# Shocky Femur Fracture



## sean818 (Jun 24, 2015)

Just a quick scenario question. If you came on scene to find a trauma patient in shock, with an obvious femur fracture, would you take the time to apply traction splint before spinal immobilization and transport? Or would you skip the splint, jump straight to transport, and let the hospital deal with the fracture?(because you can't apply the splint once they're secured to the spine board.) The reason I find this situation tricky is that a patient can lose a large amount of blood with a fractured femur, so it could feasibly take them from compensated to decompensated pretty quickly. However we are taught to load and go without preforming lengthy interventions, and deal with everything else in the rig. I can't decide if the benefits of rapid transport outweigh those of taking the time to correct an injury that could worsen the patients condition en route. Any input is appreciated.


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## Jim37F (Jun 24, 2015)

Don't see why you couldn't apply traction splint in the back en route....but we're also pretty spoiled here, minimum 5-6 (more often 6) providers on scene, and since we'd have to go back to the rig to grab the c-spine bag and backboard, we can spend an extra second to grab the Sager, it shouldn't take any longer to apply it than it does to apply full C-spine+backboard


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## Flying (Jun 25, 2015)

The theory behind the traction splint is to reduce pain, bleeding and other complications by hindering muscle (and bone) movement.
So splinting a closed complete fracture of the femoral shaft would be part of your mitigating shock, after laying the person supine and providing oxygen and etc.

If your expected transport time is short enough to make Hare/Sager a "lengthy intervention" by comparison, it's hard to say you will lose much from omitting the splint.


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## Summit (Jun 25, 2015)

If applying a traction splint is a lengthy intervention, practice on it until you are fast.

It is actually long transport times (hours) where you start considering not applying the traction splint.


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## RedAirplane (Jun 25, 2015)

Summit said:


> If applying a traction splint is a lengthy intervention, practice on it until you are fast.
> 
> It is actually long transport times (hours) where you start considering not applying the traction splint.



Why?


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## Carlos Danger (Jun 25, 2015)

sean818 said:


> Just a quick scenario question. If you came on scene to find a trauma patient in shock, with an obvious femur fracture, would you take the time to apply traction splint before spinal immobilization and transport? Or would you skip the splint, jump straight to transport, and let the hospital deal with the fracture?(because you can't apply the splint once they're secured to the spine board.) The reason I find this situation tricky is that a patient can lose a large amount of blood with a fractured femur, so it could feasibly take them from compensated to decompensated pretty quickly. However we are taught to load and go without preforming lengthy interventions, and deal with everything else in the rig. I can't decide if the benefits of rapid transport outweigh those of taking the time to correct an injury that could worsen the patients condition en route. Any input is appreciated.



If they were in frank shock, I would probably not place the splint on scene. I'd stabilize the leg against the other one and go, applying the traction splint during transport. 

It's certainly true that people _can_ bleed a lot from a femur fracture, but it's uncommonly a sole cause of immediate shock. If someone looks that bad on scene, It's probably a safe bet that they have other injuries that are more threatening. In the case of a car crash for instance, I would be highly suspicious of (and more concerned about) a pelvic or abdominal injury in the patient who presents shocked.


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## Clare (Jun 25, 2015)

It depends on the "overall clinical picture" if you ask me.

We do not use spine boards and would remove the patient from the combi-carrier once they're in the ambulance so applying the traction splint is not a problem. 

If the patient was so profoundly shocked they were peri-arrest and the scene was extremely close to hospital then I'd be happy with simply transporting because in this situation the absolute priority is to get the patient to somewhere that can stop the bleeding; be it interventional radiology or the operating theatre. 

The overwhelming majority of patients who have femur fracture are not those described above so it's worth spending the extra ten minutes on scene to do things properly.


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