Drill of the Month Developed by Gloria Bizjak

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Drill of the MonthDeveloped by Gloria Bizjak

• Trauma Basics Managing Upper Extremity Fractures

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Trauma Basics Managing Upper Extremity Fractures

• Student Performance Objective
• Given information and resources, splinting
  materials, demonstration, and time to practice
  EMTs will be able to
• List management, assessment, and care for upper
  extremity fractures
• Review Hand/upper Extremity Trauma Protocol
• Describe and demonstrate methods of splinting
  fractures of the upper extremities
• Shoulder (scapula) and collar bone (clavicle)
• humerus (arm)
• elbow
• forearm (forearm), wrist (carpals), and hand
  (metacarpals)
• fingers (phalanges)
• EMTs will follow acceptable Maryland medical
  practice and Maryland Medical Protocols for
  Emergency Medical Providers.

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Trauma Basics Managing Upper Extremity Fractures

• Overview
• Management, Assessment, and Care
• Hand/upper Extremity Trauma Protocol
• Splinting Upper Extremity Fractures

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Trauma Basics Managing Upper Extremity Fractures

• Management
• Review Protocols for general patient care
• Review trauma patient assessment
• Initial assessment
• Vital signs, SAMPLE
• Focused history and physical exam

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Trauma Basics Managing Upper Extremity Fractures

• Management
• Review purpose of splinting
• Immobilize
• Minimize movement
• Prevent further tissue damage
• Prevent closed fracture from becoming open
• Control bleeding

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Trauma Basics Managing Upper Extremity Fractures

• Management
• Review purpose of repositioning
• Effective splinting
• Restore circulation
• Aide patient comfort
• Prevent closed fracture from becoming open
• Prevent further tissue damage

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Trauma Basics Managing Upper Extremity Fractures

• Management
• Review management of joint injuries
• Splint in position found reposition
• If circulation is absent
• If the attempt meets o resistance
• To establish a pulse

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Trauma Basics Managing Upper Extremity Fractures

• Assessment
• Patient complains of pain, tenderness
• Guards injury site
• Describes injury
• Points to site
• Care provider examines site
• Looks for deformity or angulation (compare to
  uninjured side)
• Looks for other injured areas

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Trauma Basics Managing Upper Extremity Fractures

• Assessment
• Patient complains of grating sensation or sound
  (crepitis) or a pins-and-needles sensation
• Care provider looks for
• Swelling and/or deformity or angulation
• Bruising
• Exposed bone

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Trauma Basics Managing Upper Extremity Fractures

• Assessment
• Patient complains of inability to move joint
• Care provider checks for joints locked in unusual
  position (dislocation)
• Care provider checks for distal pulse, motor
  function, sensation

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Trauma Basics Managing Upper Extremity Fractures

• Care (general)
• BSI precautions
• Initial Assessment
• Rapid Trauma Exam
• Cervical collar for suspected spine injury
• Life-threatening injuries

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Trauma Basics Managing Upper Extremity Fractures

• Care (general)
• Painful, swollen, deformed extremities
• Low-priority, stable patient
• Splint individual injuries
• High-priority, unstable patient
• Immobilize on long board
• Load and go

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Trauma Basics Managing Upper Extremity Fractures

• Care (general)
• Stabilize injury site
• Check distal pulse, motor function, sensation
• Cover open wounds, elevate while splinting
• Measure, select, position splint
• Stabilize until splint is secured not too
  tight/loose
• Recheck distal p-m-s
• Apply cold pack

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Trauma Basics Managing Upper Extremity Fractures

• Hand/Upper Extremity Trauma Protocol
• Injuries
• Complete/incomplete hand/upper extremity
  amputations
• Partial/complete finger/thumb amputations
• Crushing, degloving, devascularization injuries
• High-pressure injection injuries
• Loss of perfusion
• Nerve injury (compartment syndrome)

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Trauma Basics Managing Upper Extremity Fractures

• Hand/Upper Extremity Trauma Protocol
• Referral
• Adults Curtis National Hand Center at Union
  Memorial Hospital
• Pediatrics (have not reached 15th brithday)
  Pediatric Trauma Center
• Stable patients with isolated injury at or below
  mid-humerus Hand Center or nearest appropriate
  trauma center

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Trauma Basics Managing Upper Extremity Fractures

• Hand/Upper Extremity Trauma Protocol
• Contraindications for referral to specialty
  center
• Unstable/abnormal vital signs to trauma center
• Major/multiple system trauma to trauma center
• Partial/complete toe amputation to medical
  facility

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Trauma Basics Managing Upper Extremity Fractures

• Hand/Upper Extremity Trauma Protocol
• Care for amputated part
• Keep dry
• Place in sealed plastic bag
• Place on top of ice
• Do not freeze

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures
• Shoulder and collar bone
• Stabilize and check distal p-m-s
• Use sling and swathe Position sling, secure
  w/forearm elevated across chest
• Position knot to side of spine pad knot
• Secure point of sling
• Stabilize arm with cravat across chest
• Recheck distal p-m-s

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures Humerus
  General Care
• Stabilize extremity
• Check distal p-m-s
• Place hand in position of function
• Immobilize w/board and/or sling and swathe

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures Humerus
  Specific Care
• Proximal fracture use sling and swathe
• Distal fracture use narrow sling to support
  wrist, leave elbow exposed stabilize with swathe
• Mid-shaft measure and secure padded board
  splint, fingertips exposed support with swathe

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures
• Elbow General Care
• Check distal p-m-s
• With distal pulse, stabilize and splint in
  position found
• With no distal pulse, attempt to reposition to
  obtain pulse
• Hand in position of function
• Immobilize
• Recheck distal p-m-s

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures
• Elbow Specific Care
• Straight position
• Measure, secure padded board splint
• Leave fingertips exposed
• Pad between patient and splinted arm
• Secure arm to torso
• Bent position
• Place padded board splint over angle of arm
• Secure with cravats
• Apply wrist sling, keeping forearm elevated

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures
• Radius/Ulna, wrist, hand General Care
• Stabilize
• Check distal p-m-s
• Hand in position of function
• Immobilize
• Recheck distal p-m-s

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures
• Radius/Ulna, wrist, hand Specific Care
• Measure, apply splint from elbow to fingertips
• Secure splint with roller gauze
• Wrap distal to proximal
• Leave fingertips exposed
• Apply sling, keeping forearm elevated against
  chest
• Stabilize with cravat

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Trauma Basics Managing Upper Extremity Fractures

• Splinting Upper Extremity Fractures
• Fingers
• Splint injured finger to uninjured finger with
  tape
• OR
• Splint injured finger with tongue depressor

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Trauma Basics Managing Upper Extremity Fractures

• Student Performance Objective
• Given information and resources, splinting
  materials, demonstration, and time to practice
  EMTs will be able to
• List management, assessment, and care for upper
  extremity fractures
• Review Hand/upper Extremity Trauma Protocol
• Describe and demonstrate methods of splinting
  fractures of the upper extremities
• Shoulder (scapula) and collar bone (clavicle)
• humerus (arm)
• elbow
• forearm (forearm), wrist (carpals), and hand
  (metacarpals)
• fingers (phalanges)
• EMTs will follow acceptable Maryland medical
  practice and Maryland Medical Protocols for
  Emergency Medical Providers.

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Trauma Basics Managing Upper Extremity Fractures

• Review
• Management, Assessment, Care
• List MIEMSS Protocols for General Patient Care
• List purposes of splinting
• List management steps of joint injuries
• List assessment steps for a trauma patient
• List general care steps for a trauma patient

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Trauma Basics Managing Upper Extremity Fractures

• Review
• Hand/upper Extremity Trauma Protocol
• State MIEMSS Trauma Protocol for Hand/Upper
  Extemity Trauma
• List indications for transport to specialty
  centers for adults and peds
• List contra indications for transport to
  specialty center

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Trauma Basics Managing Upper Extremity Fractures

• Review
• Splinting Upper Extremity Fractures
• List care steps for immobilizing each of the
  following fractures
• Shoulder, collar bone
• Humerus
• Elbow
• Forearm, wrist, hand
• Fingers