My quest to be the Architectural Digests’ Best Splint Ever Winner, as well as getting an award for Most Improved Splinter continues.
Since I posted — Splinting — I have had three opportunities to splint.
1. A call almost identical to my previous post. Man fallen with lower tibia pain and deformity at the ankle. In addition to elevation, ice, and padding, I used a cardboard splint and cravats instead of a pillow. I used pillow cases to fill any void. No change in pain. 100 ugs of Fentanyl later and the patient was feeling better. At the ED, they undid the splint to examine the injury. When I went to say good bye to the patient, splint undone, his foot was elevated on a pillow, he was starting to feel some more pain. Fortunately, a nurse came in then with some more Fentanyl and all was well again.
2. Patient with anterior shoulder dislocation moaning to the Lord Jesus to help her with her pain. Now, if I ever were to suddenly go mad — me — a stark raving lunatic shouting on a street corner, after this call, there is no way I could ever claim that I was the Lord Jesus because nothing I could do helped this poor woman with her pain. Applying a sling and swath (see picture from previous post) on a practice patient is one thing, applying it on someone who feels excruciating pain just being breathed on, is another. I have done many sling and swaths in my time, but sometimes the patient won’t stop moving and what is left does not resemble what you started with. I gave her some Fentanyl IM, then tried to splint again. We managed to get it on, also using a pillow, but had no luck finding any kind of position of comfort. After getting an IV, I eventually drained my standing order limit of Fentanyl and called for more. “Lord Help me Jesus!” she screamed as I spoke with the doc. No relief. Ice, padding, pillows, sling and swath, 200 ugs of Fentanyl. I considered getting on my new I-phone and Googling to see if there was any online way to get a medical degree in 5 minutes so I could learn how to reduce a dislocation (not in our paramedic scope of practice) and legally do it in the field because that was likely the only thing that was going to help her pain. But no luck finding such a course. In the ED, she got a milligram of dilaudid. She was still crying and rocking back and forth as I left. It was a sorrowful haunting, tear-strewn cry – a cry I have heard in many EDs. “Help me, help me, Jesus!” Despite all our efforts, sometimes we just don’t have the tools to take away the pain. (In retrospect, I might have called for a touch of Ativan).
3. Fall with hip fracture. Man on ground with 7 of 10 pain. Now a recent post there was a comment about how much you can learn working with another medic. Since for many years I have worked solo, it was with great delight, I got to work with another medic on this call. (He responded in a fly car while I was in the transport ambulance). The medic suggested we try a reverse KED splint. Having never heard of a reverse KED for a hip fracture, I was instantly intrigued. “Tell me more!”
After I premedicatied the patient with 50 mgs of Fentanyl, we carefully lifted the man’s torso and legs and slid the upside down KED underneath him. We wrapped the main part around his hips using the three chest straps. The head pillow was folded and placed between his legs and then his legs were wrapped around it with the head straps. It was AWESOME!
We carried the patient, who we also backboarded, down three flights of stairs with no discomfort. Pain free on arrival at the hospital. “Behold the Reverse KED!” I declared. The ED staff was very impressed. “I call it ‘The Canning,’” I said. “I thought of it myself!”
Actually, I call it “The Dennis.” Kudos to a great medic. Thanks for passing on a tip of the trade! Never too old to learn.