Leg injury and shock position

bigdude

bigdude

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Let's say a patient has a laceration mid femur with profuse bleeding. After bleeding is controlled and assuming the patient is showing signs of shock, would you transport in shock position or supine?

From what I can remember the only contraindiction for shock position is a suspected spinal injury, correct?
 
bigdude said:
Let's say a patient has a laceration mid femur with profuse bleeding. After bleeding is controlled and assuming the patient is showing signs of shock, would you transport in shock position or supine?

From what I can remember the only contraindiction for shock position is a suspected spinal injury, correct?
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Just elevate the legs above the level of the head, cover, O2 and transport
 
Would it not depend on how the laceration happened? And if there was enough MOI to think possible femur injury? Say there was a broke femur, depending how that happened, you might be able to suspect spinal injury. So I guess this question could go both ways, because not enough info is presented.
 
Amber said:
Would it not depend on how the laceration happened? And if there was enough MOI to think possible femur injury? Say there was a broke femur, depending how that happened, you might be able to suspect spinal injury. So I guess this question could go both ways, because not enough info is presented.
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OK so what is more important to your PT? Stabilizing the spine or treating for shock that can become irreversible and you PT dies?
 
Ive been taught that treating for shock as a EMT-B we can only provide O2, cover, and watch for breathing. I recently learned that you can immobilize and still elevate feet?

So I guess in a perfect world we could do both?

crazycajun said:
OK so what is more important to your PT? Stabilizing the spine or treating for shock that can become irreversible and you PT dies?
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Cover and dress the wound first. During Medic practicals, if it was lets say an open femur fx, you obviously can't splint that. Place a gloved hand over it to provide pressure, then bandage. You still need to splint the injury because of susprected fracture. Aircast or air splint. As the bascis go, ABC's and you've covered your bleeding control.
 
bigdude said:
Let's say a patient has a laceration mid femur with profuse bleeding. After bleeding is controlled and assuming the patient is showing signs of shock, would you transport in shock position or supine?

From what I can remember the only contraindiction for shock position is a suspected spinal injury, correct?
Click to expand...

I think you should transport in the shock position.

From my reading, the shock position is really helpfull, and can greatly improve the patients appearance and bp.
 
Amber said:
Ive been taught that treating for shock as a EMT-B we can only provide O2, cover, and watch for breathing. I recently learned that you can immobilize and still elevate feet?

So I guess in a perfect world we could do both?
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Yea. Just lift the whole LSB. Same thing is accomplished.

Of course if you actually believe in science, Bryan Bledsoe has a good article on this issue: http://www.ems1.com/ems-products/ed...-Current-Slant-on-the-Trendelenburg-Position/

So actually tilting the whole LSB really doesn't accomplish anything. I have personally only ever put one person in the Trendellenburg positions and that was because it made it easier for me to put in an IO.


Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.
 
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tickle me doe face said:
From my reading, the shock position is really helpfull, and can greatly improve the patients appearance and bp.
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Hmmmm, that's the problem with reading EMT text....

Supine, yes, it can improve patient condition over them being upright. I've yet to see elevating the patient's legs provide any sort of improvement though.
 
LSB and trendelenburg? Have we considered if adding crystal therapy or aroma therapy to help out?
 
tickle me doe face said:
I don't understand how either of these would work, but am very interested to learn!

link!
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Here's a better idea. Look for research showing the efficacy of spinal immobilization or trendelenburg.
 
JPINFV said:
Here's a better idea. Look for research showing the efficacy of spinal immobilization or trendelenburg.
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You can argue the point but I have personally seen leg elevation and trendellenburg improve a PT vitals and general condition in shock.
 
crazycajun said:
You can argue the point but I have personally seen leg elevation and trendellenburg improve a PT vitals and general condition in shock.
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Just that? You mean it couldn't have been simply because of a bunch of strangers manhandling, questioning a patient, and doing several other things that cause an increase in stress past the fact that the patient is sick?
 
crazycajun said:
You can argue the point but I have personally seen leg elevation and trendellenburg improve a PT vitals and general condition in shock.
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Legs up will help improve vitals (too tired for more details) but trendellenburg will do zip. Look at the situation in another way: a fractured femur can lose a lot of blood, so it needs to be splinted for pain, long term recovery and also to reduce blood loss. Combine this with the need for spinal precautions as enough trauma to snap a femur is also likely to damage the spine, and you have a patient who needs to be supine with legs flat. How would you elevate a splinted leg anyway?
 
McGoo said:
Legs up will help improve vitals (too tired for more details) but trendellenburg will do zip.
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...and how will legs up increase blood pressure that wouldn't be contributed by trendelenburg? After all, increasing venous return is increasing venous return...
 
tickle me doe face said:
My EMT book says both are good, and has detailed instructions with pictures for each.
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I've got science. While the studies are small, small consistent studies are significantly more evidence than no evidence at all. My bar for accepting trendelenburg (or spinal immobilization for that matter) are rather low, but there evidence for them are simply not there.

http://journals.lww.com/ccmjournal/...nburg_position__hemodynamic_effects_in.2.aspx (No increase in MAP in either hypotensive or normotensive cardiac patients)

http://www.sciencedirect.com/science/article/pii/S0196064485808787 (1.8% auto transfusion... wee)

http://ajcc.aacnjournals.org/content/14/5/364.short (Review paper that came to the conclusion that there simply is no evidence to support trendelenburg).

...oh, and sorry, there aren't any pictures involved.
 
McGoo said:
Legs up will help improve vitals (too tired for more details) but trendellenburg will do zip. Look at the situation in another way: a fractured femur can lose a lot of blood, so it needs to be splinted for pain, long term recovery and also to reduce blood loss. Combine this with the need for spinal precautions as enough trauma to snap a femur is also likely to damage the spine, and you have a patient who needs to be supine with legs flat. How would you elevate a splinted leg anyway?
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That is assuming the same force that was applied to the femur was applied to the spine. I can think of a few patients off the top of my head who had mid-femur fractures and none of them got back boarded because they were all isolated injuries.

tickle me doe face said:
My EMT book says both are good, and has detailed instructions with pictures for each.
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We're considering EMT books accurate sources of peer-reviewed scientific information now?
 
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