Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

98

Wilderness and Rescue Medicine

disability. Reduce the dose as soon as improve- ment is noted. Using tape and padding, you can create a soft splint that will help reduce the stress on the irritated structure. Joint taping is another tech- nique for providing support and limited mobility. Encourage the patient to rest frequently, letting pain be the signal to stop. Continue only after the pain is under control.

wrapping to minimize the increase in pain and swelling is a reasonable goal for early treatment in a difficult situation.

General Principles

Unstable Injury

18

Wilderness Perspective

High Risk Problems: • Persistent ischemia • Significant deformity • Femur fracture • Pelvic fracture • Compartment syndrome

• Open fracture • Joint infection

Low Risk High Risk

©2018WMA

Splints and wraps are applied where necessary to reduce the risk of further soft-tissue trauma in unstable musculoskeletal injury. At the same time, they can create an increased threat to the patient’s safety and survival. A sling and swathe, for example, can inhibit a skier’s ability to negoti- ate a cliff band safely. Backboard or litter stabiliza- tion can drown a patient on an overturned boat. Sometimes the benefit of a stabilized injury does not match the overall risk to the patient and the plan must be modified.

Joint tape can provide support, reduce pain, and improve mobility. This can be useful for the ankle and the wrist where continued use of the extremity is necessary for travel and survival. Risk Versus Benefit Traction into position to restore alignment in sig- nificantly deformed fractures and dislocations can be painful for the patient and intimidating for a practitioner inexperienced in the procedure. It is worth remembering that significant deformity represents a high risk of ischemia to infarction and increased bleeding and tissue damage. It is also more painful and difficult to stabilize and evacuate safely. Gentle repositioning is a low-risk procedure for a high-risk problem. Procedures that seem to cause intolerable pain or require a lot of force are more dangerous. When you meet significant resistance, you should stop and reassess. Wait a few minutes or modify the technique and try again. If you are still unsuccess- ful, consider the persistent deformity and severe pain to indicate a high-risk problem and the need for urgent evacuation. Even stable injuries, with continued use, run the risk of becoming worse. This must be balanced against the benefit of continued mobility and self- sufficiency. Moderating activity with splinting or