Backboarding a Hip fx

[jaksasquatch]

Say you have a pt with a hip fx with noted pn with an obviously shortened limb. This patient shows NO MOI for a C-spine injury, say its an elderly woman who fell in the shower. Would you then backboard the pt since it acts as a big "splint" or would you use the scoop stretcher or maybe a sheet? Also how can I tell the difference between a hip fx and a pelvic fx in the field? I'm assuming by the crepitis and discoloration in the pelvic area but you never know until you take pictures

 

[Onceamedic]

The only way I would backboard this patient is if I planned to take her sledding before going to the ED.

 

[medichopeful]

The only way I would backboard this patient is if I planned to take her sledding before going to the ED.

I think the OP meant use the backboard as a splint, but not necessarily apply it all the way (so no head blocks/immobilization).

 

[Mariemt]

If you feel the need to backboard the patient to avoid moving and jostling , then yes, but I would prefer not to if possible. This is where the traction splint is appropriate and I would use that.

 

[rmabrey]

If you feel the need to backboard the patient to avoid moving and jostling , then yes, but I would prefer not to if possible. This is where the traction splint is appropriate and I would use that.

Isnt A hip Fx a contraindication for a traction splint?

ETA, yes I would use a board as a splint and to facilitate movement. And this is one of few occasions that I pad the voids

 

[Roby777]

Isnt A hip Fx a contraindication for a traction splint?

ETA, yes I would use a board as a splint and to facilitate movement. And this is one of few occasions that I pad the voids

Only mid femur fracture for traction

 

[phideux]

I like the scoop stretcher for hips.
No to the traction splint on hips.

 

[Yarbo]

I like to use scoop stretchers to get patients with hip fractures off the floor. Also, another thing you can use is a KED upside down. I've heard great things about this method and intend on trying it.

 

[DesertMedic66]

Sheet wrapped tightly over both hips + breakaway flat + pain medication.

 

[CALEMT]

The two (2) times that I have had a pt with a hip fx we back boarded both. For me and my partner it was quick and fairly easy.

 

[TheLocalMedic]

NO! Why would you subject a patient who is already in pain to the added discomfort of a backboard??? Have you ever had to lay on one for any length of time? It's super uncomfortable!

Do a sheet around the hips and then possibly a breakaway flat of you need to move them, once on the gurney you can make the flat fold a bit so they can have their head elevated.

DON'T BACKBOARD PEOPLE UNLESS IT IS TRULY WARRANTED! Especially older folks!

 

[TheLocalMedic]

Oh, and copious pain meds... We carry morphine and I generally do a first dose of 5 mg before moving them followed by another 5 after the move. Aim for them to be feeling good by the time you roll in.

 

[DesertMedic66]

Oh, and copious pain meds... We carry morphine and I generally do a first dose of 5 mg before moving them followed by another 5 after the move. Aim for them to be feeling good by the time you roll in.

Every hip fracture/dislocation that I have had 5mg-10mg had little to no pain relief :/

 

[Medic Tim]

Pain management prn then move them to the stretcher with a scoop.

One of the services I used to work for never had scoops so we would use a draw sheet/blanket or a board( for extrication only)

 

[MSDeltaFlt]

Say you have a pt with a hip fx with noted pn with an obviously shortened limb. This patient shows NO MOI for a C-spine injury, say its an elderly woman who fell in the shower. Would you then backboard the pt since it acts as a big "splint" or would you use the scoop stretcher or maybe a sheet? Also how can I tell the difference between a hip fx and a pelvic fx in the field? I'm assuming by the crepitis and discoloration in the pelvic area but you never know until you take pictures

Elderly female (especially those who have bore children) = osteoporosis until proven otherwise. Falling in the slippery confined space of a shower that has fractured the hip is always MOI for other injuries up to and including spinal. Do not get caught by distracting injuries. Rule out all other injuries by invading their personal space and placing your hands on each and everything that might get injured before not treating it.

I don't like treating mechanisms of injury. I like to treat clinical assessments.

 

[rmabrey]

Every hip fracture/dislocation that I have had 5mg-10mg had little to no pain relief :/

Dilaudid FTW!

 

[Handsome Robb]

Say you have a pt with a hip fx with noted pn with an obviously shortened limb. This patient shows NO MOI for a C-spine injury, say its an elderly woman who fell in the shower. Would you then backboard the pt since it acts as a big "splint" or would you use the scoop stretcher or maybe a sheet? Also how can I tell the difference between a hip fx and a pelvic fx in the field? I'm assuming by the crepitis and discoloration in the pelvic area but you never know until you take pictures

One way to differentiate from a pelvic injury and a acetabular/femur injury is that a pelvic injury that requires a pelvic sling (sheet wrapped around the heps) is if the pubis symphysis is widened. A pelvice sling is indicated for an "open book" pelvic fracture. the pubic symphysis is generally the width of your thumb, maybe two fingers. Any wider than that without femoral/acetabular involvement (shortening and/or rotation) a sling should be placed. With shortening and rotation you can assume an acetabular injury or hip dislocation and a pelvic sling should not be applied as you can actually cause more damage. Same goes for a pelvis that's extremely unstable (read: suspected multiple pelvic ring fractures).

I'll add my ALS twist to this call but I know it's in the BLS section. I'd give the pt a fentanyl and midazolam cocktail, wait for it to take effect and then remove the patient from the shower and place them on a scoop stretcher. the concave of the scoop is much more comfortable for the patient. Also, it's easy to use to move them and then remove once they're on the gurney then place it again if you want to move them from the gurney to the ED bed. A scoop stretcher is not meant to stay in place during transport. If you don't have a scoop using a LSB to move the patient is appropriate but I'd remove it as soon as they were on the gurney if at all possible.

Also, another great splint for a femoral neck/dislocated hip is a large vacuum splint. Doesn't compress the injured site but will help stabilize it. I'll usually apply one prior to placing the scoop stretcher.

The caveat to this is if the patient is in so much pain that they cannot properly follow your assessment to use NEXUS or the Canadian C-Spine Rule to clear their c-spine in the field you're going to have to board them unfortunately. If this is the case you need to pad the hell out of them.

 

[Mariemt]

Isnt A hip Fx a contraindication for a traction splint?

ETA, yes I would use a board as a splint and to facilitate movement. And this is one of few occasions that I pad the voids

It has a shortened limb. Most hip fractures are actually an upper femur. With the shortened limb this sounds like an actual femur.

 

[jaksasquatch]

So when your talking about backboarding you would still use the headblocks and pad the voids if c-spine couldn't be cleared? Also I've read that the traction splint shouldn't be used on hip fx (proximal femur fx) or pelvic fx. How can I tell a midshaft femur from a hip fx? I assume a midshaft would shorten more so then a proximal.

 

[Christopher]

So when your talking about backboarding you would still use the headblocks and pad the voids if c-spine couldn't be cleared? Also I've read that the traction splint shouldn't be used on hip fx (proximal femur fx) or pelvic fx. How can I tell a midshaft femur from a hip fx? I assume a midshaft would shorten more so then a proximal.

Backboards are not spinal immobilization devices, they're extrication devices. You can choose to add head blocks, tape, towel rolls, a C-collar, spider straps, 9 foot straps, perhaps even a head bed...but it still has nothing to do with immobilization.

Once you separate your terminology to remove this confusion, the answer becomes obvious.

Rolling your hip Fx patient is going to be awful, sliding your hip Fx patient is going to be awful. Whatever you choose, you must limit both of these actions.

If you had some indication for spinal motion restriction, you should continue through whatever your procedures are for SMR.

If you have no indication for spinal motion restriction, you should continue through whatever your procedures are for moving a patient with a hip Fx.

You probably have a device which can satisfy both the Brothers Grimm and your patient's hip Fx: the scoop stretcher!