PASG and Traction Splints

[Guest guest]

It is my observation that almost any extremity fracture can effectively be

splinted using the long spineboard or one of the new scoop stretchers with

appropriate padding from rolled sheets, blankets, pillows, and so forth.

Actually the full-body air splints are probably the best answer but awfully

expensive.

I would not spend any time at the scene applying the PASG nor a traction

splint to an unstable patient. For an isolated femur fracture in a stable

patient, I will apply the Sager on scene, which only takes about a minute.

The best traction splint for application enroute is also the SAGER, which can

be applied by one person in less than a minute and splints the extremity

without the angulation that the Hare causes. If one HAS to use the Hare, put

it in between the legs and turn it sideways and use it like a Sager. Also,

remember that if you apply the Hare or its clones before you get into the

truck, you may find that you can't close the back door, always a

disconcerting development. Also, you probably won't be able to put a Hare

on enroute unless you have the patient's feet forward, because there will be

no room for anybody to pull traction.

I would restrict use of the PASG to those patients who are moribund, in

advanced shock and in vascular collapse, more than 15 minutes from a trauma

center and where it is clear that there's no uncontrolled bleeding, either

internally or externally. For example, the patient who has bled out from an

amputation/crushing/mangling injury and has now been disentangled and

external bleeding stopped. I hasten to add that I don't believe you can

demonstrate any decreased mortality from doing this, but anecdotally I have

had one or two survive by doing this and then getting lines going.

One interesting orthopedic injury that is very difficult (yet ridiculously

simple it you know how) to immobilize is an avulsion of the head of the

medial femoral condyle, which happens in sports injuries when the patient's

feet are planted and they are hit from the lateral side. When the condyle

snaps loose, the lateral muscles contract, causing the leg to be abducted at

about a 45 degree angle laterally.

I would make this a puzzle, but since it is Halloween, my treat will be to

let you know that ladder splints are the way to handle this. Bend two of

them to the angle of the deformity, put one medial and the other lateral,

wrap with Kerlix, et voila`. If it's the right leg you'll have to transport

your patient feet first; otherwise, the leg will contact the left wall of the

truck.

gene g