Question: In NYS are EMT's allowed to attempt to straighten a severely angulated long bone fracture if distal perfusion is compromised? Answer: YES
Tuesday, June 10, 2014
Pediatric Angulated Fracture
Angulated fracture in young boy who fell off blow-up slide. Distal
perfusion was good. Since distal blood flow was not compromised injury was splinted as found and patient was transported to hospital.
Question: In NYS are EMT's allowed to attempt to straighten a severely angulated long bone fracture if distal perfusion is compromised? Answer: YES
Question: In NYS are EMT's allowed to attempt to straighten a severely angulated long bone fracture if distal perfusion is compromised? Answer: YES
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NYS BLS protocol is now very clear; See page T6: (does NOT have to be lacking pulses)
ReplyDeleteSplint the bone injury, keeping the following guidelines in mind:
Long Bone Injuries:
A.
If the long bone is severely deformed
or
the distal extremity is cyanotic
or
lacks
pulses, align the long bone by applying gentle manual traction prior to splinting.
If resistance is encountered, the extremity should be splinted in the deformed
position
NYC BLS protocols, see pg. 24. also pretty straight forward..
ReplyDeleteAngulated long bone deformities should be straightened provided resistance is not felt, into a splintable position.
Protocols are written as general guidelines and therefore will not fit every patient encounter. It is a common "rookie" mistake to only try to fit every patient care situation into a protocol. Patient care is too dynamic to allow this. Protocols should be used a general guideline.
ReplyDeleteIn the case of this patient it would be illogical to manipulate a fracture site that has good distal perfusion. This could result in further neurological and /or circulatory injury. At the least, it would subject the child to unnecessary pain. Unfortunately many of us feel that since we responded we must do something to justify our existence. In my opinion, the appropriate treatment for an angulated fracture with NO nervous or circulatory compromise would be to splint in the position it was found and transport. Remember, protocols are guidelines, if you need to deviate from the protocol you just need to call medical control and explain the situation and ask for permission to perform your desired treatment.
A recent example of this was a moderately obese patient who fell down a flight of stairs. He was complaining of back pain but had no neurological deficits on physical exam. When the crew tried to immobilize him he immediately became combative (hypoxia) and complained of not being able to breath. They sat him back up and called medical control. They discussed the situation with the MC physician who agreed that spinal immobilization would be detrimental. The patient was placed on stretcher in a semi-fowlers position and transported to the hospital.
Thanks for reading this post and researching the protocol.
Thanks Frank for your response. You are well respected and I respect your valid points. I'm not new and have recently followed this protocol for smiler fx. Pain and general pt. condition was greatly RELIEVED. Your point of "feeling of doing something to justify our existence" is a strong one, but some ER staff argue same about medics doing their job, and I saw BLS not having courage to do traction for femur, which is wrong. (they usually say they were not sure, etc. but is lack of clinical experience) Same with those not txt level one criteria pts to facilities the state/remco requires, saying pt was not stable, resources, etc. We DO need to be proactive and be taken serious and not just taxi..
DeleteI'm not hiding, my CME instructors pointed this out and says the DOH did research and concluded the damage of leaving bones like that is greater then any possible damage of some traction back in place. (for Joints they didnt change) I have seen ER docs do the same right when you walk in, saying leaving it for 15 more minutes is bad.
We can disagree and I appreciate this discussion. If I'm wrong I'll retract.. Maybe you're correct I should not post this for rookies.
Thanks,
Primum non nocere is a Latin phrase that means "first, do no harm."
ReplyDeleteNon-maleficence, which is derived from this maxim, is one of the principal precepts of bioethics that all healthcare students are taught in school and is a fundamental principle throughout the world. Another way to state it is that, "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the health care provider that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.