DMACC EMT Chapter 30

1. PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
TENTH EDITION
Musculoskeletal
Trauma
30

2. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Learning ReadinessLearning Readiness
• EMS Education Standards, text p. 832

3. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Learning ReadinessLearning Readiness
ObjectivesObjectives
• Please refer to page 832 of your text to
view the objectives for this chapter.

4. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Learning ReadinessLearning Readiness
Key TermsKey Terms
• Please refer to page 833 of your text to
view the key terms for this chapter.

5. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Setting the StageSetting the Stage
• Overview of Lesson Topics
 Musculoskeletal System Review
 Injuries to Bones and Joints
 Basics of Splinting

6. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case Study IntroductionCase Study Introduction
Forty-five-year-old Dominique Foster rushes
out the door of her office building. "Running
late, as usual," she thinks. As she steps off
the curb onto the parking lot, she slips on a
patch of ice and pitches to the left.
Reflexively, her left arm shoots out to stop
her fall. As she lands on her outstretched
hand, Dominique simultaneously hears and
feels a snap just above her left wrist.

7. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
• What are some safety considerations
for the EMTs and patient in this
scenario?
• What signs and symptoms should the
EMTs look for in their assessment?

8. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
IntroductionIntroduction
• Injuries to muscles, bones, and joints
are common.
• Such injuries vary in severity from
minor to life-threatening.
• Proper emergency care can prevent
additional damage.

9. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Musculoskeletal System ReviewMusculoskeletal System Review
• Functions of the musculoskeletal
system are to:
 Give the body shape
 Protect the internal organs
 Provide for movement
 Store salts and other materials
 Produce red blood cells
continued on next slide

10. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Musculoskeletal System ReviewMusculoskeletal System Review
• Three types of muscles
 Voluntary (skeletal)
• Major muscle mass of the body
• Allows movement
 Involuntary (smooth)
• Internal organs
 Cardiac
• Heart
continued on next slide

11. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Musculoskeletal System ReviewMusculoskeletal System Review
• Tendons and ligaments
• Cartilage
continued on next slide

12. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Ligaments connect bone to bone. Tendons attach muscle to bone.
continued on next slide

13. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Structure of a joint.
continued on next slide

14. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Musculoskeletal System ReviewMusculoskeletal System Review
• The skeletal system
 Supports the body
 Motion is permitted by joints.
• Flexion
• Extension
• Adduction
• Abduction
• Rotation
• Circumduction
continued on next slide

15. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Musculoskeletal System ReviewMusculoskeletal System Review
• The skeletal system
 Axial skeleton
 Appendicular skeleton

16. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
The skeletal system.

17. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Bones of the upper extremity.

18. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Bones of the lower extremity.

19. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Types of injuries
 Fractures
 Strains
 Sprains
 Dislocations
continued on next slide

20. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• A fracture is a break in the continuity of
a bone.
• A fracture may be open or closed.
• Displacement of bones can cause
damage to surrounding tissues.
continued on next slide

21. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Types of fractures.
continued on next slide

22. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Closed and open injuries.
continued on next slide

23. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
A closed fracture has no associated open wound. (Shown here, a Colles fracture to the wrist, also called a silver
fork deformity because the deformed wrist looks like an inverted fork.)
(© Charles Stewart, MD, FACEP)
continued on next slide

24. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
An open fracture presents with an open wound, often with a bone end protruding through the skin.
continued on next slide

25. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Fracture signs and symptoms
 Pain
 Tenderness
 Deformity
 Discoloration
 Paresthesia
continued on next slide

26. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Fracture signs and symptoms
 Anesthesia
 Paresis
 Paralysis/inability to move the extremity
 Decreased pulse/perfusion
continued on next slide

27. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Fracture of the wrist. (© Charles Stewart, MD, FACEP)
continued on next slide

28. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• A pathologic fracture involves a
diseased bone; less force is required to
fracture the bone.
• Osteoporosis is a bone disease that
affects geriatric patients.
continued on next slide

29. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Complications of fractures include:
 Hemorrhage
 Tissue damage, including nerves and
blood vessels
 Infection
 Interruption of the blood supply
continued on next slide

30. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• A strain occurs when overexertion or
overstretching causes muscle fibers to
tear.
• Pain is usually localized with no edema
or discoloration.
continued on next slide

31. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• A sprain is an injury to a joint capsule,
with damage to the connective tissue,
usually the ligaments.
• Immediate pain and tenderness with
delayed swelling and discoloration.
continued on next slide

32. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Dislocation
 Displacement of bone from its normal
position in a joint
 Can cause damage to blood vessels and
nerves
 Presents with pain, tenderness, and
inability to use the joint
 Ligament or joint capsule damage is
likely.
continued on next slide

33. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Dislocation of the shoulder joint.

34. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Click on the injury that is characterized byClick on the injury that is characterized by
overstretching and tearing muscle fibers.overstretching and tearing muscle fibers.
A. Strain
B. Sprain
C. Dislocation
D. Fracture

35. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• General injury considerations
 All musculoskeletal injuries can present
with similar signs and symptoms.
 The force that causes the
musculoskeletal injury also may cause
other injuries.
 Always assess the mechanism of injury
and the signs and symptoms.
continued on next slide

36. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Mechanism of injury
 Direct force
 Indirect force
 Twisting force
continued on next slide

37. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Critical fractures
 The femur and pelvis
 Potential for significant bleeding; can be
life-threatening
continued on next slide

38. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
The bones are highly vascular and can bleed profusely if injured, as illustrated with the long bone shown. The
bones of both the femur and the pelvis contain a large blood supply with a tendency to bleed heavily when
fractured.
continued on next slide

39. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Assessment-based approach
 Size-up the scene for safety and
mechanism of injury.
 Perform a primary assessment; do not
be distracted by the dramatic
appearance of musculoskeletal injuries.
continued on next slide

40. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Assessment-based approach
 Life-threats or a pulseless or cyanotic
extremity require transport immediately
after the secondary assessment.
 For life-threatening conditions, use a
long backboard to immobilize the
patient; do not splint individual injuries
prior to transport.
continued on next slide

41. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Assessment-based approach
 Perform a rapid or modified secondary
assessment as indicated by the patient's
condition and mechanism of injury.
 Inspect and palpate the injured
extremity.
continued on next slide

42. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Assessment-based approach
 Check for deformity, contusions,
tenderness, swelling, and discoloration.
 Check the skin color, temperature, and
condition, and the circulation distal to
the injury site.
continued on next slide

43. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Signs and symptoms of bone or joint injuries.
continued on next slide

44. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Assess for the six "Ps"
 Pain
 Pallor
 Paralysis
 Paresthesia
 Pressure
 Pulses
continued on next slide

45. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Emergency medical care
 Use Standard Precautions.
 Administer oxygen, if needed.
 Maintain in-line spinal stabilization, if
indicated.
 Splint bone and joint injuries.
continued on next slide

46. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Emergency medical care
 Apply cold packs to reduce pain and
swelling.
 Elevate the extremity.
 Transport.
continued on next slide

47. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Injuries to Bones and JointsInjuries to Bones and Joints
• Reassessment
 Vital signs
 Interventions
 Distal pulses, motor function, and
sensation

48. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
EMTs Kyle Velez and Ellen Peterson have
arrived on the scene, glad to see that the
first-in engine has spread some sand on the
surface of the ice to minimize chances of
further injury.
continued on next slide

49. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
The EMTs quickly complete a primary
assessment and determine that the patient
does not have a serious mechanism of injury
or a likelihood of spinal injuries. Their next
concern is getting her out of the cold. The
patient is doing a good job of self-splinting
the injury for the moment, so they place her
on the stretcher and load her into the
ambulance before completing a modified
secondary assessment.
continued on next slide

50. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
Kyle carefully examines Dominique's left
upper extremity. She has a deformity and
swelling above the wrist. Her radial pulse is
present and strong, and distal motor and
sensory function are intact. She also has a
laceration of her left palm.
continued on next slide

51. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
• What would be some choices of splints
that would be effective in this case?
• What principles of splinting should the
EMTs follow as they immobilize the
injury?

52. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Splints are used to:
 Prevent movement of bone fragments or
ends, or dislocated joints to reduce
further injury
 Reduce pain and chances of
complications
continued on next slide

53. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Complications include:
 Damage to muscles, nerves, or blood
vessels
 Conversion of a closed fracture to an
open one
 Restriction of blood flow
continued on next slide

54. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Complications include:
 Excessive bleeding
 Increased pain
 Paralysis of extremities (from spinal
injury)
continued on next slide

55. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• General rules of splinting
continued on next slide

56. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT SKILLS 30-1
General Splinting Rules
continued on next slide

57. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Assess the distal pulse and motor and sensory function.
continued on next slide

58. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Cut away clothing to expose the injury site.
continued on next slide

59. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Place a sterile dressing over the open wound.
continued on next slide

60. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Align the extremity with gentle traction if there is severe deformity, absence of distal pulses, or cyanosis.
continued on next slide

61. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Pad the splint to prevent discomfort and unnecessary pressure. The correct size splint will immobilize the joint
above and below the site of a bone injury.
continued on next slide

62. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Maintain manual traction. Do not release until the splint has been applied. Assess distal pulse and motor and
sensory function after the splint has been applied.
continued on next slide

63. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
If your service uses commercially prepared prepadded splints, skip the padding step, but maintain manual
traction in any case.
continued on next slide

64. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• General types of splints:
 Rigid splints
 Pressure splints
 Traction splints
 Formable splints
continued on next slide

65. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• General types of splints:
 Vacuum splints
 Sling and swathe
 Spine board
 Improvised splints
continued on next slide

66. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Examples of splints.
continued on next slide

67. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
A bipolar traction splint.
continued on next slide

68. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT SKILLS 30-2
Applying a Vacuum Splint

69. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Manually stabilize the suspected fracture and assess pulse and motor and sensory function.

70. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Apply the splint and secure it to the extremity.

71. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Suction the air out of the splint until it is rigid. Reassess pulse and motor and sensory function.

72. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
An injured foot or ankle may be splinted by wrapping the area in an ordinary bed pillow.
continued on next slide

73. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Hazards of improper splinting
 Compression of nerves, tissues, blood
vessels
 Delayed transport
 Reduced distal circulation
 Aggravation of the injury
 Excessive movement
 Skin damage from improper padding
continued on next slide

74. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Splinting a long-bone injury
continued on next slide

75. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT SKILLS 30-3
Splinting a Long Bone
continued on next slide

76. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Apply manual stabilization to the injured extremity.
continued on next slide

77. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Assess the distal pulse and motor and sensory function.
continued on next slide

78. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
If the deformity is severe, distal pulses are absent, or the distal extremity is cyanotic, align with gentle manual
traction.
continued on next slide

79. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Measure the splint for proper length.
continued on next slide

80. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Secure the entire injured extremity. The hand (or foot) must be immobilized in the position of function.
continued on next slide

81. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Reassess the pulse and motor and sensory function.
continued on next slide

82. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Splinting a joint
continued on next slide

83. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT SKILLS 30-4
Splinting a Joint
continued on next slide

84. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Manually stabilize the joint in the position found. Then assess distal pulse and motor and sensory function.
continued on next slide

85. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Apply the splint to immobilize the bone above and below the joint.
continued on next slide

86. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Reassess sensory function, pulses, and motor function after the splint is applied.
continued on next slide

87. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Traction splinting
 Femur fractures can be accompanied by
bleeding, pain, and muscle spasm.
 Using traction to align the femur can
reduce complications.
 Treat for a fracture if the thigh is
painful, swollen, or deformed.
continued on next slide

88. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Do not use a traction splint if:
 The injury is within 1 to 2 inches of the
knee or ankle
 The knee has been injured
 The hip has been injured
 The pelvis has been injured
 There is partial amputation or avulsion
continued on next slide

89. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Traction splints may be unipolar or
bipolar.
continued on next slide

90. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Pelvic fracture
 Associated with pain and significant
bleeding
 Splinting methods include:
• PASG
• Commercial splints
• Improvised splints
continued on next slide

91. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
A pelvic fracture can be effectively splinted with a commercial pelvic splint. A pelvic splint may also be improvised
from a sheet.
continued on next slide

92. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Compartment syndrome
 Pressure develops within the injured
area.
 The pressure exceeds the capillary
pressure needed to perfuse the tissues.
 The tissue becomes hypoxic, which
results in further damage and swelling.
continued on next slide

93. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Compartment syndrome signs and
symptoms
 Severe pain or burning sensation
 Decreased strength in extremity
 Paralysis of the extremity
 Pain with movement
 Extremity feels hard to palpation
 Distal pulses, motor, and sensory
function may be normal
continued on next slide

94. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Basics of SplintingBasics of Splinting
• Compartment syndrome treatment
 Splint
 Elevate
 Apply cold
 Transport

95. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case Study ConclusionCase Study Conclusion
Kyle selects a padded, rigid splint that
extends from the fingertips to just below the
elbow. He carefully applies and secures the
splint, and then applies a sling to immobilize
the elbow. He reassesses the distal pulse,
and motor and sensory function.
At the hospital, Dominique is diagnosed with
a fractured radius and ulna, and will be
wearing a cast for the next six weeks.

96. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• Musculoskeletal injuries include
fractures, sprains, strains, and
dislocations.
• Some fractures can result in life-
threatening hemorrhage.
• EMT management of musculoskeletal
injuries can prevent complications.
continued on next slide

97. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• A variety of types of splints are
available to EMTs.
• Always assess pulse, motor, and
sensory function before and after
splinting.