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Discussion Starter · #1 · (Edited)
Dealing with compound fractures, a recent experience (long)

Let me preface this post by stating I am NOT a doctor, EMT, paramedic or other medical professional. My only medical training was a 2 week "Wilderness First Responder" course designed to deal with major trauma in remote locations where medical help was days away (I was a mountaineering guide at the time). I should also note that it has been 6 years since I took the course. That said...

Last Friday night I went to the local BMX track for my ritual humiliation by young kids. I've been going to this track for about 2 years now - great people and a wonderful experience. The only negative is, like all sports, sometimes people get hurt. And as luck seems to have it, when people get hurt, I'm the closest guy with any medical training.

In the time I've been there, we have had about a dozen kids (and adults) take hard falls, but basically get up OK. We have had 2 minor concussions, one separated shoulder, and one (suspected) ruptured spleen. The spleen was an immediate 911 transport. The others went to the doc via car. (Note: both the riders with concussions were wearing Snell/DOT MX helmets and both fractured the helmets! Think about that next time you bomb down hill or dirt jump with a cheap bike helmet!)

So last night I knew it was going to be ugly when one of the track officials told me ?we really need you bad!!! A young lady (early 20's) had attempted to clear a double, came up short and ate it big. The good news was her body cleared the landing - so she didn't have an abrupt stop. She was also thrashing in pain - another good sign that a spinal injury was unlikely (but I still checked).

However, her injury was immediately obvious - a pool of blood lay near her upper left arm, her elbow was WAY TOO CLOSE to her shoulder, and her upper arm was bulging wider than it was long. She had a compound fracture of the left humorous and it was open.

Any compound fracture is extremely serious and can be life threatening. When a compound fracture occurs the muscles around the bone start to spasm - pulling the jagged sections of bone past each other. These jagged ends can cut tissue, nerves, and arteries. If nerves are cut, feeling or control of the limb could be permanently lost. If an artery is cut, the person could bleed to death. In the case of a compound fracture of the femur (upper leg), if the femurial (sp?) artery is cut, the individual could bleed out in only a few minutes!!

If the fracture is open (bone sticking out), serious risk of infection exist. We are talking life threatening infection. If the bone is exposed, leave it out; do not pull it back in!

The young lady in question last night was lucky for several reasons. First off she did not have any spinal injuries. Second, she was not on a remote trail and emergency services were readily available. Third, while there was a rupture in the skin (caused by the bone for sure) the bone was not sticking out, simplifying her transport and probably lowering her risk of infection. Forth, while there was some blood, she showed no signs of bleeding out internally or externally. Fifth, she had some feeling in her hand - indicating nerve damage was unlikely.

Since help was on the way, I simply held traction, checked for other injuries, and tried to keep her distracted until the paramedics arrived. Once they arrived I gave them a quick report and told them I would move out of the way at their request. They chose to have me continue to hold tension while they fashioned a splint and did other duties. Once the splint was in place we loaded her onto the gurney and into the ambulance. They set up a morphine drip and waited for it to take hold before rolling.

So what to do in a case like this? Here is a quick list:

1. Secure the scene - NO NEW VICTIMS. In this case it meant making sure no one was about to bomb down the track and hit her and the people helping her.
2. ABC - airway, breathing, circulation are your top 3 priorities in a trauma situation. It means making sure the person is breathing (and has an unobstructed airway to do so), their heart is beating, and they aren't loosing blood.
3. C-spine - basically making sure there are no spinal injuries before attempting to move the person. Since she was thrashing, I could ignore this for the moment and check later when I had more time.
4. In the case of a compound fracture, your goal is to prevent muscle spasms from allowing the bone to saw arteries, nerves, and tissue. To do this, simply hold gentle traction on the limb to prevent the muscles from contracting further. If the fracture is open (bone is sticking out), be careful not to pull the bone back in.
5. Hopefully you have someone with you that can go for help, or cell phone in service range to call 911. If not, life is going to get interesting.
6. So your cell has no signal, no one else is around, and you?ve come to the hard conclusion that you are going to have to go for help. Transporting the victim yourself is unlikely, but regardless if you transport or leave them while you go for help, you will need to fashion a crude splint to hold traction as you (nor the victim) can continue holding traction. You should also cover the victim with whatever clothing is available as shock will be setting in.
7. After the splint is in place, check for circulation and feeling in the extremity of the limb. You can check circulation by gently squeezing a finger (or toe). The skin should turn pale and then regain color as the blood refills the tissue. Basically you want to make sure your splint hasn't cut off circulation.
8. Go the shortest distance/time to summon help and return to the victim as quickly as possible. This might mean going to a clearing where you could obtain a cell signal or flagging a motorist on a nearby road.
9. Good luck.

I hope none of you ever need this advice, and if you do, there is someone nearby with much more medical training than me.

Finally, if any medical professionals have any comments on cycling trauma injuries, I'm all ears.
 

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Wow, scary! But very good info. Either if I come across someone or if someone comes across me in that shape. Hopefully neither. I am so squeamish when it comes to that stuff, but at least the few situations I've been in I've been able to put that in check until things have been stabilized. Example: father-in-law chainsaw accident. After helping get him off to the hospital, I had to sit with my head between my legs and focus on breathing to keep from passing out! S
 

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Discussion Starter · #3 ·
DSR said:
<snip>I am so squeamish when it comes to that stuff, but at least the few situations I've been in I've been able to put that in check until things have been stabilized. <end snip>
I know exactly what you mean. I was the kid in 5th grade science class who passed out when the teacher started talking about the heart and blood circulation. Making it through the Wilderness First Responder course was a real challenge for that reason. However, it is like you say, when the heat is on and someone is hurt, some how you suck it up and do what needs to be done.

With this incident, even though it did make me a little squeamish thinking about it afterward, my main preoccupation afterwards was replaying everything over and over, making sure I did the right thing, what could I have done better, hoping I didn't do anything wrong.

I went back to the track today for Sunday races, but was having a hard time keeping my head on the bike. Somehow I managed to qualify for the main. Then, before the main the young lady who had been injured showed up with her mom.

I was thrilled to see she was doing fine. Turns out she had some numbness in her hand and couldn't move her fingers, so the first hospital sent the ambulance to a specialist hospital, suspecting the nerve was severed. Fortunately the nerve was only bruised and she is expected to fully recover.

She also had the X-rays to show off - very clean break with no obvious bone fragments. She is young, so it should heal up nicely.

I thanked her for coming to the track to let everyone see how she was doing. It certainly made me feel a lot better.
 

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Good Advice...

...but too bad for the lady. Ya I'm an EMT student right now and you got everything right. The way you "package" your patient is an essential part to the care you give. The rule of EMS is "Do no harm" so the way you treat that is the steps Old Dong laid out. Maybe I would have immobilized c-spine real fast as this was a trauma patient, but its ok if you have other injuries to take care of. I know first hand that we all have our share of falls and I think all of us need to take an Adult/Child First Aid class at the very minimum. Also consider a CPR/AED class as well. Trust me, the faster to patient care the more likey things will turn out for the better. Now I think I'll go ride my bike and have a nasty fall. j/k
 

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Good Work!

Wow, I'm glad to see you had the training to help. Good thing you were there and Good Job!

You bring up the seriousness of accidents than can happen. I'm often way out in wilderness areas and having something like this happen is pretty scary. Your story and how critical it is to do the right things is encouraging me to look around for a course I can take. Your Wilderness First Responder course sounds like a perfect course for those going way out in their riding. Where can you take this course?
 

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Discussion Starter · #6 ·
BigLarry said:
Your Wilderness First Responder course sounds like a perfect course for those going way out in their riding. Where can you take this course?
WFR courses are hard to come by. The one I took was sponsored by a local mountaineering guiding company that I was guiding with at the time. They are typically only offered by organizations that specialize in outdoor skills training, and often have schedules that are unfriendly to working people with kids (mine was 2 very long weeks, with no time for anything else).

You will have to search around on the net, ask people at your local mountaineering store (or REI), or maybe your local community college. I do know you can take an EMT course at most community colleges - typically all day Saturday for a semester. There is also something called a Wilderness EMT (WEMT).

There are also First Aid and Advanced First Aid courses offered by Red Cross and other agencies. While these are far less training than EMT or WFR, it is far better than nothing. Ideally we would all be WEMTs or Wilderness Paramedics, but hey, when was the last time you saw an ideal accident?
 
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