Splinting (Update)

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.

6 Comments

  • Angelo says:

    I’ve heard people talk for years about using the KED for hip fractures but have never actually seen anyone do it. I always wondered exactly how to do it. I just learned something. And that makes it a good day.

  • Renee says:

    Those were some nice commentaries on splinting!

    I’ve used the reverse KED myself. There are a few ways to apply it. You can also use the head straps around the thigh of the affected side. Depends on positional comfort and stabilization. 🙂

  • colleen holman says:

    Hi do you have any suggestions for school nurses?..abount anything in general I find myself in situations where parents want me to call you in because they daon’t want to pay to take their child to the ER. And there are a lot of emotional students who claim all sorts of symptoms and are pretty good actors. I think it puts us in a vulneravle position. Any help would be appreciated!

  • colleen holman says:

    Sorry about spelling,grammar in previous post. I have some keyboard issues (about)don’t (vulnerable)..and it wouldn’t hurt for me to read before I send! Thank you!

  • Matt S - MN says:

    As to your comment on Ativan, I found myself in a similar situation at a local ski resort a few months back. A very fit male pt. in his mid 20s had suffered a dislocation of his left shoulder after a fall.
    The poor guy was in enough pain that i didn’t even really consider a c-collar and back board (per protocol) due to the pain he was having. He did not exhibit tachy-lawdia (thanks to Kelly Grayson for that gem) but was in pretty obvious discomfort.

    Protocol here would have been up to 4mg of IV/IM Dilaudid then Ativan (continuum under pain control policy). He’d have been stoned and probably still hurting as his pain was chiefly related to muscle spasms in his shoulder.

    I called on-line medical control and got permission for 1mg of IV Dilaudid and 1mg of IV Ativan. I gave the Ativan first followed by the Dilaudid. The pt quickly reported a dramatic decrease in pain 10/10 to 3/10 and required no further medication during the 20 minute trip to the local ER where his dislocation was reduced.

    I guess my point is that beyond the obvious affects that the Ativan would have had on your patient’s histrionics, it may have also served a direct purpose in the management and treatment of your patient’s pain.

    Note: The medications were given prior to splinting the dislocated extremity using a sling and a well-placed pillow to the patient’s comfort. I have no doubt that the splinting affected some of my pt’s reduction in pain.

  • Brandon O says:

    I’ve also heard folks using the KED as a short backboard to fully immobilize kids… haven’t seen that one in person though.

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *