Immobilization Extrication

8/13/2019 Immobilization Extrication

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IMMOBILIZATION

EXTRICATIONBy;

Nazri B. Aiwan @ Ismail

Kolej Pembantu Perubatan Ulu Kinta


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Introduction

To move casualty to hospital.

Early priority in the rescue effort.

Need appropriately planned.

To ensure safe and speedy transportation

while maintaining casualty comfort,

preventing further injury or damage &allowing full monitoring to take place.


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Basic Principles of Immobilization

1. To prevent further injury.

2. To provide pain relief.

3. To reduce blood loss.

4. To reduce the risk of fat emboli.

5. To facilitate extrication & rescue.


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3. To reduce blood loss

Traction splintage of long bone # ;

volume available for hematoma formation.

Restore muscle tensionclosed largevenous channels.

4. To reduce the risk of fat emboli

incidence marrow fat emboli enters venouscirculation.


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5. To facilitate extrication & rescueImmobilization

Should be supported on either site of the #.

Immobilized the joints above & below theinjury.

The principles of equipments design;

simple

easy to uselightweight

Damage-proof

Easily cleaned following use.


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Basic Principles of Extrication

Entrapment

trapped casualty. Hospital staff alert for possible problems

a) Actual entrapment;

Victims are physically enclosed in avehicle or in area by the structureimpinging on their body eg MVA, buildingcollapse.

b) Relative entrapment:

No actual physical entrapment present.

Unable to extricate because of ptconditions eg # femur.


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Preparation & Approach

Training & knowledge.

Equipment regularly checked & in

working order. Know the equipment & their potential.

Know own limitation.


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Pain Relief

Moving injured limbs or extrication

casualties may produce pain.

Tractionrelief pain Drugs for pain killer eg. entonox,

ketamine, titrated intravenous

analgesia and local block.


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Methods of Immobilization

a) Cervical Immobilization

Manual immobilization

i. Approach from behindii. Approach from in front

iii. Approach from the side.

Cervical collars

Injury above clavicle

Unconscious

Cervical spine #


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Cervical Collar

Types of collar

a) Stiffneck.

b) Necloc.

Optimal position for cervical

immobilization.

Slight degree of flexion

2 cm of occiput elevation


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Cervical Collar

Manual in-line stabilization Sizing the collar

Head in neutral position

Distance between an

imaginary line drawn across

the top of shoulder and a

parallel line running

backwards from the tip of

chin.

Front piece is applied

under the chin.

Fasten Velcro strap.


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Limb Immobilization

Simple methods

Arm slings jacket, tie or scarves

Manual methods

support injured hands

Triangular bandage

simple pre-hospital care for upper limb

injuries.used as a high arm sling, broad arm sling

or collar & cuff sling.


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Limb Immobilization

Frac straps

Fasten one leg to another or immobilize

an arm to the side of chest.

Neighbour strapping

Injured fingers bound to fingers on either

side or lower limb bound to other limb.


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Limb Immobilization

Inflatable splint

clear plastic, double walled tubes.

little contribution to # Mx.

use in Rx of soft tissue injury.

inflate by blowing only.

often crack & perish or tend to leak.

vulnerable to damage from sharp objects.


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Limb Immobilization

Box splint (Loxley splint)Consists of three long padded pieces of

board joined to form an open oblong

together with a foot support at one end.

Vacuum splint

Bag of polystyrene bead enclosed in

tough plastic.

provide rigid support to the body & verycomfortable.

Used to immobilize the limbs, the cervical

spine & other spinal injuries.


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Limb Immobilization

Vacuum splintVacuum splints conform to the exact shape of the

injury site.

Providing excellent support without applying

unnecessary circumferential pressure.Eliminates the potential for compartment

syndrome, unnecessary pressure sores, or

impairing circulation to the injured area.

Sensory function remains intact, yet the injuredarea is immobilized properly to prevent further

injury and reduce pain.


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Traction Splint

Hare traction splint.Indications

closed & open # femoral shaft.

closed & open # of the shaft of thetibia & fibula.

# around the knee (avoid traction)

Contraindications

dislocation of hip.

# dislocation of the knee

Ankle injuries.


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Limb Immobilization

Functionsimmobilized # in a reduced position.

pain.

prevent further neurovascular damage.

severity shock

fat embolism.

Complication

damage neurovascular supply to the leg.

pressure sores pt with sensory loss.

limited space in ambulance.


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Application

Correct application requires 2 people.

Applied after extrication.

Method

1. Give appropriate analgesia.

2. Control external hemorrhage.

3. Remove footwear & assess MSC.

4. Select appropriate ankle hitch & adjust splint

length against normal leg. Open all straps &

placed correctly.


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Application

5. The hitch is placed under the ankle & thestraps are then tightly folded across the frontof the ankle.

6. Manual traction is started with one hand. Theleg is supported whilst the splint is put onposition. Role pt away from the splint thenslide the splint under the pt. The top paddedring must fit under the ischial tuberosity. Thept is then rolled back onto the splint. Manualtraction must be maintained throughout thisprocedure.


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Application

7. The top strap is then done up avoiding the

external genitalia.

8. The traction hook is then put through the D

rings & traction taken up, ensuring themanual traction is not released before the

traction is tightened. Traction is applied until

the limb is comfortable. Repeat MCS

assessment.

9. Raised the footstand & velcro straps are

positioned & tightened.


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Pneumatic Antishock Garment (PASG)

Military Anti Shock Trousers (MAST)

An inflatable garments that surrounds the

leg & abdomen.

Indications

Hypovolaemic shock.

splinting of pelvic & lower limb #.


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Contraindications

a) Absolute

Cardiac failure.

Pulmonary edema.Significant blunt chest injury.

ruptured diaphragm

advanced pregnancy.b) Relative

significant head injury.

uncontrolled bleeding above garment


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Complications

Extreme hypotension.

Ischaemic compartment syndrome,

tissue damage & metabolic acidosis.Respiratory embarrassment.

Exacerbation of;

Cardiac /thoracic vascular bleedingpulmonary edema

Congestive cardiac failure


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Extrication Devices

Kendrick extrication device (KED)

Russell extrication device (RED)

Provide support & stabilization to the

upper spine.Replaced short wooden board.

Flexible & can be positioned between the

casualty and the seat.


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Kendrick Extrication Device


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Long Spinal Board Immobilization

At least 3 rescuers ( preferably four)

Perform log roll.

Manually stabilize pts head & neck.

Apply rigid cervical collar.

Assess pulse, movement & circulation in all four

extremities.

Position the pthis arm straight down by his

side.


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Long Spinal Board Immobilization

Position the rescuersat the signal of the

rescuer at the head, the two at the side should

reach to the far side of pt.

1strescuer -Shoulder & hip.2ndrescuer - Thigh & lower leg.

On signal, simultaneously roll the pt on to his

sidemove as a unit.

Position the spinal board under the pt.


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LONG SPINAL BOARD


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Log Roll


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Log Roll


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Pelvic Splint

The human pelvis comprises three pelvic bones which

combine to form a strong anatomic ring. Major trauma - injuries may include pelvic fractures &

disrupt the integrity and stability of the pelvic ring.

lead to significant pelvic bleeding in the victim since thearteries and major veins passing through the pelvic area

may easily be pinched, torn, or lacerated by thefractured bones.

Pelvic bleeding is the major cause of death.

Immediate and important concern in early treatment ofthe victim is stabilization of the pelvis, which reduces

bleeding, improves the comfort of the victim, andincreases the victim's chances of survival.

The temporary measure most often undertaken tostabilize the pelvis involves the use of a splint.


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Noninvasive Pelvic Immobilization

Royal Hospital London Pelvic Splint


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Noninvasive Pelvic Immobilization

Dallas Pelvic Binder


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Invasive Pelvic Immobilization

Pelvic Clamp


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Extrication Devices

Stretchers

Provide means of lifting pt onto a trolley

or trolley cot.


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Removing a Helmet


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Removing a Helmet


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Documents

Immobilization Extrication