Forum Presentation: DCMT (Directorate of Combat Medic Training) U.S. Army

Whiskey, 2007 Instructor Training Breakout Sessions, Ft. Sam Houston, TX

RR and D, Inc., © May 2007 WWW.SPLINTS.COM

References:

Heightman, MPA, EMT-P JEMS “Articulated Injuries”,

Auerbach, MD Annals of Emergency Medicine, “Experience…”

MonchikMonchik, , MD, NREMT-P MD, NREMT-P Compression SyndromeCompression Syndrome

Warwick and Williams, Gray’s Anatomy,

Lopez and Antunez, “Atlas of Human Anatomy”,

SBC Yellow Pages Phone Book, “Survival Guide”,

Marvel Circa’ 1968 product page.

TOPIC:TOPIC:EMERGING ISSUES IN THE EMERGING ISSUES IN THE

FIELD TREATMENT OF LOWER FIELD TREATMENT OF LOWER EXTREMITY FRACTURES AND EXTREMITY FRACTURES AND

DISLOCATIONS…DISLOCATIONS…

TOPIC:TOPIC:EMERGING ISSUES IN THE EMERGING ISSUES IN THE

FIELD TREATMENT OF LOWER FIELD TREATMENT OF LOWER EXTREMITY FRACTURES AND EXTREMITY FRACTURES AND

DISLOCATIONS…DISLOCATIONS…

““SAVING LIFE AND SAVING LIFE AND LIMB”LIMB”

““SAVING LIFE AND SAVING LIFE AND LIMB”LIMB”

SAVING LIFE AND SAVING LIFE AND SAVING LIMB’S, SAVING LIMB’S, TOOTOO””

SAVING LIFE AND SAVING LIFE AND SAVING LIMB’S, SAVING LIMB’S, TOOTOO””

““Discussion of: Types, Basic Discussion of: Types, Basic Anatomy, Causes…”Anatomy, Causes…”

““Discussion of: Types, Basic Discussion of: Types, Basic Anatomy, Causes…”Anatomy, Causes…”

Orthopedic EmergenciesOrthopedic EmergenciesOrthopedic EmergenciesOrthopedic Emergencies

Open fracturesOpen fractures Long Bone Fractures Long Bone Fractures DislocationsDislocations Extremities with Extremities with

neurological or vascular neurological or vascular compromise (GSW)compromise (GSW)

Compartment Compartment syndromessyndromes

Open FracturesOpen Fractures

Long Bone FractureLong Bone FractureLong Bone FractureLong Bone Fracture

DislocationsDislocationsDislocationsDislocations

Gun Shot WoundsGun Shot WoundsGun Shot WoundsGun Shot Wounds

““Immobilizing injuries in Immobilizing injuries in the position found.”the position found.”

““Immobilizing injuries in Immobilizing injuries in the position found.”the position found.”

““Immobilizing the joints Immobilizing the joints above and below the above and below the

injury site”injury site”

““Immobilizing the joints Immobilizing the joints above and below the above and below the

injury site”injury site”

Help to prevent further injury…Help to prevent further injury…

Help to Relieve pain…Help to Relieve pain…

Help to Determine Mechanism of Help to Determine Mechanism of injury…injury…

Help to prevent further injury…Help to prevent further injury…

Help to Relieve pain…Help to Relieve pain…

Help to Determine Mechanism of Help to Determine Mechanism of injury…injury…

The The KneeKnee and and AnkleAnkle are are always in play and must be always in play and must be

frozen in placefrozen in place

The The KneeKnee and and AnkleAnkle are are always in play and must be always in play and must be

frozen in placefrozen in place

LACK of LACK of UNDERSTANDINGUNDERSTANDINGLACK of LACK of APPRECIATIONAPPRECIATIONLACK of LACK of EQUIPMENTEQUIPMENT

LACK of LACK of UNDERSTANDINGUNDERSTANDINGLACK of LACK of APPRECIATIONAPPRECIATIONLACK of LACK of EQUIPMENTEQUIPMENT

““Knee Anatomy”Knee Anatomy” ““Knee Anatomy”Knee Anatomy”

The “The “TWO P’sTWO P’s” in the knee. ” in the knee. Peroneal Nerve, Popliteal Peroneal Nerve, Popliteal

ArteryArtery

The “The “TWO P’sTWO P’s” in the knee. ” in the knee. Peroneal Nerve, Popliteal Peroneal Nerve, Popliteal

ArteryArtery

Peroneal Nerve & Popliteal Peroneal Nerve & Popliteal ArteryArtery

Peroneal Nerve & Popliteal Peroneal Nerve & Popliteal ArteryArtery

Common Common Peroneal Peroneal

NerveNerve

Common Common Peroneal Peroneal

NerveNerve

Popliteal Popliteal ArteryArtery

Popliteal Popliteal ArteryArtery

Peroneal Nerve & Popliteal Peroneal Nerve & Popliteal ArteryArteryPeroneal Nerve & Popliteal Peroneal Nerve & Popliteal ArteryArtery

Entrapment…Compression Entrapment…Compression Tractioned or StretchedTractioned or Stretched

Entrapment…Compression Entrapment…Compression Tractioned or StretchedTractioned or Stretched

Compartment Compartment SyndromesSyndromes

Compartment Compartment SyndromesSyndromes

Compartment SyndromeCompartment SyndromeDefinitionDefinition

Compartment SyndromeCompartment SyndromeDefinitionDefinition

Elevated tissue Elevated tissue pressure within a pressure within a closed fascial spaceclosed fascial space

Reduces tissue Reduces tissue perfusionperfusion

Results in cell deathResults in cell death PathogenesisPathogenesis

Too much inflow Too much inflow (edema, hemorrhage)(edema, hemorrhage)

Decreased outflow Decreased outflow (venous obstruction, (venous obstruction, tight dressing/cast)tight dressing/cast)

Compartment SyndromeCompartment SyndromeEtiologyEtiology

Compartment SyndromeCompartment SyndromeEtiologyEtiology

Fractures-closed Fractures-closed and openand open

Blunt traumaBlunt trauma Temp vascular Temp vascular

occlusionocclusion Cast/dressingCast/dressing Closure of fascial Closure of fascial

defectsdefects Burns/electricalBurns/electrical

GSWGSW IV/A-linesIV/A-lines Snake biteSnake bite Arterial injuryArterial injury

Compartment SyndromeCompartment SyndromeTissue SurvivalTissue Survival

Compartment SyndromeCompartment SyndromeTissue SurvivalTissue Survival

MuscleMuscle 3-4 hours - reversible 3-4 hours - reversible

changeschanges 6 hours - variable 6 hours - variable

damagedamage 8 hours - irreversible 8 hours - irreversible

changeschanges Nerve Nerve

2 hours - looses nerve 2 hours - looses nerve conductionconduction

4 hours - neuropraxia4 hours - neuropraxia 8 hours - irreversible 8 hours - irreversible

changeschanges

Compartment SyndromeCompartment SyndromeDiagnosisDiagnosis

Compartment SyndromeCompartment SyndromeDiagnosisDiagnosis

Pain out of Pain out of proportionproportion

Palpably tense Palpably tense compartmentcompartment

Pain with passive Pain with passive stretchstretch

ParalysisParalysis Pulselessness/Pulselessness/

pallorpallor

““MORBIDITY ISSUES”MORBIDITY ISSUES”““MORBIDITY ISSUES”MORBIDITY ISSUES”

1. Foot drop 1. Foot drop 2. Ankle and Foot Palsy 2. Ankle and Foot Palsy 3. Gaiting difficulties 3. Gaiting difficulties 4. Loss of sensation 4. Loss of sensation 5. Toe Dragging 5. Toe Dragging 6. Loss of muscle tone 6. Loss of muscle tone 7. Long term health 7. Long term health effects effects

8. Psychological8. Psychological

1. Foot drop 1. Foot drop 2. Ankle and Foot Palsy 2. Ankle and Foot Palsy 3. Gaiting difficulties 3. Gaiting difficulties 4. Loss of sensation 4. Loss of sensation 5. Toe Dragging 5. Toe Dragging 6. Loss of muscle tone 6. Loss of muscle tone 7. Long term health 7. Long term health effects effects

8. Psychological8. Psychological

The “Perfect Splint” for the job

The “Perfect Splint” for the job

Extrication Extrication ManagementManagementStrap Architecture Strap Architecture Repositioning Repositioning Traction CapabilityTraction Capability

Extrication Extrication ManagementManagementStrap Architecture Strap Architecture Repositioning Repositioning Traction CapabilityTraction Capability

““Tactical System… Perfect Tactical System… Perfect traction too”traction too”

““Tactical System… Perfect Tactical System… Perfect traction too”traction too”

The changes can be expressed in a The changes can be expressed in a matter of degreesmatter of degrees

The changes can be expressed in a The changes can be expressed in a matter of degreesmatter of degrees

The changes can be expressed in a The changes can be expressed in a matter of degreesmatter of degrees

The changes can be expressed in a The changes can be expressed in a matter of degreesmatter of degrees