Improvised Traction Splint | Wilderness Medicine

[@MedWild]

See the instructor in this video (Dr. Howard Donner) teach a variety of hands-on workshops at the upcoming National CME Conference on Wilderness Medicine. All medical specialities are welcome! wilderness-medicine.com/cme-conferences/santa-fe/

[@dunkerfilm]

I've used a traction splint (not an improvised one tho) on a femoral fracture only once, but it litteraly had that almost magic "Ahhh... that's better-effect"! The pain went away - or should I say became easily tolerable. We carried the patient on a strecher half a mile through rough terrain to the ambulance. On board the ambulance on our way to the hospital three hours away, we had to adjust/increase the traction a little a couple more times as the straps gradually slackend and the patient got pains again, and it worked fantasticly every time. This happened 35 years ago, but I remember we followed the manufactures recommandations and I think it was 5-10 percent traction of the patients weight ( a scale was built in to the splint) and checking pulse on the foot regularly during transport.

[@jaimelyn6710]

I love the duct tape around the thermos idea!!!

[@josh55611]

Awesome points especially about rotation, and knee support that isn't typically covered.

[@DaimyoD0]

"In many backcountry situations, it can be impossible to distinguish a femoral shaft fracture from a femoral neck or pelvis fracture that might be further deformed by the application of traction. Even when properly applied, traction splints are notoriously difficult to monitor and package. When the proper amount of traction is applied to the femur, the pressure at the anchor points will inevitably cause skin and soft tissue ischemia. For these reasons, the use of a traction split may not be appropriate or safe for backcountry rescue or long-term care. In this setting, femur fractures are best stabilized in a litter, vacuum mattress, or well-padded backboard." pg 82-83, Wilderness and Rescue Medicine 6th Edition, Jeffrey E. Isaac, PA-C and David E. Johnson, MD

[@DaimyoD0]

@Chase Kylan that's some pretty sophisticated spambot bullshit, replying to yourself and all.

[@pmagistro]

Do Isaac and Johnson cite reseach in that opinion or is it based on anecdotal evidence? The only study I've been able to find is Weichenthal 2012 which was small but found little difference in effectiveness between improvised and commercial traction splints. The NPS field manual for emergency medicine demands the use of a commercial traction splint for mid-shaft femur fractures, and some wilderness education providers have continued teaching the practice (NASAR/Donelan, for example). I prefer to base my treatment decisions on documented case studies and or research, and am having difficulty finding those on this topic.

[@redderek]

This is focused on a mid-shaft femur fracture. Any fracture above that point is considered as a hip fracture and splint accordingly.

[@jjaldin5769]

You`re the best! Thank you!

[@Kip5ter]

Great video - thanks

[@sergioecheverria3114]

Great! Thanks. Like when you said "Huevos"! haha

[@dongrider9040]

10/11/2020 Med Wild> Thanks. This is the 3 review of yours that I have watched. Timeless! Good simple reinforcement of safe practices with real world access to some supplies and alternatives is a great review. You blew me away at the paddle to hip with the simple loop. Too easy but very effective, reliable and fast. I know padding from other demos and reenactments and practice is important and will be in place. Now I ask should I plan to mummy and wrap the patient for transport as soon as possible prior to the traction? This would require additional tarps, rope, padding and stabilization methods for spine stabilization prior to the splint that may further injure the patient when moving. What is the best patient comfort during that prep for mummy wrap or moving to the mummy wrap after splinting? I did note that you prepped the backpack under the patients shoulders for head and neck stabilization. I was involved, not lead, in a broken hip transportation prior to stabilization. I will not do that again. Done deal, safe again and now we all go home. Thanks Don.

[@nicholisdulcimer1911]

good stuff.

[@antonlords6]

He was good.

[@skyboydston1531]

I admire your example of using plain language.

[@unvexis]

This is a 7-year-old video. It may have been good practice at the time. But: "Splinting a fractured femur with a traction device has been a tool for managing femur fractures [...] However, trends in practice note that traction splints are not recommended for fractures close to the knee or the hip, that they create a risk of injury to the ankle, and finally that there is a lack of medical evidence that traction improves patient outcomes. In addition, improvised traction splints are challenging to build [...] Many emergency medical services [...] no longer advocate traction splints for femur fractures." -- NOLS Wilderness Medicine 7th Ed (2021), p. 101, Tod Schimelpfenig.

[@pmagistro]

Does Schimelpfenig cite reseach in that opinion or is it based on anecdotal evidence? The only study I've been able to find is Weichenthal 2012 which was small but found little difference in effectiveness between improvised and commercial traction splints. The NPS field manual for emergency medicine demands the use of a commercial traction splint for mid-shaft femur fractures, and some wilderness education providers have continued teaching the practice (NASAR/Donelan, for example). I prefer to base my treatment decisions on documented case studies and or research, and am having difficulty finding those on this topic.

[@redderek]

Your VERY LAST thing to do is to check distal CMS! Not bad if I had an oar and can spare the excess length.

[@PaulTarsitano]

With all Respect Dr. Just a friendly note: That open knife was too close to the leg for some time. My Humble observation. Thank you. Good info!

[@frankblangeard8865]

He suggests the possibility of using two ice axes to make a splint 0:22. That's as far as I got. Wouldn't want this crazy person treating me!