Advanced Paramedic Practice
This is a trauma case. It requires a certain amount of force and trauma to fracture a femur as it is the strongest bones in the odd. SQ. This film shows a mid-shaft, oblique fracture of the left femur.
The middle third is the most common site of femoral shaft fractures, as the bones international bowing is at its maximum. Femoral shaft fractures are categorized based on their pattern, degree of commutation, and soft-tissue disruption, if open. Fractures can be transverse, oblique, or spiral (Hake & Blanch 2000).
This fracture is an oblique fracture as the bone is broken on an angle; this is normally a result of indirect trauma. It is also a closed fracture as the bone has not broken through the skin.
This fracture is only slightly displaced. The amount of displacement depends on the breaking force, the pull of the muscles and gravity. SQ. Femoral shaft fractures in pediatrics are often linked with unintentional trauma; however child abuse must be taken into consideration, especially in children who are less than one year old (Angle & Choc 2005).
Up to 30% of femoral shaft fractures in Children younger than four years of age may be the result of child abuse, and is the most common cause of femur fracture in infants (Hake & Blanch 2000).
Other signs to look out for that may suggest child abuse are; bruising, burns and other fractures t several phases of healing. Unintentional trauma that could cause a child’s femur to fracture include; falls, for example falling of the playground; sporting accidents in contact sports; and motor decide accidents. Motor Vehicle account for a large number of femur shaft fractures n pediatrics (Hake & Blanch 2000).
These include being bicycle riders or pedestrians being stuck by motor vehicles. Bone tumors such as osteoporosis and bone cysts can also lead to femoral fractures in children (Hake & Blanch 2000).
If a child’s femur fractures from low energy trauma then one should be suspicious of such a disease. Stress fractures can also become more serious fractures in the event of low energy trauma. SQ. The likely ambulance management for this patient would include pain relief and splinting of the leg. One must first gain the trust of the patient, as you are dealing Ninth a child this can be more challenging than normal.
To gain the patients past medical history, history of how the injury occurred, medications and allergies, one should gain everything they can trot the patient but also ask the parents T “eight and last meal should also be asked.
The treating paramedic should conduct a remarry survey, respiratory status assessment, perfusion status assessment, Glasgow coma score and secondary survey. They should also gage the patient’s pain score, however as the patient is a child; the Wong-baker faces may be of better use. The paramedic should also use BUILDUPS to assess the injury.
BUILDUPS consists of assessing pain, irregularity, loss of function, swelling, deformity, unnatural positioning, creepiest, and tenderness. Once the patient’s history and pain score has been gathered, the paramedic can start to manage the patient’s pain. If the patient’s main score is above two then the treating paramedic can administer analgesia.
An ALAS paramedic should consider if Motherlands and/or Fontanel given via the Intranasal route are appropriate (Ambulance Victoria Gaps, 2009, p. 177). If the paramedic does decide to give Motherlands, they can give OMG, followed by another OMG if required. MGM is the maximum amount of Motherlands that can be given. The paramedic may also choose to use intranasal Fontanel at OMG/keg.
A second dose can be given after five minutes at 1 meg/keg titrated to obtain a reduction n pain to a comfortable level. The Max amount that can be given is OMG/keg *ambulance Victoria Gaps, 2009, p. 177). If the paramedic has exhausted all of these options, they can consult with the Royal Children’s Hospital to give one single dose of Morphine at 0. 1 MGM/keg via the intramuscular route (Ambulance Victoria Gaps, 2009, p. 77).
If MICA paramedics are available then they can give morphine intravenously. Once the patient’s pain has been managed the paramedics can start to splint the fracture. Depending on the size of the child, the Downward traction splint may or may not be an option. If the patient is too small for the Downward then the paramedics may hose to use anatomical splinting. SQ. Currently there is no specific diagnostic measure used by paramedics to diagnose this injure.
If a patient has a fractured femur then this should be fairly apparent.
However paramedics do uses the BUILDUPS survey, which is part of the secondary survey, to help them diagnose a fracture and the severity of the fracture. Ere BUILDUPS survey consists of asking the patient about their pain and looking for irregularity, for example looking at both limbs to see if there is a noticeable difference between them. The survey also aims to find out if the patient has a loss of unction, swelling and deformity such as broken skin on the affected limb. Unnatural positioning such as medial rotation of the affected limb will also give an indication of the severity of the fracture, as well as creepiest and tenderness.
He limitations of the BUILDUPS survey are that it is a subjective measure. The information gathered from the survey and how that information is interpreted can ‘array from person to person. This survey can only work if the patient is cooperative and conscious. If this is not the case then it will be incredibly hard for the paramedic o gain all the information needed. Some measures to overcome these limitations could include having the BUILDUPS survey written into the clinical practice guidelines much like the respiratory and perfusion status assessments.
This would allow for paramedics to put the patient into categories to help them decide on the severity of the injury.
Using the parents to get intimation trot uncooperative patients can also help. SQ. The x-ray shows a definitive fractured femur however other x-rays may be ordered of the other limb to make comparisons. Both x-rays should show the hip and nee to see if the patient has also sustained injuries to the femoral neck, and proximal and distal growth plates (Owen & Stephens, 2007). X-rays at other angles may also be needed.
The stability of the ligaments of the knee should also be tested, and a thorough neuromuscular examination should also be carried out. Regular x-rays may be taken for many months following the injury to track and monitor the bones healing and growth (Owen & Stephens, 2007). SQ. Age, fracture pattern and location, soft tissue injury, other fractures and injuries, family preference and social situation can all influence how the fracture is treated. Fractures in infants can be treated with a Pavlov harness (Angle & Choc 2005). While Children up to six years of age can benefit from Spice casting.
Other forms of treatment for pediatric patients with a fractured femur include external fixation, plating, flexible nailing and intermediately nailing (Angle & Choc 2005). Following treatment, rehabilitation may need to be undertaken by some patients. This type of fracture will normally heal fine in pediatric patients. They will usually recover full function of the limb and have legs that are the same length. If the fracture has been iced with intermediately nails, then they may need to be removed once the fracture has healed if they produce irritation to the skin and tissues underneath.
Sometimes pediatric patients will need additional treatment; this can be either early after the initial treatment or years after, if the patient has a substantial variance in the length of the legs, improper insulation or irregular rotation of the healed bone, infection or if it re-fractures (Hake & Blanch 2000). Any of these issues can normally be fixed Ninth additional treatment. References: Ambulance Victoria. (2009). Clinical practice guidelines for ambulance and MICA paramedics, revised edition. Detonates, Victoria.