Emergency Fracture Management & Patient Mobilization Techniques

Emergency Fracture Management: Initial Steps

When treating fractures, immediate actions are crucial to prevent further injury and stabilize the patient.

• Stop Bleeding: Apply direct pressure to control any external bleeding.
• Calm the Victim: Reassure the injured person to reduce anxiety and pain.
• Remove Jewelry: Carefully remove any rings, watches, or other jewelry from the affected limb before swelling occurs.
• Immobilize the Fracture: Prevent movement of the fractured bone by immobilizing the joint above and below the fracture using any rigid element available.
• Monitor Peripheral Pulse: Regularly check for the presence of a pulse distal to the injury to ensure adequate blood circulation.

Managing Hazardous Fractures

Certain fractures pose significant risks due to their proximity to vital structures.

• High-Risk Injuries: Fractures of the head, thigh, or pelvis can involve major blood vessels, organs, or the spinal column.
• Spinal or Organ Involvement: If there is a life-threatening injury or suspected spinal damage, move the patient with extreme caution.
• Block Mobilization: When moving a patient with potential spinal injury, ensure the spine and head remain perfectly aligned. This often requires 3 people, moving the patient as a single "block" onto a rigid surface like a backboard or scoop stretcher.

Polytraumatized Patient Care

A polytraumatized patient is defined as someone with two or more severe traumatic injuries (peripheral, visceral, or joint) that significantly impact the circulatory and respiratory systems. A polyfractured patient specifically refers to someone with multiple fractures affecting the musculoskeletal system.Proper mobilization of a polytraumatized patient offers significant benefits:

• Prevention of secondary injuries.
• Diminution of pain and increased comfort.
• Lower incidence of systemic complications and fat embolism.

When to Move a Polytraumatized Patient

Patients should only be moved or transferred if there is an immediate vital risk, such as fire, explosion, uncontrolled bleeding, or asphyxia, making it impossible to provide care in their current location. Always move the injured person as a single block to avoid damaging the spinal cord.

Immobilization Devices for Polytrauma

Various accessories are crucial for safely immobilizing a polytraumatized patient:

Cervical Collar

Used to immobilize the cervical spine. It must be placed before mobilizing the patient. Two rescuers are needed for proper placement: one to stabilize the cervical column, and the other to apply the collar.

Scoop Stretcher (Camilla Bucket)

An aluminum stretcher that separates into two longitudinal, slightly concave halves. Its length is adjustable to adapt to the patient's size. It allows for minimal patient movement during transfer.

Vacuum Mattress

Considered the best complete immobilization system. It consists of a sealed envelope filled with spherical particles. Once the patient is positioned, air is removed, causing the particles to solidify and mold perfectly around the patient, providing rigid, custom immobilization.

Kendrick Extrication Device (KED)

A rigid device reinforced with internal steel bands, placed like a jacket on the patient's back, trunk, head, and groin. It is secured with straps. The KED allows for the mobilization of the trunk and head as one unit, safely moving the patient from a confined space (e.g., car seat) onto a stretcher.

Splinting Techniques

A splint is a system used to maintain alignment and immobilize injured limbs, ensuring they are fixed and stable.

Classes of Splints

Pneumatic (Inflatable) Splints

Made of plastic or cloth, available in different sizes and shapes. They are placed around the injured limb, then inflated with air and secured with Velcro or zippers.

Pneumatic Vacuum Splints

Similar to inflatable splints, but they gain consistency by removing air with a pump instead of introducing it. This creates a rigid, custom-molded support.

Rigid Splints

Hard or padded splints that should cover the joints proximal and distal to the fracture. They are then secured firmly with bandages.

Victim Positioning for Specific Pathologies

Also known as "waiting and transportation positions," these aim to improve the patient's condition and comfort during transport.

Dyspnea (Bronchial Asthma, Heart Failure)

Position the patient in a semi-sitting position with the torso incorporated, often from a supine position. This facilitates breathing.

Chest Trauma

Place the patient in a lateral position, supporting the injured hemithorax on the back of the stretcher or bed. This frees the healthy hemithorax, allowing for better respiration, and immobilizes the affected side to reduce pain.

Abdominal Pain or Injury

Position the patient supine with legs flexed over the abdomen, placing a pillow under the knees. This relaxes the abdominal muscles.

Hypovolemic Shock

Elevate the lower extremities (modified Trendelenburg position) to facilitate venous return to the heart.

Pregnant Women (Third Trimester)

Position in the left lateral recumbent position to reduce pressure on the vena cava, which can be compressed by the uterus.

Unconscious Patients

Place in the recovery (lateral safety) position to maintain an open airway and prevent aspiration of vomit.

The Survival Blanket: Uses and Benefits

A very thin, durable plastic blanket that is waterproof and windproof, coated with aluminum. It has two sides: one golden and reflective, and one silver.

• Heat Retention: To keep the patient warm, wrap them with the silver surface facing inwards (towards the patient) to reflect radiant body heat.
• Sun Protection/Cooling: To protect the patient from the sun or to reflect external heat, expose the silver surface outwards.

Reutek Maneuver: Emergency Extrication

The Reutek maneuver is an emergency mobilization technique used to extricate a victim from a vehicle when there is an immediate risk, such as fire or explosion. It prioritizes rapid removal over complete spinal immobilization, though efforts are made to minimize movement.