OECTools Class # Splints

Transcription

1 OECTools Class #10196 Splints Anterior Shoulder Dislocation Splint: Pigs in a Blanket... 2 Bent Knee Splint: Flag Fold Clavicle Splint: Figure 8 Cravat Elbow Splint: Chopsticks Humerus Splint Posterior Shoulder Dislocation: Airplane Splint Sager Traction Splint: Mid Femur Fracture Page 1

2 Anterior Shoulder Dislocation Splint: Pigs in a Blanket Setup the Pigs.. Fold a blanket into quarters. You need 4 cravats. Tie two together and leave two others. This is where it s important to identify your cravats. The super long cravat is usually easy to tell. Just tie knots in the ends of one of the other cravats, or number the ends etc etc. Page 2

3 Roll up the pigs into the blanket. Page 3

4 The blanket will unroll in one direction. Make sure you put the part which unrolls, toward the patient s chest. Imagine you are going to roll the wrap over their head. If you put it on their chest and can unroll it over their head you ve got it correct. If on the other hand you start unrolling toward their feet, you ve botched it. You ll see why.. Page 4

5 Anterior Shoulder dislocation. Check CSM before and after splinting. Page 5

6 Patient cannot lower their shoulder. Just insert the pigs in the blanket and have the patient hold them in place supporting their injured shoulder. Page 6

7 Tie one set of short cravats into a sling on the patient s back side using a square knot. Page 7

8 Tie the second short cravat around the patient s waist. But use a bow tie. We ll be coming back to this knot to pull it tighter shortly. Page 8

9 Return to the front of the patient and fold the long cravat coming out of the blanket from the patient s right side back over the injured arm and over the blanket for now. Page 9

10 Twist the two cravat s together and send one down along the patient s chest between the blanket and his chest. The other cravat just hangs down over his arm for now. Think of this as being the bottom side of a present, which you re attaching a ribbon to. Doesn t matter which one goes where, one needs to go down between chest and blanket. Page 10

11 Tucking the cravat in between the chest and the blanket is only possible if you put the blanket roll on the patient properly.. Page 11

12 And what do you know, out pops the cravat on the bottom! Page 12

13 Now just tie the two long cravats together using a square knot. Page 13

14 If you have excessively long cravats, you might have some extra fluff.. Page 14

15 Go back to the back of the patient and undo the bow tie you did. Page 15

16 Ask the patient to take a deep breath and let it out. When they let it out, tighten the cravats and this time tie a square knot. Page 16

17 Completed Splint. Check for CSM and you re done! Page 17

18 Bent Knee Splint: Flag Fold Fold a blanket into quarters. Not thirds, but quarters. Page 18

19 Fold over the end and start flag folding the entire blanket. Page 19

20 Continue the flag fold till you get to the end of the blanket. Page 20

21 Tuck the final part of the blanket into the fold. Page 21

22 Get copious amounts of duct tape and secure the blanket into it s form. Page 22

23 Patient s knee is locked in the bent position. They cannot move it. Page 23

24 Put the flag fold underneath their leg for support. Page 24

25 Some settling will occur on the blanket, but the duct tape will help it maintain it s form. Secure the patient s ankles together with duct tape to help support the knee. Page 25

26 Taping over clothes is usually fine, but if there is an issue, stick some carpet padding in. Page 26

27 Lay out 3 cravats as shown. You ll be using two to tie to the patient s leg and the third will pull the two cravats together. Page 27

28 Pull the cravats under the patient s knees and up over the injured leg. Page 28

29 Pull the cravats up between the patient s legs. Page 29

30 Tie one cravat on the thigh. The other on the tib/fib. Page 30

31 Now tie the third cravat together to pull the two cravats securing the entire package together. Page 31

32 Check Distal CSM once more and you re done! Page 32

33 Clavicle Splint: Figure 8 Cravat Dude in obvious discomfort. Check distal CSM on the injured side. Page 33

34 Start by tying two cravats together with a square not. Page 34

35 Put the knot in the center of the patient s back and run one end of the cravat in front of the patient s right arm. Page 35

36 Run the other end of the cravat under and then over the patient s left arm. Page 36

37 Tie the two ends of the cravats together with another square knot. As you pull them together, you re pulling the clavicles back into position and splinting the injury. Page 37

38 Notice how the shoulders are lifted back and away re-seating the clavicles. Page 38

39 Finish the splint by tying off the two cravats. Try to get them away from the center of the shoulder, but it s a given that this person will be riding the toboggan down in a chaise lounge. Check distal CSM on the injured side once again. Page 39

40 Elbow Splint: Chopsticks Setup the splint. Start first by optionally marking the midpoint of the cardboard. Page 40

41 Score the cardboard by cutting through one side, being careful to not create a second patient by avoiding cutting yourself! Page 41

42 Turn the cardboard over and fold it. Cut it through to the other side and Wa-la!. Page 42

43 Fold the two pieces of cardboard into small triangles, and tape them at least in 4 positions. Page 43

44 Patient will present the injury as being unable to move the elbow at all. Go to skin. Check CSM. Page 44

45 Stick a cravat over the elbow for now... Page 45

46 Bring over the cardboard splints and measure for size. Do not disturb the elbow. Mark with your sharpie where you need to cut the back ends off. Only make one cut off the back. Page 46

47 Remove the cardboard from the patient and cut the splints to size. Page 47

48 Bring the splints back to the patient and get their help in stablizing them. Page 48

49 Tie the two splints together with the cravat so the splints are held in place. Page 49

50 Tie the two splints together over the wrist to secure the splint over the wrist. Page 50

51 Tie the two splints together over the shoulder to apply pressure and lock the elbow in place. Might want to notch the splint to keep the bandages from sliding off if that is a problem. It wasn t here. Page 51

52 Tie the entire splint to the patient s chest if you have enough cravat left. If not, make a sling and swath. Check CSM and you re done. Page 52

53 Humerus Splint Injury is typically presented as self splinting. Position of comfort. Page 53

54 Measure the splint near the patient s arm for best fit. Bend over the top corner so the splint rests comfortably in their arm pit. Page 54

55 Apply the splint so that there is about 2 fingers worth of space under the elbow. Make certain the SAM is rigid by making aggressive folds on the sugar tongs. Page 55

56 Always get the patient s help if possible. Page 56

57 Start securing the splint with roller gauze on the wrist. Start with a Tail.. Page 57

58 Secure the Tail and start a figure 8 wrap around the splint. Page 58

59 This is a splint, make sure it is securely held in place by twisting bandages, no less than every other wrap. Page 59

60 Your goal is to get to the top of the splint which is covering the joint as quickly as possible. To do this, you will NOT be over-wrapping the bandage as you go up. Leave gaps. Page 60

61 Remember to twist to secure the bandage in place on the splint. Page 61

62 Once you reach the top of the splint, go over it with the roller gauze and start back down again. Page 62

63 Fill in the gaps which you created on the way up the arm, remembering to twist the gauze to make it secure. Page 63

64 When you get back down to the forearm again, you might want to add a second roller just to fully secure the splint. Page 64

65 Start another Tail Page 65

66 Secure the Tail. Page 66

67 Start figure 8 wrapping around the arm and the humerus again. Page 67

68 Go back up the arm one more time, filling in any spots which are not covered/secured. Page 68

69 Remember to twist the friggin roller!! Page 69

70 There you go!! Page 70

71 Over the top again.. Page 71

72 Finally, back down the arm again Page 72

73 If you don t have enough left to tie it off, just use Tape, but make sure you use enough to hold it into place. Page 73

74 Tape really only will stick to itself when it s wet out, so you need to carefully circle the arm making sure you re not cutting off the circulation. (Don t wrench it down). Page 74

75 Completed splint.. This splint easily will pass the rub test meaning you can run your hand up and down it and it won t come apart or loosen. Page 75

76 Always remember to check CSM before and after splinting. Page 76

77 Get the patient to help while you get your monster cravats out. Page 77

78 Tie a not in the corner of the sling (at end of triangle). Page 78

79 Pull up the sides. Page 79

80 Square not in the back, try to get it to the side of the patient so they don t sit on the knot when riding down in the sled. Page 80

81 Patient no longer needs to support injury once it s in the sling. Page 81

82 Use a second cravat for a swath. However, open up this cravat double-wid so that the force is distributed evenly over the injury. Page 82

83 Opening the swath wide allows you to secure the sling to the patient without causing pain on the injury site. Page 83

84 Square not in the front for patient comfort. Page 84

85 Completed splint with sling and swath. Page 85

86 Posterior Shoulder Dislocation: Airplane Splint Setup the splint. Tape the cardboard into a large triangle in at least 3 places. Don t worry about where you tape for now. We ll fine tune that later. Page 86

87 Patient will present themselves with dislocation which prevents them from lowering their arm. First priority, check for bleeding by going to skin and then check CSM. Page 87

88 Secure the arm to the head using a figure 8 bandage of the head and the wrist. Page 88

89 Tie a cravat around the patient s waist and then bring in the cardboard. Insert the cardboard into the waist strap and check for alignment. Use your sharpie pen to mark the angle of the arm which you want to replicate. Page 89

90 Use your sharpie to draw in the other side of the cut. In this instance we need to add more tape otherwise we ll cut away almost all the holding force of the existing tape. Page 90

91 So no big deal, just add another tape band to the splint. Page 91

92 After cutting the splint, just open the top of it. You also want to make a notch in the side of the splint to keep your cravat from sliding down the splint. Page 92

93 Put the splint on the patient at the waste and then attach a sling around the chest to hold it in place and support the arm. Lock this cravat into the notch that you cut on the side of the splint. Page 93

94 The splint portion which covers the arm, ought to be cut to size. Since it s on the patient, you cannot use your knife, but paramedic shears are fine. Just mark a line with your sharpie and then cut it off. Page 94

95 Wa-la! Page 95

96 Now secure the arm in place with another roller bandage and you ll be set. Ideally we should add carpet padding if we have it to make the best fit possible. Page 96

97 The completed splint supports the patient s arm in the position found. There is nothing to sling and swath. It s already packaged to go into the toboggan sitting in a chaise lounge. Just check CSM once more and you re good to go. Page 97

98 Sager Traction Splint: Mid Femur Fracture Sager bi-lateral traction splint comes with 4 bands: 2 short, one medium, one large and one huge. Since it s bilateral, it has two booties. One for each foot. Page 98

99 Bilateral sager never needs to have the head reversed, but it is useful to make sure the D rings are both at the top of the splint and that the bottom flexes. Page 99

100 Put the splint between the patient s legs and ask them to pull it into their crotch as far as they can. For guys, make sure the make the necessary adjustments. Page 100

101 Try to get the sager belt as high on the top of the thigh as possible. It ll slip down somewhat as you tighten it so the higher you start up the better off you will be. As you tighten, pull from the bottom to get the splint to curve over under the leg. Page 101

102 The booty goes over the foot for ski boots (as shown here even though we don t have ski boots on the patient course this patient never has ski boots on..) Page 102

103 Attach the sager booty to the bilateral splint. Make sure there are no twists in the belt. Page 103

104 Tighten the booty until one of two things occurs: 1) 1) Bottom of sager is directly beneath the foot. 2) 2) All slack comes out of the strap It s important to not over-tighten the strap as this will put traction on the leg. Page 104

105 Pull traction by: 1) 1) Pushing with one arm on the splint into the patient s crotch. 2) 2) Pulling on the handle one click at a time. Page 105

106 Read the traction setting black readings are in lbs, red are in kg. Make sure you pull lbs.. Maximum traction applied to a single leg should be 15 lbs. Or 10% of body weight whichever is LESS. Maximum traction applied to dual lets should be 30 lbs or 20% of body weight whichever is LESS. Page 106

107 All sager belts will be threaded under the gap in the knee. Grab the large sager belt and bring it through. Be careful with the belts to keep the snow out of the Velcro otherwise it will not work. Page 107

108 Position the large sager as high on the leg as you can get it and securely fasten it to the leg. It s perfectly fine for Sager belts to go over the injury. It helps secure the injury and adds direct pressure to help control bleeding. Page 108

109 Bring the next short belt under the knee just like the first belt. Page 109

110 Depending on patient, position this belt above the knee or below the knee. It s important to not put it over the knee. Page 110

111 Position the third sager belt under the knee. Page 111

112 Attach the third sager belt just above the booty on the lower leg. Page 112

113 Cravat the legs together by running a cravat under the ankles just like we do for backboards. Page 113

114 Page 114

115 Page 115

116 Bring the Huge sager belt under the knees of both legs. Page 116

117 Secure both legs together with the huge sager belt. In the case of a bilateral injury, you would hook up the second booty prior to pulling traction. You d use 3 sager belts on the limb which was injured the most severely and then wrap the big belt at the end around both. Page 117

118 Finally, check distal CSM and you re done.. Page 118