Drill of the Month
Developed by Gloria Bizjak
Trauma Basics: Managing
Upper Extremity Fractures
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
2
Trauma Basics:
Managing Upper Extremity Fractures
Overview
 Management, Assessment, and Care
 Hand/upper Extremity Trauma Protocol
 Splinting Upper Extremity Fractures
Drill of the Month
3
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
4
Trauma Basics:
Managing Upper Extremity Fractures

Management
– Review purpose of splinting
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

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
Immobilize
Minimize movement
Prevent further tissue damage
Prevent closed fracture from becoming open
Control bleeding
Drill of the Month
5
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
6
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
7
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
8
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
9
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
10
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
11
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
12
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
13
Trauma Basics:
Managing Upper Extremity Fractures

Hand/Upper Extremity Trauma Protocol
– Injuries
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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
14
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
15
Trauma Basics:
Managing Upper Extremity Fractures

Hand/Upper Extremity Trauma Protocol
– Contraindications for referral to specialty
center
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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
16
Trauma Basics:
Managing Upper Extremity Fractures

Hand/Upper Extremity Trauma Protocol
– Care for amputated part
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


Keep dry
Place in sealed plastic bag
Place on top of ice
Do not freeze
Drill of the Month
17
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
18
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
19
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
20
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
21
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
22
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
23
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
24
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
25
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
26
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
27
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
28
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
29