Splinting of A Fractured Sternum??

[Uller55]

OK..... I'm taking paramedic classes and currently in ITLS, my instructor gave us a homework question about would you splint a sternum fracture and how??

I have researched this for a wile with no good out comes......Any thoughts?

Thanks

Scott Slaterback EMT-I

 

[DesertMedic66]

I wouldn't split itfor 2 reasons:
1: I have no clue how to possibly splint that.
2: I don't think it could really be supported by any kind of prehospital splint.

 

[bahnrokt]

Unless it was a horrific injury I'm not sure I'd even be able to ID a broken sternum from ribs.

Place pt in position of comfort and assess/treat for flail chest if present.

 

[VFlutter]

Not really sure how you would splint a fractured sternum, if at all possible, but I would be cautious moving to the patient due to the possibility of a bone fragment puncturing a lung or the heart.

 

[NYMedic828]

Don't want to put anything too tight across the chest for risk of inhibiting expansion of the chest wall.

Also need to be careful with the potential for sharp bone fragment/sternal edges shearing underlying tissue, primarily cardiac.

For a suspected sternal fracture, my treatment would be ice, position of comfort and fentanyl. (they will have a lot of pain on breathing)

 

[Handsome Robb]

Could it be similar to a flail segment? With a fractured sternum you've effectively "destroyed" the continuity of the rib cage which is the structural basis for how breath, no structure, no breathing. In that case PPV + an ETT would be the first choice as a splint until surgical intervention can take place. Internal splinting if that makes sense?

Just my .02

 

[DPM]

Could it be similar to a flail segment? With a fractured sternum you've effectively "destroyed" the continuity of the rib cage which is the structural basis for how breath, no structure, no breathing. In that case PPV + an ETT would be the first choice as a splint until surgical intervention can take place. Internal splinting if that makes sense?

Just my .02

That's a little bit much, I fractured mine and I could breathe It hurt a lot but that was about it, and no worse than the broken ribs.

I wonder if your ITLS instructor is on here....

 

[bigbaldguy]

Light pressure to alleviate pain during inhalation perhaps? Like a broken rib. A folded towel down the center of the chest and an ace bandage wrapped around the patient might help with stabilizing it.

 

[mycrofft]

Define broken

 

[Medic Tim]

I would use a pillow or blanket. Have the pt hold it over chest in position of comfort. Or the position that allows them to breath. Oh and fentanyl.

 

[lightsandsirens5]

Are we talking simply fractured, or totally separated? Fractured, I'd "splint" it with fentynal just to make breathing easier. Separated, manually stabilize it (Ie, use your hand to keep it from moving in and out), then PPV them. The biggest problem I see with a fractured sternum is pain. For a separated sternum on the other hand, you have loss of some negative pressure, as well as probably extreme pain, and trouble breathing due to chest rigidity comprimise. (As well as pain of course.)

 

[Akulahawk]

I might simply place a pillow on the patient's chest and have the patient hold the pillow in place to allow for some comfort that the patient can control. I might also then consider CPAP to make it easier to inhale so the patient has to simply relax and inhalation occurs basically passively instead of having to create a neg pressure (that basically grinds the bone ends together) resulting in pain. If I can give the patient some opiates, carefully titrated morphine or fentanyl would be what I'd give, titrated to relieve pain to a tolerable level.

 

[Handsome Robb]

Are we talking simply fractured, or totally separated? Fractured, I'd "splint" it with fentynal just to make breathing easier. Separated, manually stabilize it (Ie, use your hand to keep it from moving in and out), then PPV them. The biggest problem I see with a fractured sternum is pain. For a separated sternum on the other hand, you have loss of some negative pressure, as well as probably extreme pain, and trouble breathing due to chest rigidity comprimise. (As well as pain of course.)

Lights did a better job explaining what I was talking about than I did.

 

[firetender]

This is simply a matter of making the patient as comfortable as possible. There's no real formula as it's dependant on the actual injury and the Pt's reaction. Keep in mind, it's not about stabilizing the injury itself so much as it's about maneuvering and supporting the patient's whole body to minimize discomfort.

 

[Doczilla]

Splint it with ketamine

 

[VFlutter]

Well the first thing you want to do is a thoracotomy. Then find yourself something stiff to stabilize the sternum with, preferably sterile, but in a pinch a rusty spoon will work. Then grab some tape and go crazy, don't be stingy with the tape you want that thing secure. Throw an ABD pad in top and bam your done. Pain medication optional.

 

[lightsandsirens5]

Well the first thing you want to do is a thoracotomy. Then find yourself something stiff to stabilize the sternum with, preferably sterile, but in a pinch a rusty spoon will work. Then grab some tape and go crazy, don't be stingy with the tape you want that thing secure. Throw an ABD pad in top and bam your done. Pain medication optional.

Whoa! Whoa! Whoa! Hold your horses buddy! Several issues here.

#1) Thoracostomy? What, what.......just automatically?
#2) Since when have splints needed to be sterile?
#3) "Going crazy" with the tape, why? So we can inhibit chest wall expansion?
#4)Pain medication optional? Oh really? I suppose TECHNICALLY it is. But answer this: You have just had your chest crushed, your sternum completely separated, you cannot breathe, someone has just shoved a 10 guage railroad spike between your few good ribs left, and applied the equivalent pressure of a Army sandbag on your chest with tape and dressings. Do you want a leetle something? Or...was that just an option?

I would not recommend the approach suggested by yourself, simply because the taping and splinting will, as aforementioned, restrict chest all movement while not doing all that much to stabilize the flailed sternum. (Unless of course you splint it tight enough to secure it to the spine.) Furthermore, the reduced expansion will reduce airflow (no duh) to an already damaged and probably swelling portion of lung tissue, greatly increasing the likelihood of developing atelectasis.

Now then, the thoracostamy, do keep that in mind as it will come in later. (Actually, the consideration thereof will come in.)

As for the problem of reduced air movement (due to decreased airway pressures) CPAP or PPV has been shown to be marvelously effective in the cases of flail segments and separated sturnums (now THAT is an odd plural....). All these failing of course, simply RSI that poor dude (who by now would be screaming from lack of pain control. Or possibly not screaming because of near inability to move air....but would still be screaming in his head.) SO....hit him with some fentynal, or morphine, or something! (Preferably well before some of these interventions.)

The thoracostamy in my opinion really only comes into play in this case in the event the patient develops as tension pneumothorax secondary to positive airway pressure.

Side note: If I ever run across a medic who is doing needle thoracostamys arbitrarily on any chest trauma patient, I will get a bunch of firefighters to hold him down while I administer a needle thoracostamy to release all of the evil heart he has inside that chest.

 

[VFlutter]

Whoa! Whoa! Whoa! Hold your horses buddy! Several issues here.

#1) Thoracostomy? What, what.......just automatically?
#2) Since when have splints needed to be sterile?
#3) "Going crazy" with the tape, why? So we can inhibit chest wall expansion?
#4)Pain medication optional? Oh really? I suppose TECHNICALLY it is. But answer this: You have just had your chest crushed, your sternum completely separated, you cannot breathe, someone has just shoved a 10 guage railroad spike between your few good ribs left, and applied the equivalent pressure of a Army sandbag on your chest with tape and dressings. Do you want a leetle something? Or...was that just an option?

I would not recommend the approach suggested by yourself, simply because the taping and splinting will, as aforementioned, restrict chest all movement while not doing all that much to stabilize the flailed sternum. (Unless of course you splint it tight enough to secure it to the spine.) Furthermore, the reduced expansion will reduce airflow (no duh) to an already damaged and probably swelling portion of lung tissue, greatly increasing the likelihood of developing atelectasis.

Now then, the thoracostamy, do keep that in mind as it will come in later. (Actually, the consideration thereof will come in.)

As for the problem of reduced air movement (due to decreased airway pressures) CPAP or PPV has been shown to be marvelously effective in the cases of flail segments and separated sturnums (now THAT is an odd plural....). All these failing of course, simply RSI that poor dude (who by now would be screaming from lack of pain control. Or possibly not screaming because of near inability to move air....but would still be screaming in his head.) SO....hit him with some fentynal, or morphine, or something! (Preferably well before some of these interventions.)

The thoracostamy in my opinion really only comes into play in this case in the event the patient develops as tension pneumothorax secondary to positive airway pressure.

Side note: If I ever run across a medic who is doing needle thoracostamys arbitrarily on any chest trauma patient, I will get a bunch of firefighters to hold him down while I administer a needle thoracostamy to release all of the evil heart he has inside that chest.

Whoa! Whoa! Not sure if you missed the sarcasm of my post or if I am missing the sarcasm in yours lol I thought the rusty spoon comment was a dead give away that it was a joke.....


Also Thoracotomy,cracking open the chest. Not Thoracostamy, needle decompression or chest tube.

 

[lightsandsirens5]

Whoa! Whoa! Not sure if you missed the sarcasm of my post or if I am missing the sarcasm in yours lol I thought the rusty spoon comment was a dead give away that it was a joke....

Ahhhh....ok. Sorry about that.

Also Thoracotomy,cracking open the chest. Not Thoracostamy, needle decompression or chest tube.

Even worse! I misread that one. Therefore I will amend my treatment of the paramedic who randomly does that to include a thoracotamy to do a direct debriedment of his evil heart. :lol:

 

[Anjel]

Originally Posted by ChaseZ33<br />
Well the first thing you want to do is a thoracotomy. Then find yourself something stiff to stabilize the sternum with, preferably sterile, but in a pinch a rusty spoon will work. Then grab some tape and go crazy, don't be stingy with the tape you want that thing secure. Throw an ABD pad in top and bam your done. Pain medication optional.

<br />
<br />
Whoa! Whoa! Whoa! Hold your horses buddy! Several issues here.<br />
<br />
#1) Thoracostomy? What, what.......just automatically?<br />
#2) Since when have splints needed to be sterile?<br />
#3) "Going crazy" with the tape, why? So we can inhibit chest wall expansion?<br />
#4)Pain medication optional? Oh really? I suppose TECHNICALLY it is. But answer this: You have just had your chest crushed, your sternum completely separated, you cannot breathe, someone has just shoved a 10 guage railroad spike between your few good ribs left, and applied the equivalent pressure of a Army sandbag on your chest with tape and dressings. Do you want a leetle something? Or...was that just an option?<br />
<br />
I would not recommend the approach suggested by yourself, simply because the taping and splinting will, as aforementioned, restrict chest all movement while not doing all that much to stabilize the flailed sternum. (Unless of course you splint it tight enough to secure it to the spine.) Furthermore, the reduced expansion will reduce airflow (no duh) to an already damaged and probably swelling portion of lung tissue, greatly increasing the likelihood of developing atelectasis. <br />
<br />
Now then, the thoracostamy, do keep that in mind as it will come in later. (Actually, the consideration thereof will come in.)<br />
<br />
As for the problem of reduced air movement (due to decreased airway pressures) CPAP or PPV has been shown to be marvelously effective in the cases of flail segments and separated sturnums (now THAT is an odd plural....). All these failing of course, simply RSI that poor dude (who by now would be screaming from lack of pain control. Or possibly not screaming because of near inability to move air....but would still be screaming in his head.) SO....hit him with some fentynal, or morphine, or something! (Preferably well before some of these interventions.)<br />
<br />
The thoracostamy in my opinion really only comes into play in this case in the event the patient develops as tension pneumothorax secondary to positive airway pressure.<br />
<br />
Side note: If I ever run across a medic who is doing needle thoracostamys arbitrarily on any chest trauma patient, I will get a bunch of firefighters to hold him down while I administer a needle thoracostamy to release all of the evil heart he has inside that chest.

Let it all out lights. Tell us how you really feel. Lol poor dear. Maybe some sleep would do you well.