Mandatory Splinting: A Case Study

Dispatch:

20:10hrs, Paramedic crew, responding to 47-year-old-male cyclist, fall at speed, conscious and breathing. DDx considered: head/spinal injury, fractures, lacerations/abrasions. Time to scene, 14 minutes. Accompanied by Fire EMS.

Initial Findings:

Patient sitting on gatepost, alert, orientated, wearing helmet. Obvious injuries: self-splinting right arm, multiple abrasions; both arms/legs, right shoulder. MOI: cycling downhill at speed, contact with another cyclist, causing fall. C-Spine control initiated by practitioner (PHECC, 2014) (Appendix 1). Adequate ventilation, although respiratory splinting is noticed (Kochar, 2013).

Secondary Survey (PHECC 2014) (Appendix 2):

Vital signs:

• HR: 88 BPM/regular

• RR: 28 RPM/shallow

• SpO2: 92% (O2 Therapy Initiated) (Appendix 3)

• BP: 135/70

• GCS: 15/15

• Pupils: 4+

• BM: 6.1 mmol/L

• Temperature: 36.6oC

Detailed physical exam reveals no head injury, no neck, back pain or midline spinal tenderness. Right clavicle guarding and malformation, ecchymosis and tenderness right posterior thoracic region, no evidence of flail chest (Caroline, 2014). No abdominal tenderness or distention, no pelvic pain or neurological deficit in any limbs. Pain score 6/10, 8/10 on deep inhalation (Breivik et al., 2008) (Appendix 4). Auscultation reveals reduced breath sounds mid-axillary right side. Abrasions require irrigation and dressing as road debris will cause contamination (Percival, 2002). No medical Hx, no regular medications. Working Dx: right clavicle fracture, possible pneumo/haemothorax with rib