[0:07]Hi, this is Miles with Best Practice Medicine. In our video today we're going to continue our discussion on extremity splinting, focusing on the lower arm, wrist, and hand.
[0:29]One of the key principles of extremity splinting is to immobilize not only the site of the injury, but also neighboring tissues. For a long bone injury, the principle is to immobilize both the joint below and above the site of the injury. For an injury to a joint, you immobilize the long bone above and below. Common materials used for extremity splinting include triangular bandages or cravats, roller gauze, Coban, Sam splints, ace bandages, or commercial splinting devices. However, as a provider, you're not limited to these options for splinting materials. You can use your judgment to improvise from materials available at the scene, especially in a back country setting. A Sam splint is commonly used to immobilize injuries to the wrist and forearm. The strength of the splint comes from its cylindrical channel shape. Key points to pay attention to is the continuation of the channel all the way up to the hand portion of the splint. When preparing a Sam splint to immobilize an arm or wrist, make a roll at one end for the patient's hand to rest on to preserve position of function. Another aspect to pay attention to is where to place the roll on top or on the bottom of the plane of the splint. Most patients work best with the roll on top, preventing the formation of a gap or void at the patient's wrist. If the rolled portion is placed on the bottom, a patient's hand may naturally slide forward as the fingers wrap around the material and create a large void which will need to be filled later. It's important to keep in mind that every patient's anatomy is slightly different, and you should use whatever method works best to achieve the desired result. Using the patient's non-injured extremity, or if you're of similar size and build, your own same side extremity, form a channel by gently pushing the material up to match the patient's arm. I like to fold one layer at a time. Sam splint material folds easier when it's thinner and prevents the application of excessive force to the patient's tissues. Once a close approximation of the patient's form has been achieved, position the splint on the injured extremity, and gently custom mold without displacing their tissues to achieve a close fit, watching out for any voids and filling if necessary. After this initial channel has been formed, bring the second layer of splint up and form it to the first, providing more structural support. Once the splint has been formed to match your patient's arm, secure it using Coban, Ace bandage, or other material. When applying the securing material, wrap loosely at first, adding tension on more superficial layers, making it easier to adjust if it appears the securing material is limiting the patient's circulation. If the injury is to the patient's wrist, make sure that both the bones of the forearm and the metacarpal bones of the hand are effectively immobilized. If the injury is to the patient's forearm, we'll immobilize the joint of the wrist, as well as the elbow joint, using a sling and swath.
[4:33]When immobilizing a finger, the same principles of immobilizing the tissues above and below the injured part apply. This can be accomplished using a splinting material such as a tongue depressor or other improvised object and securing with tape or Coban. You can choose to wrap only the injured extremity, or you may include one or more adjacent fingers in the wrap to perform a buddy splint and help reduce movement of the injured tissues. If necessary, you can continue the wrapping all the way up into the patient's hand and wrist. As with the application of the Sam splint, it's important to wrap gently to prevent cutting off circulation to the patient's fingers. If the patient's finger is immobilized, you can check distal CSM by squeezing the patient's nail bed and watching how long it takes the capillaries in the nail bed to return to their pink color. Capillary refill time of less than two seconds is normal in most healthy adults. It's important to remember that every splinting intervention begins with manual stabilization of the injured part, followed by initial assessment of the patient's CSMs, and ends with reassessment of the patient's CSMs. Familiarity with commercial and improvised splinting materials is important for effective extremity immobilization. However, the most important takeaway from this video is a solid understanding of the fundamental principles of extremity immobilization by splinting. We hope you've enjoyed this episode of BP MTV and found it informational and helpful to your clinical practice. Looking forward to seeing you next time. As always, thanks for watching.
[6:39]Thank you for watching this episode of BPM TV. As always, we hope you found it informational and helpful to your clinical practice. Tune in next time. Thanks for watching. But the most important takeaway from this video is a solid under flubbed it.
[7:05]When the saints go marching in. Oh, when the saints go marching in. Oh, how I want to be in that number. When the saints go marching in.
