|This is a leg cast.|
|This is a leg splint.|
Why the difference? Because when you initially break or fracture a bone, you may experience severe swelling over the next few days. If we gave you a cast right away, then your leg or arm could swell up so much that you could lose circulation. No circulation could cost you the whole arm or leg. By leaving some "breathing room" the extremity can swell a little and you still have blood flow. However, a splint is temporary and recommended for 3 days until the swelling has passed and you can see an orthopedic doctor.
SO someone walks up to me with a broken wrist (or almost any bone). How do I treat it?
1. Observe: It is important to pinpoint where the injury has occurred. The most simple solution to this is to ask the patient, "Where does it hurt?". Also examine for any additional injuries, a grating sensation (broken bones rubbing against themselves), or strange angles in the bone. Also make sure the patient is staying conscious and not entering shock. If they are having trouble breathing, it is your priority to stabilize that first. Shock will kill a person much sooner then broken bones.
2. Wound Care: If any bones are protruding out of the skin, you will need to apply a sterile dressing to cover the opening and an ice pack to reduce swelling. Elevating the extremity is also very useful for swelling.
3. Bone Realignment: This is what we always see in the movies. Preferably with a partner holding the extremity, you need to pull gently on the injured extremity until it enters a neutral position. While painful at first, patients will experience a huge sense of relief afterwards as the bones, veins, arteries, and nerves straighten out. If this is NOT done, then the splint will cause further damage or the bone could heal improperly. If any strong resistance is felt, then you need to stop and splint as close to a neutral position as you can.
4. Assess: Check for the 5 P's (pain, pallor (color), poor circulation, paresthesia (numbness), pulse, and paralysis}. This is important because we will need to check these AFTER applying the splint to make sure it isn't too tight.
5. Splinting: This is widely regarded as a very creative process. There isn't a right or wrong way to splint, so it is kind of an art form for us EMTs. You can use anything from a piece of wood to a soccer shinguard. The important thing is we are wrapping the extremity to a stable surface so there is no chance it will be moved after realignment. Wrap the injured bone as well as the joints above and below so they cannot move. At this point also cut/remove any jewelry such as rings.
6. Reassess: Recheck the 5 P's (Step 4). If they have had some pain relief and still posses the same level of function, then this person is well on their way to recovery.
|Notice that the top and sides of this splint are |
SOFT bandage. The bottom is hard fiberglass bandage.
Following up with an orthopedic specialist is always recommended to ensure proper healing. Always see a professional if you think you may have broken something, but this tutorial can assist you in emergency situations and if you are far from a hospital.