Archive for April, 2007

Wilderness Orthopedics – Sprains and Strains

April 18, 2007

Sprains & Strains:Sprains and strains are by far the most common backcountry injuries.
Sprains and strains are injuries to muscles, tendons, ligaments, and the supporting structures of joints.

Signs & Symptoms of a Sprain/Strain:
Think of how a sprained ankle appears.
There is generalized pain and tenderness around the affected joint.
Unlike a fracture that is no point tenderness, if there is then suspect a fracture.
There is pain with movement of the affected joint.
There is pain with weight-bearing or use of the affected joint.
Swelling can be rapid and dramatic because of bleeding from the damaged blood vessels.
The area may become discolored over several hours, “black and blue” = ecchymosis.

Evaluation of a sprain/strain:
Consider the mechanism of injury.
Expose the injured area to look at the injury and the skin.
That includes removing boots and socks.
You cannot properly evaluate an injury that is hidden by clothing.
Gently palpate the area for pain, tenderness, and crepitation.
Put the injured joint through passive range of motion, that is, you gently move the joint and monitor for pain, loss of motion, or crepitation.
Loss of motion, a locked joint, indicates a dislocation.
Crepitation indicates a fracture.

Treatment: 
The goal is to minimize swelling. The less the sprain swells the faster it will heal. We use the acronym RICE to remind us of the principles to control swelling:
REST, ICE, COMPRESSION, & ELEVATION  
Rest, put the affected joint at rest. This will minimize blood flow and chance of further injury.
Ice, keep the area cool, this causes vasoconstriction thus reducing bleeding into the damaged tissues.
Compression, with a wide ACE wrap applies counter pressure to damaged tissues, again helping to control bleeding.
Elevation, raise the affected area above the level of the heart to decrease blood pressure and aid in the control of bleeding.
Immobilize & support affected joint. Splinting the affected area puts the injury at rest allowing the healing process to begin and continue.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Wilderness Medicine by Paul S. Auerbach, MD, MS

April 9, 2007

Once again, Paul Auerbach has managed to provide us with a tome that holds an absolute wealth of information. He has not only updated all the information contained in the previous edition, but he has also called upon more experts in the field who have added a wide variety of new topics. The list of contributing authors reads like a Who’s Who in Wilderness Medicine and Rescue. This text is a true accomplishment and a marvelous contribution to the wild side of medicine.

The Fifth Edition, 2007, consisting of 2316 pages is divided into 97 chapters, written by 157 contributing authors. A myriad of charts, tables, and spectacular photography complement the well-written text.

Needless to say, I have not had the time to read the entire book, but the several chapters I have read were packed with valuable information for all of us who are interested in or participate in wilderness medicine and rescue work.

Paul, a personal thanks. Great job! What a tremendous contribution this text will make to emergency medicine that is practiced in the extended care environment.

Wilderness Medicine, Fifth Edition, by Paul S. Auerbach, MD, MS is published by Mosby, ISBN 978-0-323-03228-5 and available through www.elsevier.com and probably amazon.com.

The Principles of Managing Musculoskeletal Trauma in the Backcountry

April 2, 2007

Assessment:  Look, Listen, and Feel

Look: 
Look at possible fracture sites.
Remove clothing, remove boots, and socks.  
Do you see any wounds, deformity, angulation, discoloration, or swelling?
Look around: 
What was the Mechanism of Injury (MOI)?
If the MOI indicates a possible fracture, treat as such. 
Listen: 
Talk to the victim. 
Did they feel anything break, snap, crack, or pop? 
Is there decrease in normal function? 
Is there guarding?
Feel: 
Check Circulation, Sensation, and Motion (CSM)?
Is there any point tenderness or crepitus?
WHEN IN DOUBT, SPLINT!

The Principles of Splinting:

Circulation, Circulation, Circulation
Is there good circulation distal to the site of the injury?
Can the injury be immobilized in the position found?
If not, pull traction-in-line to slowly and gently move the extremity into proper anatomical alignment. This is to establish and maintain good circulation distal to the site of the injury.
Create a rigid but very well padded splint.
Splints should be BUFF; Big, Ugly, Fat, and Fluffy.
It is more important for a splint to be well padded than rigid.
Immobilize the entire extremity, the joint above and below the site of the injury.
Monitor all splints, check C/S/M distal to the site of the injury every fifteen minutes for the duration of the evacuation.
In the cold winter environment beware of the risk of frostbite in immobilized extremities, may have to apply chemical heat packs to the hands and feet. 

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.


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