# traction



## GAmedik34 (Apr 16, 2013)

high speed mvc, driver unrepsonsive, rightward gaze. upon extrication (after dash was removed off his waist) pt responds by screaming and grabbed towards left leg, and once again goes unresponsive. obvious femur fracture, possible l hip fracture, possible dislocated knee, distal pulses intact, shortened and rotated. doctor ask me if they still teach traction..... with all this going on who else would have placed pt in traction? 

yes limb was stabilized


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## DesertMedic66 (Apr 16, 2013)

Yes traction and traction splints are still taught and used. 

As for my area traction would not have been used. For us it has to be a closed mid-shaft femur fracture with no hip/knee/ankle involvement and the patient has to be stable.


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## chaz90 (Apr 16, 2013)

I've always been taught to use traction splints only in the case of isolated mid-shaft closed femur fractures. This certainly sounds like it was a far cry from an isolated injury.


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## Summit (Apr 16, 2013)

DesertEMT66 said:


> Yes traction and traction splints are still taught and used.
> 
> As for my area traction would not have been used. For us it has to be a closed mid-shaft femur fracture with no hip/knee/ankle involvement and the patient has to be stable.



This


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## GAmedik34 (Apr 16, 2013)

all that and some more... thats why I did not apply traction, obviously doc didnt agree


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## hogdweeb (Apr 16, 2013)

chaz90 said:


> I've always been taught to use traction splints only in the case of isolated mid-shaft closed femur fractures. This certainly sounds like it was a far cry from an isolated injury.


+1

the dislocated knee, and hip would prevent me anyway..dont want to dislocate them more, or take a chance on further agitation.


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## EMT B (Apr 19, 2013)

in this case, my protocol would not have said to traction. but what if med control tells me to traction?


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## Epi-do (Apr 19, 2013)

EMT B said:


> in this case, my protocol would not have said to traction. but what if med control tells me to traction?



Here, you would repeat the order back and ask if it was correct a total of 3 times.  If you are still told to do it, do what is best for the patient (I.e. not using traction) and document the crap put of it.

Of course, that is assuming you are online with med control.  If it is in the ED after the fact, smile and acknowledge that you have heard what he said.  Next time around, do the right thing and again document why you did it.


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## PaddyWagon (Apr 19, 2013)

chaz90 said:


> I've always been taught to use traction splints only in the case of isolated mid-shaft closed femur fractures. This certainly sounds like it was a far cry from an isolated injury.



Ditto here.  We were taught to splint in place for support as long as distal pulse is there, else try small adjustments to restore pulse and high tail it to trauma.  Or so says class learning


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## Handsome Robb (Apr 19, 2013)

Suspected or known hip involvement is a contraindication for traction if I'm not mistaken. Add the knee in and it's not even a question.

Like others have said, traction splints are for *isolated* mid shaft femur fractures. 

Your patient needed a trauma surgeon, their team and an operating room, not an EMS crew ****ing around with a traction splint on scene.


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## Medic Tim (Apr 19, 2013)

EMT B said:


> in this case, my protocol would not have said to traction. but what if med control tells me to traction?



Repeat the order back for confirmation ......then tell the md you can only place one in an isolated midshaft fx.


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## wanderingmedic (Apr 20, 2013)

Medic Tim said:


> Repeat the order back for confirmation ......then tell the md you can only place one in an isolated midshaft fx.



that...but....

some of it might depend on your relationship with the med control docs. if you interact with them regularly and know them.....i might strongly consider following their orders and then talking with them in person after i drop off the patient.


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## Medic Tim (Apr 20, 2013)

azemtb255 said:


> that...but....
> 
> some of it might depend on your relationship with the med control docs. if you interact with them regularly and know them.....i might strongly consider following their orders and then talking with them in person after i drop off the patient.



doc can ask or order me to do anything under the sun..... doesnt mean I am going to do it.....putting a traction splint on this pt can cause more damage. 

Only reason I can think of for an MD to order this would be based on a poor report where the doc doesnt realize there are hip/pelvic and or other leg/knee/ankle injuries.


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## GAmedik34 (Apr 21, 2013)

doc asked while we were rolling into trauma bay why I didn't apply traction. after I saw x rays sure glad I didn't. +1 to trauma surgeon didn't take long before he was heading to OR


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