broken arm/leg

[lampnyter]

Is there a way to actually tell if somebody broke their arm or leg on the field? Does pulling traction help you decide if its broken or not?

 

[lightsandsirens5]

Is there a way to actually tell if somebody broke their arm or leg on the field? Does pulling traction help you decide if its broken or not?

NOOOOOOOOOOOOO!!!!!! Don't go around yanking on peoples possibly broken limbs just to determine if they are broken or not!!!!

I only call a break when there is obvious deformity, bone ends sticking through the skin, etc. Or like the guy yesterday. Got pulled into the tractor auger and had his arm twisted around so bad that it was like jello. From his shoulder to his forearm. Poor guy was hurting like crazy. I would know for sure that it was broken in that case.

 

[46Young]

NOOOOOOOOOOOOO!!!!!! Don't go around yanking on peoples possibly broken limbs just to determine if they are broken or not!!!!

I only call a break when there is obvious deformity, bone ends sticking through the skin, etc. Or like the guy yesterday. Got pulled into the tractor auger and had his arm twisted around so bad that it was like jello. From his shoulder to his forearm. Poor guy was hurting like crazy. I would know for sure that it was broken in that case.

What he said.

We'll document the injury as a (swollen) painful, deformed extremity. It's a catch-all, and also happens to be the criteria for our pain management protocol regarding injuries.

It's not our place to officially diagnose the pt, even though it is in the practical sense. This is more of a medic thing, but we are effectively diagnosing the pt within our capabilities and resources. However, when documenting the call, it's best to do so as if you're just treating signs and symptoms. This is to protect you in court.

Example: "What did you say your diagnosis was?" "I didn't. My assessment revealed bilat rales, inability to speak full sentences, low SPO2, elevated BP, normal temp, sinus tach, no recent hx of infection or illness, rapid onset of S/Sx, etc. etc. I treated the pt according to the findings under our pulmonary edema protocol". IMO that's the best way to come across in court.

 

[lampnyter]

I was on a call before and the medic made me hold traction for a possible broken humerus. Was that wrong?

 

[alphatrauma]

I was on a call before and the medic made me hold traction for a possible broken humerus. Was that wrong?

Define "hold traction", as it pertains to what you actually performed. Were you just holding/stabilizing the injury, or were you actively applying traction? I don't see the logical of holding traction on a possible humeral fx, as there is no practical way to maintain it.

 

[46Young]

I was on a call before and the medic made me hold traction for a possible broken humerus. Was that wrong?

Did the medic say traction when they actually meant stabilization, or did they really mean pull on the limb?

 

[46Young]

Define "hold traction", as it pertains to what you actually performed. Were you just holding/stabilizing the injury, or were you actively applying traction? I don't see the logical of holding traction on a possible humeral fx, as there is no practical way to maintain it.

True, I've yet to see a field traction splint for the upper ext's.

 

[mycrofft]

Back to the book, whichever one you used in your class....

Pulling hard enough on an upper extremity to affect a spasmed fx limb may damage joints and nerves. Even dislocations we treated in house we did with the addition of enough benzo to relax em.

Field DX of POSSIBLE ( no Dx without xray) fx is history, point tenderness, pain, often loss of distal function, sometimes palpable step-off or crepitus, rarely angulation...unless you manipulate it like tractioning..

 

[MrBrown]

I am not an Orthopaedist and neither are you.

With that in mind is it swollen up?, is it painful?, is it bruised or discoloured?, is there a grating or crunching sound when moved?, is there a large piece of bone poking thru the skin going hey all whats up?, is it at a funny angle?

If so, chances are it's broked.

 

[lightsandsirens5]

If so, chances are it's broked.

Brown, I think the word is brokened, or maybe braked.

 

[mycrofft]

No, "broked"..

Two sylables, pronounced "BROK-ed", long "o", short "e".
At least my daughter said it that way when she was four...

BTW, don't we all think forearm or distal leg when we say "broken bone"? We sure tend to teach it that way!

 

[lampnyter]

yea the medic actually told me to apply traction by pulling on the arm.

 

[Sassafras]

Two sylables, pronounced "BROK-ed", long "o", short "e".
At least my daughter said it that way when she was four...

BTW, don't we all think forearm or distal leg when we say "broken bone"? We sure tend to teach it that way!

For some reason I do think forearm, but I always think femur if I envision legs.

 

[akflightmedic]

yea the medic actually told me to apply traction by pulling on the arm.

Since you were directed to do it, and you kind of hint that you did do it...can you please tell me HOW you did it and the patient's response? And after doing it, how you maintained it? Also the reaction of the hospital staff please?

If you decided not to do it, what was the outcome?

 

[Akulahawk]

Is there a way to actually tell if somebody broke their arm or leg on the field? Does pulling traction help you decide if its broken or not?

Two answers: Yes, there is... and no, it doesn't. In order.

A little more explanation is in order. Not many Paramedics are ever educated in how to determine whether or not someone has a strain, sprain, or fracture in the field. Those that do have that level of education, did not acquire it as part of their Paramedic Education and therefore do not have that in their authorized scope of practice. Learning this takes time, and years to acquire the expertise and (literal) feel for it. The best at it are Orthopedic Surgeons. Why? When they're in surgery, they get to see what they (literally) felt during their exam and saw in the imaging studies.

Pulling traction may help some in pain control... but if the muscles start contracting to splint the break, the amount of force necessary to provide an adequate level of pain control can cause dislocations, neurovascular damage... a little traction can help stabilize long bone fractures though. FWIW.

 

[lampnyter]

Since you were directed to do it, and you kind of hint that you did do it...can you please tell me HOW you did it and the patient's response? And after doing it, how you maintained it? Also the reaction of the hospital staff please?

If you decided not to do it, what was the outcome?

well the patient was a 2 y/o so he was still crying. i was the first responder on scene and i went onto the ambulance to help but i didnt go to the hospital with the medic. What the medic told me to do was to hold about at the shoulder and pull at the wrist. I didnt maintain it because i got off the truck.

 

[akflightmedic]

I am sorry you were instructed to do that. You are not to be faulted as you did not know better. That medic needs a new career...

There are so many questions about this call...a 2 year old with a fractured humerus???
Pulling traction on a fractured arm?
Pulling traction on a pediatric?

Was this a car accident? Toddlers do not routinely break their humerus.

In EMT school, when you were taught to pull traction on a FEMUR fracture, what was the reasoning? In addition to why you pulled traction, how did you know you were making progress or pulling the right amount? Answer: most times the patient will express some relief. So even in the unlikely event that traction being pulled was the right thing...do you think the toddler would express relief? Do you think he would suddenly stop crying and smile at you?

I am not pointing fingers at you, I am asking questions to walk you down the path of critical thinking, so in the future, you may know better or have better reasoning skills to think past the immediate and understand the hows and whys of a treatment.

One of my favorite quotes of all time is:

Training gives us a 1000 ways to skin a cat.
Education tells us the cat didn't need to be skinned to start with.

 

[mycrofft]

KId's folks have a potential lawsuit if that arm atrophies.

Cutting to chase....if there are signs of fracture as listed in training, treat for fracture as in training. If in doubt, splint. Splinting is even good for severe lacs (in combination with bandaging), allowing clotting to begin in place, so long as the binding does not result in circulation compromise due to swelling, as in any case.
Personally, unless circulation is affected, I have been shy of even straightening a fractured limb. A fracture hurts, even if it were reduced and splinted by a professional; movement including maltreatment makes pain worse. Immobilization even if "as it lies" (pillows and duct tape) is often sufficient and best.
Doctors don't treat definitively without xray, we should not either.

 

[lampnyter]

The kid fell about like 8 feet. I just did what the medic told me because i was only an EMR at the time and not EMT.

 

[ajax]

filed under "not our scope of practice"

One way to evaluate potential long bone fractures is auscultating. Read more here: http://www.ems1.com/ems-products/EMS-Equipment/articles/592414-Wait-a-Minute-You-Auscultated-What/