So, we have a lower leg injury, in
this case a tibia-fibula
injury. We can check Jordan's CSMs.
Circulation - you're foot feels pretty warm, Jordan?
Jordan: Yes
Can you close your eyes for me? Which
toe is this?
Jordan: The pinky one.
Great, and can you wiggle those toes?
Since we have a lower leg injury, I do not need to do
a lot of pushing and pulling while testing here.
We have done our inspection. We are
ready to build a splint.
I have taken, in this case, an
Ensolite pad.
I measured it out so that it extends about the
same length as Jordan's foot past
her heel.
I am going to fold the top part
over
so that it is just as long as
her leg, coming up towards the top of her
femur,
and I am going to think about some
padding in places where there are going to
be curves. This one will come
underneath Jordan's knee so it does not
lock her knee in a straight position.
And then some padding
is going to come down
around her lower leg
to try to come around the curves
of her calf and her ankle.
I would like this padding
to be flat
and not wrinkled
so as to minimize any
places where there might be hot spots
or uneven pressure being exerted
against her leg. In order to move all of my material
underneath Jordan's leg, I need to be very
deliberate
about supporting the injury site
perhaps grabbing some extra help to
slide our padding underneath. In this case,
Jordan might be able to help me a little
bit here
as we slide all of this under her leg
trying not to cause any
unnecessary or painful movement. I am going to
take some
cravats to tie my splint into place,
and I am going to think about taking advantage of
ways
to move my cravats
up without having to manipulate my
patient's leg. I can slide them up
and get them to position.
I would like to have at least two
securing points
above Jordan's knee,
and if I had a patient with particularly long
legs I might need three or more.
I am going to have at least two securing points
beneath Jordan's knee, but
I am going to try not to tie anything
directly over her knee, as that would probably be
uncomfortable. And now I can start to
secure my splint to create some of the
rigidity that comes with
compression. Jordan, would you mind
putting your hand up here for me?
When I tie my cravats over my patient,
I would like to make sure that any place the
tie off comes over tissue is nice and
wide so that I do not create any localized
tissue pressure that could cause more injury. I can
start off with a standard knot and if I
wrap it around one more time, I have
created a little extra friction in a
surgeon's knot that can be pulled fairly
snug. It is still adjustable. I can tie
my bow so that as my patient needs the
splint adjusted during
their evacuation, I can come back and do so.
I am going to tie one more tie off down here,
right around Jordan's
ankle, and so far I have done a nice job of
immobilizing Jordan's femur. I have set up
my padding to extend past the sole of
her foot. I am going to take all this
padding, and I am going to fold it up
to create what amounts to a
"T" shape. I am going to take the two wings of
my T and fold them towards my patient's
knee, and I can take one more tie off and use
this to secure a little box wrap
that creates some nice foot support.
Any lower leg
extremity
can be secured
in this fashion.
I still can reach in and feel her toes.
It feels pretty warm in there.
Jordan, which toe am I squeezing right here?
Jordan: Big toe.
So good circulation and sensation. And can
you wiggle those?
There is some nice movement in there as well.
We are going to deconstruct a few
other options
for a lower leg or a tibia-fibula
splint.
We have jackets and scarves, all that are
wide and able to provide good compression.
What we have down here is a roll that has
been tied off in an Ensolite pad, so that it
can come up and create a little bit of a
support underneath Kay's foot.
On the inside
we have a wool blanket that has been
wrapped in a horseshoe shape
that comes all the way underneath Kay's foot,
around her ankles, and all the way up to
provide padding so there is no movement
inside the splint itself.
In this case,
we have a wool blanket that has been
wrapped around Kay's leg
and for an outermost layer here
we are using in this case
a duffel bag. We have added a stick
or a ski pole
to provide a little bit of
prefabricated rigidity in addition to the
compression that we can apply.
In this case,
in lieu of the Ensolite pad, we have an
inflatable Thermarest that has been
applied.
The secret
to making the Thermarest work as
your outermost layer
is to put it on while it is deflated,
have it tied into place
via the same systems we have been using so
far. Once it is all
secured snugly,
inflate it, and as you can see here
once we inflate it, it actually applies a more
uniform compression throughout the
length of the splint,
and allows essentially an improvised air
splint to be built.
