How would you splint this injury?

CanadianBagel

CanadianBagel

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My first impression is that this seems to be a joint injury to me; So I would first control bleeding, check for PMS, and attempt to splint in a position of function, etc.. (splinting bone above and below)

But I feel like that may cause more damage than good by putting pressure on an open fracture, and you do not want to end up pushing the bone somewhere it can cut off circulation or cause bleeding. Maybe a pillow splint?
Please help me, this is driving me nuts!

Thanks!
 
Had something very similar last year. Generous use of blankets and Fentanyl were her friend.
 
I'd think about doing some hemorrhage control and then as long as there's still a pedal pulse, I'm going to splint it as it is. I like vacuum splints for this but a garden-variety cardboard box splint, some padding and gauze to hold everything in place will do just fine. You could even make a SAM splint work for this if you needed to. As horrible-looking as this is, don't forget that this is but ONE injury and there may be others, so quickly look for them before you get engrossed in dressing and splinting this one.
 
Fentanyl, pillow splint as is assuming adequate circulation, more fentanyl, txa if the bleeding is noteworthy and the patient is within protocol, more fentanyl.
 
Akulahawk said:
I'd think about doing some hemorrhage control and then as long as there's still a pedal pulse, I'm going to splint it as it is. I like vacuum splints for this but a garden-variety cardboard box splint, some padding and gauze to hold everything in place will do just fine. You could even make a SAM splint work for this if you needed to. As horrible-looking as this is, don't forget that this is but ONE injury and there may be others, so quickly look for them before you get engrossed in dressing and splinting this one.
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Thanks to all for the responses. This was a weird one for me to work out!
If EMS has taught me anything, it’s to look beyond the appearance of an injury.
 
Looks like a trimalleolar fracture. I had one (closed) from a motorcycle accident. Splint in place and transport. After the trauma alert, two big ortho guys gave me 4 mg dilaudid and then reduced it. Went to surgery the next day for plates, screws and kevlar wire.
 
We'd probably reduce that and then splint with a vacuum splint. Our medical direction wants reduction at the slightest hint of vascular compromise. Also Ketamine.
 
I'd splint in place with plenty of pain management. We're never far from an ER though. Long transport time would certainly warrant reduction however I'd hate to be the one to tackle that in this case. Repeated checks of pedal pulse would be critical regardless.
 
Vacuum splint, analgesic + sedative + ondansetron IV, diesel. Not gonna be a quick fix for the hospital either, that’s a straight up admission.
 
Qulevrius said:
Vacuum splint, analgesic + sedative + ondansetron IV, diesel. Not gonna be a quick fix for the hospital either, that’s a straight up admission.
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What's the Zofran for?
 
Qulevrius said:
Purely a precaution. Folks tend to get nauseated when pain mixes up with motion sickness.
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I think we give way to much prophyatic zofran. If they're nauseous give it. But giving meds just in case is silly practice, not to mention that zofran does not work particularly well for vestibular causes of nausea.
 
Tigger said:
I think we give way to much prophyatic zofran. If they're nauseous give it. But giving meds just in case is silly practice, not to mention that zofran does not work particularly well for vestibular causes of nausea.
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It works well for opioid induced one though. Can always go PRN with antiemetics.
 
Every TBI patient gets prophylactic Zofran from me. They almost always vomit without any warning and may have a reduced ability to clear their own airway.
 
VFlutter said:
Every TBI patient gets prophylactic Zofran from me. They almost always vomit without any warning and may have a reduced ability to clear their own airway.
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Sure. But I think it's kind of silly to chase fentanyl with Zofran on extremity injuries because sometimes people feel funny from opiates. Pushing it slowly seems to make more of a difference.
 
Tigger said:
Sure. But I think it's kind of silly to chase fentanyl with Zofran on extremity injuries because sometimes people feel funny from opiates. Pushing it slowly seems to make more of a difference.
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Fentanyl is supposed to be a slow push to begin with.

Sure, there are certain counter indications for chasing analgesics with Zofran, but if the 12 leads don’t show anything and there’s no prior Hx of SSRIs, it’ll do more good than bad.
 
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