IMMOBILIZATION & EXTRICATION

By; Nazri B. Aiwan @ Ismail Kolej Pembantu Perubatan Ulu Kinta

Introduction
To move casualty to hospital. Early priority in the rescue effort. Need appropriately planned. To ensure safe and speedy transportation while maintaining casualty comfort, preventing further injury or damage & allowing full monitoring to take place.

Basic Principles of Immobilization

1. 2. 3. 4. 5. To prevent further injury. To provide pain relief. To reduce blood loss. To reduce the risk of fat emboli. To facilitate extrication & rescue.

Basic Principles of Immobilization

1. To prevent further injury
risk of damage adjacent structures eg. nerve, blood vessels, muscles & skin due to movements of bone end. pressure from displaced bone.

2. To provide pain relief

painful movement of bone ends & irritation of the sensitive periosteum. painful spasm of adjacent muscle group. local painful pressure on a nerve.

Basic Principles of Immobilization

3. To reduce blood loss
Traction splintage of long bone # ; volume available for hematoma formation. Restore muscle tension closed large venous channels.

4. To reduce the risk of fat emboli

incidence marrow fat emboli enters venous circulation.

Basic Principles of Immobilization

5. To facilitate extrication & rescue
Immobilization Should be supported on either site of the #. Immobilized the joints above & below the injury. The principles of equipments design; simple easy to use lightweight Damage-proof Easily cleaned following use.

Basic Principles of Extrication

Entrapment trapped casualty. Hospital staff alert for possible problems a) Actual entrapment; Victims are physically enclosed in a vehicle or in area by the structure impinging on their body eg MVA, building collapse. b) Relative entrapment: No actual physical entrapment present. Unable to extricate because of pt conditions eg # femur.

Preparation & Approach

Training & knowledge. Equipment regularly checked & in working order. Know the equipment & their potential. Know own limitation.

Pain Relief
Moving injured limbs or extrication casualties may produce pain. Traction relief pain Drugs for pain killer eg. entonox, ketamine, titrated intravenous analgesia and local block.

Methods of Immobilization
a) Cervical Immobilization
Manual immobilization i. Approach from behind ii. Approach from in front iii. Approach from the side. Cervical collars Injury above clavicle Unconscious Cervical spine #

Cervical Collar
Types of collar
a) Stiffneck. b) Necloc.

Optimal position for cervical immobilization.

Slight degree of flexion 2 cm of occiput elevation

Cervical Collar
Manual in-line stabilization Sizing the collar
Head in neutral position Distance between an imaginary line drawn across the top of shoulder and a parallel line running backwards from the tip of chin.

Front piece is applied under the chin. Fasten Velcro strap.

Limb Immobilization
Simple methods
Arm slings jacket, tie or scarves

Manual methods
support injured hands

Triangular bandage
simple pre-hospital care for upper limb injuries. used as a high arm sling, broad arm sling or collar & cuff sling.

Limb Immobilization
Frac straps
Fasten one leg to another or immobilize an arm to the side of chest.

Neighbour strapping
Injured fingers bound to fingers on either side or lower limb bound to other limb.

Limb Immobilization
Inflatable splint
clear plastic, double walled tubes. little contribution to # Mx. use in Rx of soft tissue injury. inflate by blowing only. often crack & perish or tend to leak. vulnerable to damage from sharp objects.

Limb Immobilization
Box splint (Loxley splint)
Consists of three long padded pieces of board joined to form an open oblong together with a foot support at one end.

Vacuum splint
Bag of polystyrene bead enclosed in tough plastic. provide rigid support to the body & very comfortable. Used to immobilize the limbs, the cervical spine & other spinal injuries.

Limb Immobilization
Vacuum splint
Vacuum splints conform to the exact shape of the injury site. Providing excellent support without applying unnecessary circumferential pressure. Eliminates the potential for compartment syndrome, unnecessary pressure sores, or impairing circulation to the injured area. Sensory function remains intact, yet the injured area is immobilized properly to prevent further injury and reduce pain.

Traction Splint
Hare traction splint. Indications closed & open # femoral shaft. closed & open # of the shaft of the tibia & fibula. # around the knee (avoid traction) Contraindications dislocation of hip. # dislocation of the knee Ankle injuries.

Limb Immobilization
Functions immobilized # in a reduced position. pain. prevent further neurovascular damage. severity shock fat embolism. Complication damage neurovascular supply to the leg. pressure sores pt with sensory loss. limited space in ambulance.

Application
1. 2. 3. 4. Correct application requires 2 people. Applied after extrication. Method Give appropriate analgesia. Control external hemorrhage. Remove footwear & assess MSC. Select appropriate ankle hitch & adjust splint length against normal leg. Open all straps & placed correctly.

Application
5. The hitch is placed under the ankle & the straps are then tightly folded across the front of the ankle. 6. Manual traction is started with one hand. The leg is supported whilst the splint is put on position. Role pt away from the splint then slide the splint under the pt. The top padded ring must fit under the ischial tuberosity. The pt is then rolled back onto the splint. Manual traction must be maintained throughout this procedure.

Application
7. The top strap is then done up avoiding the external genitalia. 8. The traction hook is then put through the D rings & traction taken up, ensuring the manual traction is not released before the traction is tightened. Traction is applied until the limb is comfortable. Repeat MCS assessment. 9. Raised the footstand & velcro straps are positioned & tightened.

Pneumatic Antishock Garment (PASG)

Military Anti Shock Trousers (MAST) An inflatable garments that surrounds the leg & abdomen.

Indications Hypovolaemic shock. splinting of pelvic & lower limb #.

Pneumatic Antishock Garment (PASG)

Contraindications a) Absolute Cardiac failure. Pulmonary edema. Significant blunt chest injury. ruptured diaphragm advanced pregnancy. b) Relative significant head injury. uncontrolled bleeding above garment

Pneumatic Antishock Garment (PASG)

Complications Extreme hypotension. Ischaemic compartment syndrome, tissue damage & metabolic acidosis. Respiratory embarrassment. Exacerbation of; Cardiac /thoracic vascular bleeding pulmonary edema Congestive cardiac failure

Extrication Devices
Kendrick extrication device (KED) Russell extrication device (RED) Provide support & stabilization to the upper spine. Replaced short wooden board. Flexible & can be positioned between the casualty and the seat.

Kendrick Extrication Device

Extrication Devices
Scoop stretcher Provide means of lifting pt onto a trolley or trolley cot. Not for transfering pt for long distance. Long spinal board Assist movement of pt from the accident scene. Rapidly extricate casualty from a vehicle. Provide spinal stabilization.

Long Spinal Board Immobilization

At least 3 rescuers ( preferably four) Perform log roll.
Manually stabilize pts head & neck. Apply rigid cervical collar. Assess pulse, movement & circulation in all four extremities. Position the pt his arm straight down by his side.

Long Spinal Board Immobilization

Position the rescuers at the signal of the rescuer at the head, the two at the side should reach to the far side of pt.
1st rescuer -Shoulder & hip. 2nd rescuer - Thigh & lower leg.

On signal, simultaneously roll the pt on to his side move as a unit. Position the spinal board under the pt.

LONG SPINAL BOARD

Log Roll

Log Roll

Pelvic Splint
The human pelvis comprises three pelvic bones which combine to form a strong anatomic ring. Major trauma - injuries may include pelvic fractures & disrupt the integrity and stability of the pelvic ring. lead to significant pelvic bleeding in the victim since the arteries and major veins passing through the pelvic area may easily be pinched, torn, or lacerated by the fractured bones. Pelvic bleeding is the major cause of death. Immediate and important concern in early treatment of the victim is stabilization of the pelvis, which reduces bleeding, improves the comfort of the victim, and increases the victim's chances of survival. The temporary measure most often undertaken to stabilize the pelvis involves the use of a splint.

Noninvasive Pelvic Immobilization

Royal Hospital London Pelvic Splint

Noninvasive Pelvic Immobilization

Dallas Pelvic Binder

Invasive Pelvic Immobilization

Pelvic Clamp

Extrication Devices
Stretchers Provide means of lifting pt onto a trolley or trolley cot.

Removing a Helmet

Removing a Helmet