Week 7- Sager & Pelvic Binder Flashcards
Of the skeleton which do we usually splint?
- appendicular skeleton
The traction splint shall…
- be compatible with spinal bards and cots/ stretchers in the ambulance
- be of a size and shape that can be safely and easily stored in the ambulance
- have a mechanism that allows the paramedic to determine and document exactly how much traction is being applied
- automatically adjust to degree of muscle spasm (counter force) in the leg in response to the traction being applied (dynamic traction)
- Allow for orthopedic and vascular assessment of a patient when applied
- be easily cleaned and disinfected
Quantifiable traction
- the amount of traction is measurable in lbs/kg
Dynamic traction
- the spring inside functions to permit the traction to decrease as “spasm” releases secondary to traction being applied & muscle fatigue. Helps to decrease pain and blood loss
When can we NOT use the sager traction splint?
- Load & go pt’s
- Knee injuries
- Hip dislocation
- Ankle or foot fractures
- Neck of femur fractures
- Pelvic fracture
- Supracondylar fractures of the distal end of the femur
- Tib fib fractures
What are pelvic fractures?
- Anteroposterior compression or vertical shear injuries are consistently associated with a higher risk of mortality from bleeding
What are the 2 types of pelvic fractures?
- Stable
- Unstable
What is a stable fracture?
- Often only 1 break in the pelvic ring broken ends of the bones line up adequately
- Low energy #’s are often stable fractuers
What is a unstable fracture?
- Usually 2 or more breaks in the pelvic ring and broken bones don’t line up correctly (displacement)
- High energy events cause this
What are some causes of pelvic fractures?
- MVC
- Major falls
- Minor falls (elderly)
- Athletic activities
What are the S/S of pelvic fractures?
- Pain in groin/ lower back
- Pain in abdomen
- Intense pain when walking
- Tenderness, brusing, swelling
What are some potential abdominal injuries from pelvic fractures?
Rupture, perforation, laceration or hemorrhage of organs or vessels in the abdomen, thorax, and spinal cord injuries
What do we do if a patient has a potential pelvic fracture?
- Try to stabilize pelvis with a sheet wrap or t-pod
- Secure pt to spinal board or scoop
- Then secure and immboilize the pt’s ;eg to prevent additional pelvic injury
What are some complication of pelvic injury?
- Bleeding out (internally)
- Impaired mobility
- Chronic pain
- Long term complication (arthritis)
- Laceration of bladder
- Increased risk of deep vein thrombosis (blood clot forming in the deep vein, usually develops in the lower legs, thigh, pelvis)
- Sexual dysfunction
Why do we immboilize the pelvis when fractured?
- prevent further dislocation of fractured bone fragment, thus reducing risk of further soft tissue trauma
- facilitate clot formation
- allow for safe extrication and transport of pt
- Prevent massive internal hemorrhage
- Reduce risk of death (blood loss 1-1.5L)
- SMR to protect further damage to spinal cord
What are common causes of hip fractures?
- Falls
- MVC’s
- Women with osteoperosis
- Elderly fall or standing
- Cortisone meds have been known to get hip #’s from standing/ pivoting
- Physical & motor sport injuries (high impact collisions)
- Medical conditions (thyroid & intestinal disorders= weakened bones)
What are the s/s of hip #’s?
- severe pain in groin/hip
- Inability to put weight on it
- Inability to walk
- Bruising, swelling, inability to move/ lift/ rotate leg
- Shorter leg on injured side/ externally rotated
- Palpate will be painful around area
What is the treatment for hip #’s?
- Stabilize hip on scene
- Buddy split legs
What are common causes for femur fractures?
-High speed MVC’s
- Falls from height
- Extreme contact sports
- Gunshot wounds to femur
- Fall from standing (elderly)
- Pt’s with osteoperosis
- Pre existing conditions in the legs (cancer)
What are the s/s of femur fractures?
- Instant severe pain
- Difficulty moving leg
- Severe bruising/ swelling
- Deformity of the thigh
- Injured leg may be shorter
- Bone protruding the leg
What are the different types of femur #’s?
- Femoral shaft fracture
- Supracondylar fracture
- Proximal fracture
What is a femoral shaft fracture?
break in the middle of the bone or narrow part of the femur
What is a supracondylar fracture?
break just above the knee joint
What is a proximal fracture?
A break in the upper most part of the thigh bone next to hip joint
What is the treatment for a femur fracture?
- Immobilizing with sager (if isolated midshaft femur fracture)
- If two femur fractures, buddy splint legs
- Stop massive hemorrhage
- Pain meds
- Treat for shock
- Transport
What are the types of extremity injuries?
- Upper extremity: hand, elbow, arm/ shoulder
- Lower extremity: strains, contusions, fractures
- Severe extremity: bone/ soft tissue complications (infections, necrosis, non-union osteomyelitis), vascular complications (thrombosis), and rhabdomyolysis
The paramedic shall, splint injured extremities as followed…
- Assess distal circulation, sensation, and movement before and after splinting
- Splint joint injuries as found:
A- if distal pulse is absent or area of injury is severly angulated make a limb a limb (manipulate the area of injury back into it’s normal position)
B- if resistance or severe pain is encountered splint as found - If open or closed femur fracture, splint with traction splint (unless angulated)
- If extremity injury affects joint, immobilize above/ below injury
- If circulation/ sensation is absent after splinting and re manipulation is possible, gently move the extremity until pulse is found
- If practical elevate affected extremity (minimize swelling)
- Consider cold pack
What do we do if it’s an open fracture?
- Irrigate with saline or sterile water
- Cover ends with moist sterile dressings and/ or padding
How do we apply a sager?
- Expose and cut away clothing to visualize injury
- Assessment must reveal isolated midshaft femur #
- Assess 5 p’s
- Apply manual traction
- Repeat 5 p’s
- Position the ischial cushion between legs
- Secure proximal harness
- Secure the malleolar harness to ankle
- Obtain pt’s weight and inform them that you are going to apply traction
- Once traction is applied, partner can release manual traction
- 5 p’s reassesed
- Secure the cravats (s/ m/ L) (padding between knees)
- Figure 8 the feet
- Use extrication device
What are the sager contradictions?
- Load & go pt’s
- Knee injuries
- Ankle, foot, or neck of femur #’s
- hip dislocation
- pelvic #
- Supracondylar #’s at distal end of femur
- tib fib #’s
What is the procedure for applying a t-pod?
- slide belt under supine pt and into position under the pelvis
- Trim belt leaving 6-8’’ gap over center of pelvis
- Apply velcro backed mechanical advantage pulley system to each side of trimmed belt
- Slowly draw tension on the pull tab, creating circumferential compression
- Secure the velcro backed pull tab to the belt
- Record date/ time of application
What is the procedure for applying a sheet wrap?
- Fold a sheet length wise in 3rd’s
- Slide the sheet under the pt
- Landmark the greater trochanter
- Put sheet equal distances under pt
- Hand the opposite sides of sheet to your partner PULL TIGHT
- Together cont to maintain tension and move in circular motions
- Tape sheet into place
