Trauma Tuesday POD- Hare Traction Splint

What is a Hare Traction Splint?

When to Use a Hare Traction Splint?—Midshaft femur fracture when there is no evidence of pelvic or lower leg injury.

How to apply a Hare Traction Splint?

1. Expose the injured limb.

2. Measure distance of splint on uninjured leg- Should be 6-8inches past ankle.

   1. Measure on opposite leg of fracture as femur fracture side can be shortened

   2. Apply ankle hitch

   3. Slide splint under injured leg.

   4. Fasten the ischial strap.

   5. Connect loop of ankle hitch to splint

   6. Tighten the ratchet so the splint holds the traction

   7. Apply the rest of the straps- avoiding the fracture site.

   8. Assess neurovascular function

Here is a link to a video to see how it is applied!

https://youtu.be/498SydRP4jg

Trauma Tuesday POD- BOWING FRACTURE

BOWING FRACTURES  

What is it?

• Incomplete fracture of tubular long bones pediatric patients.

  • Commonly radius and ulna

Presentation:

• Fall on outstretched hand. Child presenting with pain and swelling of forearm

How does it happen?

• Pediatric bones bend because the cortex is thinner than adult bones.

Management

• Depends on degree of angulation

  • <20degrees= splint

  • >20 degrees= reduction of bowing (call orthopedics)

    • during the reduction they are very prone to fracturing

Pulmonary Contusion

History:

• Symptoms include SOB and chest pain.

  • Remember this may manifest as back pain depending on mechanism.

  • Look for in high impact injuries to chest (MVC, fall, pedestrian struck, trampled by livestock, etc)

  • MOA being compression-decompression.

Exam:

• Flail chest or crackles (however unlikely unable to auscultate in ED).

• Observe for crepitus for possible pneumothorax.

• Seatbelt sign.

Diagnosis:

• CXR or CT chest

• Extent of injury not apparent on CXR for 24-48 hours

• Areas of lung opacification within 6 hours diagnostic of pulmonary contusion.

• There are NEXUS chest guidelines (yes, chest!) for patients>14 to omit any imaging in chest trauma (see appendix below) - 98.8% sensitive.

• Look for homogenous focal or diffuse opacity that may cross typical anatomical landmarks (i.e. lobes).

Treatment:

• Primarily supportive. Watch for delayed presentation!

• Consider Bipap; pain control with intercostal block or epidural inpatient. Avoid unnecessary fluids.

• Up to 40-60% will require mechanical ventilation. Also may be necessary to sedate for pain control.

• Place good lung in dependent position to improve V/Q mismatch 50% go on to develop ARDS (blood in alveoli activates inflammatory cascade).

• If not improving - ECMO (V-V) is a possibility.

Bottom line:

• Monitor patients suspicious for pulmonary contusion - if they have signs of CXR there is a good chance they may need more invasive support (e.g. intubation).

• Have low suspicion for concurrent injuries including mediastinal and vascular injuries, diaphragmatic rupture, and cardiac contusion.

• Be aware of patient fluid status and try not to overload patient.

Keywords:  Pulmonary Contusion NEXUS Chest Radiography Chest Trauma