Transcript Slide 1
Forum Presentation: DCMT (Directorate of Combat Medic Training) U.S. Army Whiskey, 2007 Instructor Training Breakout Sessions, Ft. Sam Houston, TX References: Heightman, MPA, EMT-P JEMS “Articulated Injuries”, Auerbach, MD Annals of Emergency Medicine, “Experience…” Monchik, MD, NREMT-P Compression 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. RR and D, Inc., © May 2007 WWW.SPLINTS.COM TOPIC: EMERGING ISSUES IN THE FIELD TREATMENT OF LOWER EXTREMITY FRACTURES AND DISLOCATIONS… “SAVING LIFE AND LIMB” SAVING LIFE AND SAVING LIMB’S, TOO” “Discussion of: Types, Basic Anatomy, Causes…” Orthopedic Emergencies Open fractures Long Bone Fractures Dislocations Extremities with neurological or vascular compromise (GSW) Compartment syndromes Open Fractures Long Bone Fracture Dislocations Gun Shot Wounds “Immobilizing injuries in the position found.” “Immobilizing the joints above and below the injury site” Help to prevent further injury… Help to Relieve pain… Help to Determine Mechanism of injury… The Knee and Ankle are always in play and must be frozen in place LACK of UNDERSTANDING LACK of APPRECIATION LACK of EQUIPMENT “Knee Anatomy” The “TWO P’s” in the knee. Peroneal Nerve, Popliteal Artery Popliteal Artery Common Peroneal Nerve Peroneal Nerve & Popliteal Artery Peroneal Nerve & Popliteal Artery Entrapment…Compression Tractioned or Stretched Compartment Syndromes Compartment Syndrome Definition Elevated tissue pressure within a closed fascial space Reduces tissue perfusion Results in cell death Pathogenesis Too much inflow (edema, hemorrhage) Decreased outflow (venous obstruction, tight dressing/cast) Compartment Syndrome Etiology Fractures-closed and open Blunt trauma Temp vascular occlusion Cast/dressing Closure of fascial defects Burns/electrical GSW IV/A-lines Snake bite Arterial injury Compartment Syndrome Tissue Survival Muscle 3-4 hours - reversible changes 6 hours - variable damage 8 hours - irreversible changes Nerve 2 hours - looses nerve conduction 4 hours - neuropraxia 8 hours - irreversible changes Compartment Syndrome Diagnosis Pain out of proportion Palpably tense compartment Pain with passive stretch Paralysis Pulselessness/pallor “MORBIDITY ISSUES” 1. Foot drop 2. Ankle and Foot Palsy 3. Gaiting difficulties 4. Loss of sensation 5. Toe Dragging 6. Loss of muscle tone 7. Long term health effects 8. Psychological The “Perfect Splint” for the job Extrication Management Strap Architecture Repositioning Traction Capability “Tactical System… Perfect traction too” The changes can be expressed in a matter of degrees The changes can be expressed in a matter of degrees