Equipment

Question 1

Indications of a SAMsling

Answer 1

1. Suspected pelvic fracture with evidence of haemodynamic compromise

Question 2

Contraindications of a SAMsling

Answer 2

1. Suspected isolated neck of femur fracture

2. Suspected Traumatic hip disclocation

Question 3

Complication of a SAMsling

Answer 3

1. Binder should not be removed due to the risk of haemodynamic instability
2. Other methods (e.g. vacuum splint) may be used in small children.
3. Apply careful in gross open fractures to minimise pain and further complications.

Question 4

SAMsling procedure

Answer 4

1. Remove all objects from the pts pockets and pelvic area and cut off outer garments.
2. Unfold the appropriate size pelvic binder with the inner white surface facing up.
3. Gently position the binder beneath the pt to the level of the buttocks (GT or pubic symphysis). Ensure pt movement is minimised to prevent clot dislodgement.
4. Feed black strap through the buckle, placing the buckle close to midline.
5. With assistance, firmly pull black and orange loops in opposite directions. tighten the binder until it is firm (you may not require a click).
6. Maintain tension and firmly press the black strap onto the velcro.

Question 5

Is it recommended to apply the pelvic binder before extricating pt from a vehicle?

Answer 5

No

Question 6

Is the SAMsling recommended for use in pregnant trauma pt’s?

Answer 6

If applied correctly (at level of GT), it should be safe from pregnant pts, even late term. It is not officially recommended due to concern of inappropriate placement. But it is suggested to be used case by case if pelvic exsanguination exists and the risk of mortality is high.

Question 7

True or false, do not allow the Pelvic binder to be cut off the Pt?

Answer 7

True

Question 8

Is it appropriate to provide Analgesia to a pt prior to applying a pelvic binder?

Answer 8

Yes

Question 9

Indications of a CT-6

Answer 9

Mid shaft femoral fractures

Question 10

Contraindications of a CT-6

Answer 10

Fracture/dislocation of the knee

Ankle injury

Question 11

Complications of a CT-6

Answer 11

Latrogenic injury due to poor application technique

Question 12

CT-6 Procedure

Answer 12

1. Assess the injury (Expose the affected limb, assess the limb for distal perfusion, irrigate and dress open fractures as required)
2. Assembly
3. Sizing: place next to uninjured leg. ischial cap align the top of the iliac crest with the ankle hitch end approximately 15cm beyond the bottom of the pts foot.
4. Attach strap: Align 2 straps above the knee and 2 straps below the knee taking care not to strap over the injury or over the knee. Feed the strap under the pt thigh and reattach.
5. Attach ankle hitch (foot strap runs beneath foot, tighten bottom of strap)
6. Apply minimal traction (until splint rests in appropriate position)
7. Secure leg straps (start with upper inner thigh
8. Apply traction (until legs are of equal length)

Question 13

In the setting of a potential pelvic injury, the CT6 is to be applied first, followed by the SAMsling

Answer 13

False, Pelvic binder is applied first

Question 14

Open fractures need to be washed out prior to the application of a CT6

Answer 14

True, (minimum of 2L saline)

Question 15

Indications of a soft cervical collar

Answer 15

Suspicion of a cervical spine or SCI

Question 16

Contraindications of a soft cervical collar

Answer 16

1. Surgical airway

2. Penetrating neck trauma

Question 17

Complications of a soft cervical collar

Answer 17

1. Discomfort

2. Anxiety

Question 18

Soft Cervical Collar procedure

Answer 18

1. Align pt head in neutral or position of greatest comfort
2. Measure distance between the base of the chin and the suprasternal notch.
3. Select appropriate size.
4. Slide the collar under the pt neck. until velcro is visible

Question 19

Should the ends of a correctly sized soft collar meet or slightly overlap at the back of the pt neck?

Answer 19

Yes

Question 20

Indications of NIEJ

Answer 20

To facilitate safe Extrication from a confined space

Question 21

Contraindications of NIEJ

Answer 21

PT is actual time critical and application of NIEJ will delay transport

Question 22

Complications of NIEJ

Answer 22

1. Respiratory effort effected if chest straps too tight
2. Groin straps need to be firmly secured to minimise jacket and neck mov’t.
3. Cspine hyperextension or hyperflexion with incorrect head padding
4. Cspine Mov’t with immobilising head without properly securing torso

Question 23

NIEJ Procdure

Answer 23

1. Explain procedure gain consent
2. Prepare NIEJ
3. Cspine immobilisation in conjunction with NEIJ. MILS during application of Collar.
4. Position NIEJ firmly in armpits but no higher than top of head.
5. Position groin straps from back of NEIJ. (make sure they are not twisted
6. Raise pt arms to shoulder height, position chest flaps (apply straps green yellow then red).
7. Straps should cross the chest, or vertically if pt has breathing difficulty.
8. Slide groin pads onto leg strap
9. Connect leg straps on buckles and tighten
10. Recheck straps are tight.
11. attach head pads to prevent hyperextension
12. Secure collar strap and forehead strap (inline with eyebrows), tighten each side equally.
13. Extricate pt, groi straps may be loosened.

Question 24

Paediatric Specialised use of NEIJ

Answer 24

Can place blankets either side to assist with pt support

Question 25

Pregnant specialised use of NEIJ

Answer 25

Chest flaps may be folded inward to expose abdomen, and straps tightened to support

Question 26

NEIJ used of Hip immobilisation

Answer 26

Invert, chest flaps over pelvic area. Secure head flap around knee, use lumbar support between knees, secure ankles with triangular bandage.

Question 27

Indications for a NPA

Answer 27

Potential or actual airway obstruction

Question 28

Contraindications for a NPA

Answer 28

Nil in this setting

Question 29

Complications for an NPA

Answer 29

1. Airway trauma, Epixtaxis 2. incorrect size or placement will compromise effectiveness 3. Exacerbate a base of skull fracture (NPA displacing in the cranial vault) 4. Can stimulate gag reflex in sensitive pt, precipitating Vom or Aspiration.

Question 30

Procedure for inserting an NPA

Answer 30

1. Place pt head in neutral position. 2. Identify correct size NPA by measuring from tip of nose to earlobe. 3. Lubricate end of NPA. 4. Advance NPA (bevel facing septum, until flange rests against the nostril.

Question 31

Does the NPA protect the pt airway from aspiration

Answer 31

No.

Question 32

Which nostril is preferred when inserting an NPA

Answer 32

Right nostril is often preferred as its typically larger and straighter then the left.

Question 33

Indications for an OPA

Answer 33

1. Maintain airway patency | 2. Bite block for intubated pts

Question 34

Contraindications for an OPA

Answer 34

1. Nil in this setting

Question 35

Complications for an OPA

Answer 35

1. Airway trauma from OPA placement 2. Intolerance of OPA requiring removal 3. Can cause Vom/aspiration in pt with intact gag reflex. 4. Incorrect size or placement can potentially exacerbate airway obstruciton

Question 36

Indication of Vacuum Splint

Answer 36

1. Suspected fractures and dislocations of arms, legs or joints 2. Spinal immobilisation or full body splinting where appropriate for infants or small children

Question 37

Contraindications of Vacuum splint

Answer 37

1. Nil in this setting

Question 38

Complications of Vacuum splint

Answer 38

1. vacuum splints may require further extraction of air to maintain rigidity during aeromedical transport

Question 39

Procedure of vacuum splints

Answer 39

1. Apply appropriate dressing to all wounds 2. Select appropriate sized splint from limb, correct size will immobilise joints above and below the injury site 3. lay splint down, spread beads 4. position splint under injured area, so that one strap is above and below injury site. 5. support limb and spread beads to provide good mould 6. mould splint to ensure optimal coverage 7. attach hand pump to valve 8. manually pump out air from splint 9. Disconnect pump 10. secure splint straps 11. check distal pulse, recheck pulse and vital signs.