Drill of the Month Developed by Gloria Bizjak

1. Drill of the MonthDeveloped by Gloria Bizjak Trauma Basics: Managing Upper Extremity Fractures

2. Trauma Basics: Managing Upper Extremity Fractures Student Performance Objective: Given information and resources, splinting materials, demonstration, and time to practiceEMTs will be able to: • List management, assessment, and care for upper extremity fractures • Review Hand/upper Extremity Trauma Protocol • Describe and demonstrate methods of splinting fractures of the upper extremities: • Shoulder (scapula) and collar bone (clavicle) • humerus (arm) • elbow • forearm (forearm), wrist (carpals), and hand (metacarpals) • fingers (phalanges) EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

3. Trauma Basics: Managing Upper Extremity Fractures Overview • Management, Assessment, and Care • Hand/upper Extremity Trauma Protocol • Splinting Upper Extremity Fractures Drill of the Month

4. Trauma Basics: Managing Upper Extremity Fractures • Management • Review Protocols for general patient care • Review trauma patient assessment • Initial assessment • Vital signs, SAMPLE • Focused history and physical exam Drill of the Month

5. Trauma Basics: Managing Upper Extremity Fractures • Management • Review purpose of splinting • Immobilize • Minimize movement • Prevent further tissue damage • Prevent closed fracture from becoming open • Control bleeding Drill of the Month

6. Trauma Basics: Managing Upper Extremity Fractures • Management • Review purpose of repositioning • Effective splinting • Restore circulation • Aide patient comfort • Prevent closed fracture from becoming open • Prevent further tissue damage Drill of the Month

7. Trauma Basics: Managing Upper Extremity Fractures • Management • Review management of joint injuries • Splint in position found; reposition • If circulation is absent • If the attempt meets o resistance • To establish a pulse Drill of the Month

8. Trauma Basics: Managing Upper Extremity Fractures • Assessment • Patient complains of pain, tenderness • Guards injury site • Describes injury • Points to site • Care provider examines site • Looks for deformity or angulation (compare to uninjured side) • Looks for other injured areas Drill of the Month

9. Trauma Basics: Managing Upper Extremity Fractures • Assessment • Patient complains of grating sensation or sound (crepitis) or a pins-and-needles sensation • Care provider looks for: • Swelling and/or deformity or angulation • Bruising • Exposed bone Drill of the Month

10. Trauma Basics: Managing Upper Extremity Fractures • Assessment • Patient complains of inability to move joint • Care provider checks for joints locked in unusual position (dislocation) • Care provider checks for distal pulse, motor function, sensation Drill of the Month

11. Trauma Basics: Managing Upper Extremity Fractures • Care (general) • BSI precautions • Initial Assessment • Rapid Trauma Exam • Cervical collar for suspected spine injury • Life-threatening injuries Drill of the Month

12. Trauma Basics: Managing Upper Extremity Fractures • Care (general) • Painful, swollen, deformed extremities • Low-priority, stable patient • Splint individual injuries • High-priority, unstable patient • Immobilize on long board • Load and go Drill of the Month

13. Trauma Basics: Managing Upper Extremity Fractures • Care (general) • Stabilize injury site • Check distal pulse, motor function, sensation • Cover open wounds, elevate while splinting • Measure, select, position splint • Stabilize until splint is secured; not too tight/loose • Recheck distal p-m-s • Apply cold pack Drill of the Month

14. Trauma Basics: Managing Upper Extremity Fractures • Hand/Upper Extremity Trauma Protocol • Injuries • Complete/incomplete hand/upper extremity amputations • Partial/complete finger/thumb amputations • Crushing, degloving, devascularization injuries • High-pressure injection injuries • Loss of perfusion • Nerve injury (compartment syndrome) Drill of the Month

15. Trauma Basics: Managing Upper Extremity Fractures • Hand/Upper Extremity Trauma Protocol • Referral • Adults: Curtis National Hand Center at Union Memorial Hospital • Pediatrics (have not reached 15th brithday): Pediatric Trauma Center • Stable patients with isolated injury at or below mid-humerus: Hand Center or nearest appropriate trauma center Drill of the Month

16. Trauma Basics: Managing Upper Extremity Fractures • Hand/Upper Extremity Trauma Protocol • Contraindications for referral to specialty center • Unstable/abnormal vital signs: to trauma center • Major/multiple system trauma: to trauma center • Partial/complete toe amputation: to medical facility Drill of the Month

17. Trauma Basics: Managing Upper Extremity Fractures • Hand/Upper Extremity Trauma Protocol • Care for amputated part • Keep dry • Place in sealed plastic bag • Place on top of ice • Do not freeze Drill of the Month

18. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures • Shoulder and collar bone • Stabilize and check distal p-m-s • Use sling and swathe: Position sling, secure w/forearm elevated across chest • Position knot to side of spine; pad knot • Secure point of sling • Stabilize arm with cravat across chest • Recheck distal p-m-s Drill of the Month

19. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures Humerus: General Care • Stabilize extremity • Check distal p-m-s • Place hand in position of function • Immobilize w/board and/or sling and swathe Drill of the Month

20. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures Humerus: Specific Care • Proximal fracture: use sling and swathe • Distal fracture: use narrow sling to support wrist, leave elbow exposed; stabilize with swathe • Mid-shaft: measure and secure padded board splint, fingertips exposed; support with swathe Drill of the Month

21. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures • Elbow: General Care • Check distal p-m-s • With distal pulse, stabilize and splint in position found • With no distal pulse, attempt to reposition to obtain pulse • Hand in position of function • Immobilize • Recheck distal p-m-s Drill of the Month

22. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures • Elbow: Specific Care • Straight position • Measure, secure padded board splint • Leave fingertips exposed • Pad between patient and splinted arm • Secure arm to torso • Bent position • Place padded board splint over angle of arm • Secure with cravats • Apply wrist sling, keeping forearm elevated Drill of the Month

23. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures • Radius/Ulna, wrist, hand: General Care • Stabilize • Check distal p-m-s • Hand in position of function • Immobilize • Recheck distal p-m-s Drill of the Month

24. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures • Radius/Ulna, wrist, hand: Specific Care • Measure, apply splint from elbow to fingertips • Secure splint with roller gauze • Wrap distal to proximal • Leave fingertips exposed • Apply sling, keeping forearm elevated against chest • Stabilize with cravat Drill of the Month

25. Trauma Basics: Managing Upper Extremity Fractures • Splinting Upper Extremity Fractures • Fingers • Splint injured finger to uninjured finger with tape OR • Splint injured finger with tongue depressor Drill of the Month

26. Trauma Basics: Managing Upper Extremity Fractures Student Performance Objective: Given information and resources, splinting materials, demonstration, and time to practiceEMTs will be able to: • List management, assessment, and care for upper extremity fractures • Review Hand/upper Extremity Trauma Protocol • Describe and demonstrate methods of splinting fractures of the upper extremities: • Shoulder (scapula) and collar bone (clavicle) • humerus (arm) • elbow • forearm (forearm), wrist (carpals), and hand (metacarpals) • fingers (phalanges) EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

27. Trauma Basics: Managing Upper Extremity Fractures Review • Management, Assessment, Care • List MIEMSS Protocols for General Patient Care • List purposes of splinting • List management steps of joint injuries • List assessment steps for a trauma patient • List general care steps for a trauma patient Drill of the Month

28. Trauma Basics: Managing Upper Extremity Fractures Review • Hand/upper Extremity Trauma Protocol • State MIEMSS Trauma Protocol for Hand/Upper Extemity Trauma • List indications for transport to specialty centers for adults and peds • List contra indications for transport to specialty center Drill of the Month

29. Trauma Basics: Managing Upper Extremity Fractures Review • Splinting Upper Extremity Fractures • List care steps for immobilizing each of the following fractures • Shoulder, collar bone • Humerus • Elbow • Forearm, wrist, hand • Fingers Drill of the Month