1. Drill of the Month Developed 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 practice EMTs 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 practice EMTs 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