# Distal and Proximal



## Cody1911 (May 9, 2013)

Why am I having such a hard time with this? I get that distal is further "distant" Proximal = closer to the torso. 

Whenever I hear how EMT's describe wounds using distal and proximal it seems opposite though. My last EMT instructor before I had to stop class a year ago told us you would say like "The PT has a distal ulna fracture" So to me that would mean a fracture closer to the wrist. Is that how distal and proximal work? 

So what if you had a open ulna fracture to the left forearm? How would you describe that to the staff on the radio? 

I hear people use body parts first before they say distal or proximal. 

I hope that makes sense. Thanks guys.


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## Handsome Robb (May 9, 2013)

You've got it right.

For your patient described it'd just be "pt has an open left forearm fracture" they don't need any more than that.

Proximal or distal is in relation to the torso.

You could say "the patient has an open fracture distal to his left elbow" if you wanted to but it's easier to say they have an open left forearm fracture.

What would these two mean? 

"Patient has a left leg amputation distal to the knee."

"Patient had a left leg amputation proximal to the knee."

Again, it'd be easier to just say above or below the knee amputation. When it comes to the radio, as plain and simple English (or whatever language you're using) as you can use is the way to go. Short, concise messages work better than complicated, long-winded ones.

Distal and proximal are in relation to the torso. Elbow is distal to the shoulder. Wrist is distal to the elbow. Knee is distal to the hip, so on and so forth. So if you're saying "proximal to the knee" it means above the knee but below the hip. Distal to the knee would be below the knee but above the *elbow* (alright, I meant ankle but I couldn't stop laughing when I proof read it so I decided to leave it :lol: )

Think of distal = distance whereas proximal = (close) proximity.

Does this answer your question at all?


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## Cody1911 (May 9, 2013)

Perfect! That answered my question Robb thanks a bunch. 

"Patient has a left leg amputation distal to the knee." That would be below 

and the other would be above right?

But yeah... It seems a lot easier just to say below the knee etc. I guess they just want me to be familiar with these terms. Anatomy was actually really easy for me.


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## chaz90 (May 9, 2013)

The only thing I'd add to Robb's post is that distal/proximal are relative terms. A distal ulna fracture may be at the far end from the torso (hence distal), but it is still proximal to the phalanges (see that! I got to say phalanges!). That may be where you're getting confused.


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## Cody1911 (May 9, 2013)

chaz90 said:


> The only thing I'd add to Robb's post is that distal/proximal are relative terms. A distal ulna fracture may be at the far end from the torso (hence distal), but it is still proximal to the phalanges (see that! I got to say phalanges!). That may be where you're getting confused.



Yup! That too. It's when they threw proximal in there as well and I was goin wait what?

makes perfect sense now. It's basically like mapping out exactly where the wound really is. The thing is if you tell the ER doc the PT has a forearm fracture I think he's gonna know what that means. :lol: No reason throwing the words distal and proximal in there. It's good to know what they mean though.


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## rmabrey (May 9, 2013)

Cody1911 said:


> Yup! That too. It's when they threw proximal in there as well and I was goin wait what?
> 
> makes perfect sense now. It's basically like mapping out exactly where the wound really is. The thing is if you tell the ER doc the PT has a forearm fracture I think he's gonna know what that means. :lol: No reason throwing the words distal and proximal in there. It's good to know what they mean though.



You've got the right thought process going. I dumb everything down that I can. Over the phone and in person reports. If I start sounding smart people will get the wrong idea


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## Handsome Robb (May 9, 2013)

Cody1911 said:


> Perfect! That answered my question Robb thanks a bunch.
> 
> "Patient has a left leg amputation distal to the knee." That would be below
> 
> ...



Glad I could help. It took me a minute too. It takes practice. When you use it every day it becomes easier. 

Ad yessir, you are correct as to above/below the knee.


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## JPINFV (May 9, 2013)

...because I feel like being pedantic, another way to describe amputations (as in, the verbage* used) is "above knee amputation" and "below knee amputation." You'll see BKA and AKA a lot more than distal to/proximal to. 

*Shouldn't it adjectiveage? After all... those aren't verbs.


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## Household6 (May 9, 2013)

Get some nice Crayola colored pencils, trace yourself a dude in anatomical position, and color him while you watch TV.. Like, spend some time and make it look nice..

Make purple stripes around his arms and legs for proximal, make orange stripes for distal..

If you sit down and do it for a while those colors will give your brain something to relate the words to. My notebooks are full of all kinds of rainbow colored anatomical men..


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