HAEMORRHAGECONTROL1APPLICATIONOFTHOMASSPLINT&

OPENFRACTURESPOLICY

1

•  Toclinicallyrecognisefracturesofthefemurascause/contribuFontoshock

•  AbletoselectequipmentrequiredforThomasSplint

•  AbletoexplaintheapplicaFonofskintracFon

•  Reviewofpolicyforopenlowerlimbfractures

OBJECTIVES

2

DIAGNOSISOFFRACTUREDFEMUR

3

•  Mechanism,Physiology&Clinically

•  Clinically–Rapidprimarysurvey,swelling,wounds,shortlimb,can’tSLR

REMEMBER:internalrotaFon=dislocatedhipCHECKforNVstatusplusDopplerifrequired-MayneedCTangio&vascularintervenFonifcoldleg

•  Don’tforgetthepelvis!

•  MAINPROBLEMISBLOODLOSS•  Inasimplefracture,alossof½-1litreofblood,moreinanopenfracture

•  Bloodreplacementiso^enrequiredinsimplefractures,ando^enessenFalinopeninjuries

•  TRACTION=IMMEDIATETEMPORARYCONTROLOFOBVIOUSHAEMORRHAGE

FRACTUREDFEMUR

4

•  Decisionbasedonclinicalfindings,NOTx-ray•  THINKaboutanalgesia?•  Don’tforgettracFoncanbeappliedbyjustpullingtheleg!

•  Thomassplint

CONSIDERATIONSwhenapplyingtracFon

5

1.  TapeMeasurement2.  ThomasSplint3.  Tubi-grip(sizef)4.  Razor5.  AdhesiveSkinTracFonKit6.  ChineseWindlass7.  GauzeandCokonTissuePad(Gamgee)8.  WoolPadding9.  Cokonstretchbandaging(Crepe)10. Tape

EQUIPMENTFORTHOMASSPLINT

6

•  MeasurementforThomassplint•  Theuninjuredlegshouldbemeasuredandanallowancemadeforswelling,presentandanFcipated

•  Measurethecircumferenceoftheupperthigh.Addtwoinchesforringmeasurement

•  Measurethelengthofthefull,legstarFngattheglutealfold.Addfiveinchesforrequiredlengthofsplintneeded

THOMASSPLINT

7

•  ApplyingSkinTracEon

MEDIAL

APPLICATIONOFSKINTRACTION

8

LATERAL

MEDIAL

•  CordTracEon

•  PassingthemedialcordoverlateralcordhelpstocontrolthetendencyforlateralrotaFon

9

TRACTION

•  CompleEonofThomasSplint

COMPLETION

10

FREQUENTQUESTIONS•  CanIapplytracFonagainstafracturedpelvis?Ifunstablepelvicfracture,applybinderandsplintlimbs(eveninpresenceoffracturedfemur),donotapplytracFon

•  ShouldItakeoffatracFondeviceappliedpre-hospitalNO!Ifit’sworkingLEAVEitonunFltheatre,butcheckforpressureareasPLEASEreturntoEDa^ertakingoffintheatre

BEFORE&AFTER!

OpenFracturePathway