make it tighter," response, and then they grin like a madman.  Any help would be appreciated.


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## NomadicMedic (May 17, 2012)

It's not that big of a deal. The "critical fails" on an NREMT skill station are grossly moving the injury, not immobilizing above and below the joint and not checking for pulse, motor and sensation before and after. Don’t psych yourself out on this. Splinting is pretty easy. Hips are a pain, and you'll either, a) sheet the pelvis b) use a SAM splint or c) put the PT on a board and secure it there. 

Here's a skill check sheet: http://www.nremt.org/nremt/downloads/immobilizationskillslongbone.pdf

Here's a video to watch: http://youtu.be/0JlYnu0QQRE (yes, splinting the Tib/Fib is the same as splinting a radius/ulna)

Good luck.


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## Maine iac (May 17, 2012)

Youtube will be your friend for this one.

There is no good way to splint the pelvis short of a Backboard, or massive suction splint.

Look up Samsplints on youtube. They are malleable foam/metal splints and work well.

As for the splint dressing use kerlex, wrap it around the injury/splint then rip the ends and just tie a knot in the end. 

A square knot is easy man (unless you have lived your entire life with velcro shoes), just use youtube and find out how to do it. Practice some of the knots with rope before you tie it with the bandage.


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## mycrofft (May 17, 2012)

SAM makes a pelvic device. I'm told an inverted KED  and cautiously applied MAST trousers are good also.

Tip one on cravats: make it a habit and tell your future trainees never unroll/unfold the cravat until you are sure you will not use it AS a cravat.
Tip two: tying a square knot. Practice! First tie the overhand knot (the first knot when tying your shoes....or are you still using Velcro or engineer boots? Then tie a second one, but make sure on the right and left the straight lines leaving the knot are each on the same side of the loop.





Note the website is for tying shoes (????)

Real life, I grab the Medirip and wind it up. And, the more padding (to a point), the easier tightening is.

PS: if the knot keeps getting away from you, tie the first overhand with TWO instead of ONE twirls. It will help prevent it slipping away. Works on bootlaces too.
PPS: Remember once you tie cloth tightly it is pretty much forever. I use a granny purposely when applying anything with a knot I will need to adjust, then correct it to a square when I finalize it.


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## Mad Max (May 17, 2012)

Thanks for the help so far guys.  I only wish I could use kerlix for this skill, as I'm pretty sure that I could get some wicked tightness on the spints with it, but alas, they want us doing it the "old fashioned way."  My trouble with the square knot isn't so much that I can't do it (hey, I could tie my shoe before I got out of kindergarten!) it just more often than knot (haha, get it?) the knots end up being loose.  The double twirl idea looks pretty promising though.  As far as the properties of splinting go, I'm down with all of that, it's just the execution of it, and the main thing they check with these particular skills is that the interior board splint is so tight, it can't readily be pulled out by hand.  Thanks again guys.


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## Handsome Robb (May 17, 2012)

vacuum splints work wonders for hips too. 

Don't use a pelvic binder or sheet method unless you are absolutely sure its a pelvic fracture and not an acetabular fracture. An ortho surgeon and his PA drilled that one through my head.

Why can't you use the cravats like kerlex? fold it up so it's like an inch wide, use a couple of them and just tie them around the extremity and splint independently from each other.

I use slip knots for prehospital stuff like that. Maybe it comes from ski patrolling but it's a pain in the *** to untie some knots. Scissors always work well though


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## Mad Max (May 18, 2012)

Well, after about an hour and a half, and two blisters on my hand, I finally got the check off for the tib/fib board splint.  Ironically, the key to the whole thing for me was just tying it really freakin' tight, not to mention cravat placement to immobilize the knee.  I'll be quite thankful when school is done with, as most of the services that I've checked out use vacuum splints or frac-packs, certainly easier than tying a heap of square knots.  I can only hope that finishing up the hip splint will only be that much easier now, considering it's just an extension of the tib/fib splint, for the most part.


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## mycrofft (May 18, 2012)

Good for you.
The MediRip I mentioned above is a cheaper and better cousin for Coban. Second only to duct tape and clear plastic medical tape (Dermicel?) in potential utility to mankind.


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## NomadicMedic (May 19, 2012)

Agreed. I use coban for all of that splinting stuff. Quick and easy.


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## mycrofft (May 19, 2012)

...unless it's raining. The wax adhesive on those products fails when it gets wet.


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## NomadicMedic (May 19, 2012)

Ive never had that happen. However, I try not to stay outside and work in the rain. I usually move people into the ambulance for splinting.


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## MSDeltaFlt (May 19, 2012)

Mad Max said:


> So I find myself near the very end of my EMT-IV course with just a couple of things left to sign off on, and two of the glaring skills are those of splinting the tib/fib and the hip.  Honestly speaking, I suck at tying square knots, and yes, in hindsight, perhaps I shouldn't have left these two skills until the end, but I digress.  I'm looking for any tips you guys might have on putting on simple board splints, especially with getting the triangular bandage cravats super tight.  I've asked the instructors in class about this, to which I receive a, "Just make it tighter," response, and then they grin like a madman.  Any help would be appreciated.



True.  Acetabular Fx's will hurt more with a sheet wrap.  However, for your checkoff purposes it will be a true pelvic fracture so a sheet wrap will suffice.  Tying a square knot on a sheet is just like tying one on your shoelaces. Just bigger.  So practice.  Doing a sheetwrap correctly takes two people pulling on each side in opposite directions to get it good and tight first. THEN you tie the knot.  Remember to assess distal neuro before and after.


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## Devil doc (May 20, 2012)

Square knot, left over right, right over left.


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## wigwag (May 29, 2012)

As long as the knot holds, does it really make a difference if it is square?


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