First time I made the decision to apply a traction splint, using that KTD splint, it was with a young lad who'd come off the bike. I was excited to see it give him this mystical pain relief when I tightened it, but he was in just as much pain as he was before... It almost looked like it was hurting him more... Turns out he'd broken his ankle too and we hadn't noticed, we were just tugging on his snapped bones harder and harder! Always remember to do a full secondary survey in trauma, kids 😬😬😬
Hi mate and cheers for taking part in the discussion. A) What do you mean by short acting? Please keep in mind we discuss pre-hospital interventions. B) FINB/FICB? Prehospitally? If you know country where it is practicable in OOH setting, please let me know (maybe there is, I honestly don't know) Regards, Alex
Never traction without analgesia, yes splinting may help with pain but its very painful and doesn't remove all pain at the very minimum entonox or ideally penthrox but tbh iv morphine or ketamine for decent pain control. Basic prehospital care really.
Analgesia in midshaft femur fracture is a very complex thing but I agree that it should be discussed. The point I made is backed with the research I included in the description to the video plus NICE guidelines (pathways.nice.org.uk/pathways/trauma/fractures-in-the-pre-hospital-setting#content=view-node%3Anodes-management-limb-fractures) If you have/know any other research papers please let me know, maybe I will learn something new? Just to make it clear, no one (including me) is saying that no analgesia should be administered. All I say is that traction is superior to administering pain relief. In my practice on A&E and later ICU I've seen enough patients with complications only because a prehospital clinician wasted time trying to obtain an IV access (for analgesia) and leaving the limb not splinted.... So again, if you know any proper research papers please share it with me I will gladly see different point of view.
@@groupcall6570 the NICE guidelines you have quoted make it clear that analgesia should be administered its a dominant theme within the guideline NG38 on fracture management along with traction splinting. Analgesia is also well mentioned in NG39 on major trauma. I cannot see anywhere in this document that advocates splinting alone without analgesia.
@Simon: I won't agree. Also: traction splints provide not only analgesia but also a degree of haemorrhage control hence why providing analgesia prior to splinting would be like administering a pain relief before putting a tourniquet on. Also, how can you prove that there is no internal bleeding in prehospital setting? And that's not only my point of view. Hence why I wouldn't be brave enough to say "always" and "never" in medicine.
With STS and STS-C you can let the patient pull traction for their own relief. So it's not crazy to traction first and then add additional analgesia after they feel most comfort. th-cam.com/video/JK9GYCz2ido/w-d-xo.html
Tractioning without analgesia??? Cannot disagree with this point more! Tractioning is incredibly painful. Please please for the sake of your patients analgise them before you do this incredibly painful procedure. You wouldn't place stitches without local anaesthetic! So don't pull a fractured limb without pain relief.
Analgesia in midshaft femur fracture is a very complex thing but I agree that it should be discussed. The point I made is backed with the research I included in the description to the video plus NICE guidelines (pathways.nice.org.uk/pathways/trauma/fractures-in-the-pre-hospital-setting#content=view-node%3Anodes-management-limb-fractures) If you have/know any other research papers please let me know, maybe I will learn something new? Just to make it clear, no one (including me) is saying that no analgesia should be administered. All I say is that traction is superior to administering pain relief. In my practice on A&E and later ICU I've seen enough patients with complications only because a prehospital clinician wasted time trying to obtain an IV access (for analgesia) and leaving the limb not splinted.... So again, if you know any proper research papers please share it with me I will gladly see other points of view.
@@groupcall6570 somethings really Don't need that much evidence. Analgesia before hanging off an angulated fracture is one of these. Yes splinting is the ultimate analgesia. This is the case with all fractures, realignment and restriction of movement is ofcourse going to be the most beneficial. This is not what you have describe I'm the video. You very clearly say that analgesia is your second priority to splintage and don't discuss concurrent activity with this, or an analgesic/splintage package. Gaining access prior to pulling a fracture is not "wasting time" and is unlikely to have been the complication in previous cases you have seen. It takes minutes and is an important step. Yes pull fractures, yes they will give ultimate analgesia, but also yes you must analgise your patient somewhat before pulling. It is not wasting time. As someone who sedates these patients regularly for prehospital traction, I would rightly come under scrutiny if I suggested pulling without some attention to analgesia for the procedure.
@@joshuabarker2724 Hi Josh and thank you so much for taking time to write this comment. Gaining access prior to pulling a fracture is not "wasting time" (...) -> Maybe I did not describe those cases adequately but please believe me, I would not be cocky enough to make this point based solely on my assessment. There were a few more experienced and senior clinicians who confirmed what I initially thought. Especially after seeing 9 (nine!) unsuccessfull cannulation attempts on a major trauma patient kept at scene for over 45 min after extrication and not having a traction performed due to "lack of proper analgesia". Patient sadly died later on my ICU due to vascular complications. Also, I think that you will agree that traction splints provide analgesia AND a degree of haemorrhage control - if so, in some cases providing analgesia prior to splinting would be a bit like administering a pain relief before putting a tourniquet on. Unless you have enough EXPERIENCED hands on the deck and something, which will work with severe pain and its really easy to administer (but please remember that YT videos are watched all across the world and there are huge differences between the countries - including the culture of treatment of the pain so don't be so fast with going / sending someone under scrutiny). Saying that: I'm in this job for over 13 years now, both pre- and In- hospital setting but I know I'm still learning so this conversation is a big learning point for me. Cheers Alex
First time I made the decision to apply a traction splint, using that KTD splint, it was with a young lad who'd come off the bike. I was excited to see it give him this mystical pain relief when I tightened it, but he was in just as much pain as he was before... It almost looked like it was hurting him more...
Turns out he'd broken his ankle too and we hadn't noticed, we were just tugging on his snapped bones harder and harder!
Always remember to do a full secondary survey in trauma, kids 😬😬😬
So true, mate! 😂👊 the point well made!
Please have a look here too: th-cam.com/video/JK9GYCz2ido/w-d-xo.html Concurrent lower ext trauma is not an issue for the STS and STS-C.
Analgesia before manipulating a fracture!
Ideally something either:
A) short acting
or
B) a femoral nerve block.
Hi mate and cheers for taking part in the discussion.
A) What do you mean by short acting? Please keep in mind we discuss pre-hospital interventions.
B) FINB/FICB? Prehospitally? If you know country where it is practicable in OOH setting, please let me know (maybe there is, I honestly don't know)
Regards,
Alex
Tend to use Penthrox to reduce most fractures now
Never traction without analgesia, yes splinting may help with pain but its very painful and doesn't remove all pain at the very minimum entonox or ideally penthrox but tbh iv morphine or ketamine for decent pain control. Basic prehospital care really.
Analgesia in midshaft femur fracture is a very complex thing but I agree that it should be discussed. The point I made is backed with the research I included in the description to the video plus NICE guidelines (pathways.nice.org.uk/pathways/trauma/fractures-in-the-pre-hospital-setting#content=view-node%3Anodes-management-limb-fractures)
If you have/know any other research papers please let me know, maybe I will learn something new?
Just to make it clear, no one (including me) is saying that no analgesia should be administered. All I say is that traction is superior to administering pain relief. In my practice on A&E and later ICU I've seen enough patients with complications only because a prehospital clinician wasted time trying to obtain an IV access (for analgesia) and leaving the limb not splinted....
So again, if you know any proper research papers please share it with me I will gladly see different point of view.
@@groupcall6570 the NICE guidelines you have quoted make it clear that analgesia should be administered its a dominant theme within the guideline NG38 on fracture management along with traction splinting. Analgesia is also well mentioned in NG39 on major trauma. I cannot see anywhere in this document that advocates splinting alone without analgesia.
@Simon: I won't agree. Also: traction splints provide not only analgesia but also a degree of haemorrhage control hence why providing analgesia prior to splinting would be like administering a pain relief before putting a tourniquet on. Also, how can you prove that there is no internal bleeding in prehospital setting? And that's not only my point of view. Hence why I wouldn't be brave enough to say "always" and "never" in medicine.
With STS and STS-C you can let the patient pull traction for their own relief. So it's not crazy to traction first and then add additional analgesia after they feel most comfort. th-cam.com/video/JK9GYCz2ido/w-d-xo.html
Tractioning without analgesia??? Cannot disagree with this point more!
Tractioning is incredibly painful. Please please for the sake of your patients analgise them before you do this incredibly painful procedure.
You wouldn't place stitches without local anaesthetic! So don't pull a fractured limb without pain relief.
Analgesia in midshaft femur fracture is a very complex thing but I agree that it should be discussed. The point I made is backed with the research I included in the description to the video plus NICE guidelines (pathways.nice.org.uk/pathways/trauma/fractures-in-the-pre-hospital-setting#content=view-node%3Anodes-management-limb-fractures)
If you have/know any other research papers please let me know, maybe I will learn something new?
Just to make it clear, no one (including me) is saying that no analgesia should be administered. All I say is that traction is superior to administering pain relief. In my practice on A&E and later ICU I've seen enough patients with complications only because a prehospital clinician wasted time trying to obtain an IV access (for analgesia) and leaving the limb not splinted....
So again, if you know any proper research papers please share it with me I will gladly see other points of view.
@@groupcall6570 somethings really Don't need that much evidence. Analgesia before hanging off an angulated fracture is one of these.
Yes splinting is the ultimate analgesia. This is the case with all fractures, realignment and restriction of movement is ofcourse going to be the most beneficial. This is not what you have describe I'm the video. You very clearly say that analgesia is your second priority to splintage and don't discuss concurrent activity with this, or an analgesic/splintage package.
Gaining access prior to pulling a fracture is not "wasting time" and is unlikely to have been the complication in previous cases you have seen. It takes minutes and is an important step.
Yes pull fractures, yes they will give ultimate analgesia, but also yes you must analgise your patient somewhat before pulling. It is not wasting time. As someone who sedates these patients regularly for prehospital traction, I would rightly come under scrutiny if I suggested pulling without some attention to analgesia for the procedure.
@@joshuabarker2724 Hi Josh and thank you so much for taking time to write this comment.
Gaining access prior to pulling a fracture is not "wasting time" (...) -> Maybe I did not describe those cases adequately but please believe me, I would not be cocky enough to make this point based solely on my assessment. There were a few more experienced and senior clinicians who confirmed what I initially thought. Especially after seeing 9 (nine!) unsuccessfull cannulation attempts on a major trauma patient kept at scene for over 45 min after extrication and not having a traction performed due to "lack of proper analgesia".
Patient sadly died later on my ICU due to vascular complications.
Also, I think that you will agree that traction splints provide analgesia AND a degree of haemorrhage control - if so, in some cases providing analgesia prior to splinting would be a bit like administering a pain relief before putting a tourniquet on. Unless you have enough EXPERIENCED hands on the deck and something, which will work with severe pain and its really easy to administer (but please remember that YT videos are watched all across the world and there are huge differences between the countries - including the culture of treatment of the pain so don't be so fast with going / sending someone under scrutiny).
Saying that: I'm in this job for over 13 years now, both pre- and In- hospital setting but I know I'm still learning so this conversation is a big learning point for me.
Cheers
Alex