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Fractures

Fractures. # - what is it?. “break in the continuity of the bone”. Mechanism Of Injury (MOI). http://www.youtube.com/watch?v=zbf8CEVNsh8 http://www.youtube.com/watch?v=y8UQHAiAziU. MOI. Think c-spine !! (especially with distracting injuries ). MOI. What happened before/during injury?

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Fractures

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  1. Fractures

  2. # - what is it? • “break in the continuity of the bone”

  3. Mechanism Of Injury (MOI) • http://www.youtube.com/watch?v=zbf8CEVNsh8 • http://www.youtube.com/watch?v=y8UQHAiAziU

  4. MOI • Think c-spine!! (especially with distracting injuries)

  5. MOI • What happened before/during injury? • How much force? • Enough force to cause #? (speed, rotation etc) • How likely is a # in the hurty area?

  6. Recognition (Look, Feel, Move) • Tenderness (on the bone) • Crepitus (grating) • Unnatural position • Pain • Loss of power • Immobility • Deformity (compare L-R) • Swelling • NB - Often difficult to diagnose a # in the field AND… • Sound/feel • Pulse / temp • Cap refil • Pins + needles • Weight-bearing!

  7. Assess • Pain (out of 10) • Pulse & cap refil (why?) • Sensation • Movement (& power)

  8. Treatment – Mild Sprain • Rest • Ice • Compress -omfortable support • Elevate • Ibuprofen • If it gets worse, get yersen to t’ th’hospital

  9. Treatment – Fracture • First, primary survey! (esp with trauma) • Rest / Immobilise! • ICE • Comfortable support (immobilise) • Elevate? (careful) • Pain management • Ice, paracetomol, distraction, entonox? • Assess perfusion / circulation • Traction required?? • Hospital • Don’t mention X-ray!

  10. Immobilising / Splinting • Immobilise & protect potentially broken bones • Reduce soft tissue (/ nerve / muscle) damage & blood loss • Reduce pain • Splinting a sprain?

  11. Upper Body # • Injuries of … hand, wrist, arm, shoulder, clavicle, scapula, sternum, ribs … • What’s most comfortable? • [Arm sling] • Hospital (999 required?)

  12. Pelvic # • Usually a LOT of force required • Take great care – don’t ‘spring’ the pelvis • Stretcher • Triangular bandage

  13. Lower Extremity # • Locate injury site • Comfortable support above & below injury • ETA for crew? Responder? • May be best to wait for a splint • After doing anything check: • Pulse (+ cap refil) • Sensation • Movement

  14. Lower Extremity # (in the wilderness)

  15. Lower Extremity # - Traction • What is traction? • When would we need it? • Why would we do it?

  16. Lower Extremity # - Traction • Indicated in long-bone fractures (particularly femur) when circulation is severely compromised. • Not indicated with ?# ankle/knee • Careful!

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