Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

rescuers to lift and move the patient with minimal rolling or twisting of the torso and pelvis. Pelvic binding with a padded strap or wide com pression bandage may be useful to help stabilize a pelvic fracture and reduce the space available for internal blood loss. This can be accomplished by wrapping a tarp or backpack hip belt around the pelvis and tightening gently to restore anatomy. The patient is then further stabilized by a litter, vacuum mattress, or well-padded backboard. Generally, a supine position with the knees slightly flexed will provide the most stability and comfort. Emergency evacuation is indicated with the anticipated problem of volume shock.

Traction into Position should be used to restore alignment and reduce soft tissue injury in this femur fracture. When the recommended amount of traction is applied with a traction device, the pressure at the anchor points will inevitably cause skin and soft tissue ischemia and necrosis. For these reasons, the use of a traction device is not appropriate for backcountry rescue or long-term care. In this set ting femur fractures are best stabilized in a well padded litter or vacuum mattress. Many EMS and ski patrol systems have adopted this practice as well. Significant deformity of the femur should be realigned with manual traction and stabilized against the other leg with padding between. Having the knees bent will usually be more com fortable. The ideal splint is a vacuum mattress with manual traction released as the splint is secured. Since the thigh has limited space for blood loss, an isolated closed femur fracture is unlikely to cause life threatening shock. A tourniquet is gen erally not necessary unless the patient is also los ing blood elsewhere, or the fracture is open with active bleeding. Pelvic Fracture Shock and distal ischemia are anticipated prob lems due to the proximity of the iliac arteries and veins. The assessment is made by the report of severe pain, feeling pelvic instability as motion or crepitus on gentle exam, or by noting obvious deformity. There is the potential for catastrophic internal bleeding, so the patient should be han dled gently and the exam should not be repeat ed. Where possible, recruit an adequate team of

Effective pelvic binding can be accomplished by wrapping a tarp, sheet, tent fly or backpack hip belt around the pelvis and tightening gently to restore anatomy and reduce pain and instability. Clavicle Fracture We mention this here because the clavicle is the most frequently fractured bone in childhood, right up to about age 70. If your work or play involves falls at speed you will probably experi ence or see one eventually. As with other bones, it is not the fracture itself that presents much of a problem. We worry more about the possibility of associated respiratory sys tem injury and significant pain and incapacitation in a high-risk environment. The same mechanism that fractured the clavicle can also cause fractured ribs and lung injury. Your primary survey should focus on the respiratory system, not the clavicle or the pain. Fortunately, most clavicle fractures are uncom plicated. They hurt, sometimes a lot, and the patient may feel the bone ends grinding together