traction splints

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billycorgi

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What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?
 
If you didn't notice the midshaft femur fracture until you got them in the truck.
 
DEmedic said:
If you didn't notice the midshaft femur fracture until you got them in the truck.
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+1,

If you go by the "National Standard" you are given 10 minutes scene time for a trauma patient. I'd prefer to mobilize the fracture before moving the patient unless unforseen condtions permit.
 
rob the mexican medic said:
still have never done this in 6 years. not even sure where it is on the unit lol. Hopefully my partner does.
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I used one twice in 13 years. We usually bust them out for annual skills review which is nice cause I know I would've forgotten how to use it by now.

But in the same way be a little aggressive know your unit
 
unleashedfury said:
I used one twice in 13 years. We usually bust them out for annual skills review which is nice cause I know I would've forgotten how to use it by now.

But in the same way be a little aggressive know your unit
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True know your unit but I honestly don't get the point. I mean I've been on lots of femur fractures we learned after the fact. It would have to be such an obvious open femur fracture for me to bust this out
 
dreadpiraterobby said:
True know your unit but I honestly don't get the point. I mean I've been on lots of femur fractures we learned after the fact. It would have to be such an obvious open femur fracture for me to bust this out
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...Wait for it...












And why would we hopefully decide not to "bust out" the traction splint on the gnarly open fracture?
 
chaz90 said:
...Wait for it...












And why would we hopefully decide not to "bust out" the traction splint on the gnarly open fracture?
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To reintroduce the exposed bone into the wound can cause sepsis. How about immobilize pt, sterile saline dressing with dry bulky cover, and lots of drugs?
 
mycrofft said:
To reintroduce the exposed bone into the wound can cause sepsis. How about immobilize pt, sterile saline dressing with dry bulky cover, and lots of drugs?
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God I love this forum. So much stuff from discussions I never would have thought of and never got told in basic class.

What would they end up doing in the ER, how do you sterilize a bone?
 
randomfire said:
God I love this forum. So much stuff from discussions I never would have thought of and never got told in basic class.

What would they end up doing in the ER, how do you sterilize a bone?
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With the help of some anesthesia.

I know where mine is (the pedi and regular one), but I have also not had the occasion to use one. I had a patient we could have possibly used it on last month but there wasn't much in the way of limb shortening and the patient was "only" in 4/10 pain when she wasn't moving, which fentanyl kept under control. I figured further moving the patient to get her on the splint would not have made things better.

The ED did not apply theirs either.
 
God star for mycroft! Traction splints only go on closed femur breaks when the break is proximal to the patella on the bottom 2/3 of the femur.
 
Ive applied a traction splint exactly once.

Im still not convinced it was a femur fracture, nor am I convinced that leaving mamaw lie on the hot concrete was the best idea
 
billycorgi said:
What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?
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This................









599458_424331127608590_1994823909_n-620x350.jpg
 
In regards to applying a traction splint to an open femur fracture, I have not seen that as a contraindication except in old textbooks (it may be listed in some newer that I'm not aware of).

I understand the thought process of not doing it. However, I decided to look around for some literature on it.* Most places I looked said withholding applying traction was old practice, and found unnecessary. For just a quick glance- a brief statement on it from ITLS can be found here.

So with that said, would like to hear some of the other guys' thoughts on it. Yes, you're reintroducing a contaminated bone into the body. However, the bone and wound are already contaminated, the entire wound will get thoroughly irrigated and cleaned, and the patient will likely be started on antibiotics anyway. Considering all of that will be covered, it seems like the benefit would lean more toward stabilizing the mid-shaft fracture, eliminating potential further damage, and alleviating pain (especially if you're in a system without fairly progressive pain management abilities).

*The brief looking I did was on my phone with limited access to full articles. I'll try and look more into it when I get a chance.
 
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rob the mexican medic said:
I don't get it. Maybe i'm retarded
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I'm pretty sure he's referring to what mycrofft addressed; introducing contaminated bone and tissue back into the body- potentially putting the patient at risk for infection.
 
STXmedic said:
I'm pretty sure he's referring to what mycrofft addressed; introducing contaminated bone and tissue back into the body- potentially putting the patient at risk for infection.
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It was. I was going off of what may have been an old adage. Admittedly, this is something I've done zero research on since my initial exposure in EMT school years ago. My entire adversion to traction on open femur fractures comes from my EMT instructor telling me that it was a "bad thing" and multiple protocols that don't allow it. Keep in mind, these same instructions would still have me backboarding everyone I see with 15 LPM O2, so take it with a grain (or bucket full) of salt. Honestly, these patients are going to be placed on an antibiotic regimen anyway with thorough irrigation of the site and surgical repair.
 
We had a patient with bilateral femur fractures last winter, the guys on scene pulled traction on both legs. We ended up calling in a DHART helicopter for him, the traction provided so much pain relief he was euphoric and on the phone with his mom "hey mom! I got hurt but I feel great and they're taking me out in a helicopter!"
 
The handful of times I've applied one it was pretty obvious that they had a femur fracture. I doubt that you'd "miss" seeing that until you were en route.

Open fractures are no longer considered a contraindication for applying traction. I also hears rumors that "they" are considering a trial for pre-hospital antibiotics for open fractures...
 
randomfire said:
God I love this forum. So much stuff from

What would they end up doing in the ER, how do you sterilize a bone?
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Nothing, that's a job for the OR.

We'd manage pain, dress, and splint in place. Open femur fx usually have a surgical consult within minutes of arrival.
 
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