Harnesses
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A harnesses is a device intended to rigidify a member or to immobilize an articulation. The splints are used mainly at the time of an attack or traumatic suspection of attack (shock, blow, fall, clumsy movement). It is in general about a provisional immobilization for the transport of the victim towards the structure of care, but it can also be a question of an intermittent immobilization prescribed by a doctor (for example, a splint of leg can be carried to immobilize the knee at the time of the station upright, and to be removed the night).
In the case of the upper limbs, it can be useful to also employ a scarf to support the weight of the member.
The splints are various sizes and forms according to the member to be immobilized (front armlever, arm, leg,…) and according to the morphology (in particular the age) of the victim.
The old word for “splint” was “fish-plate”, one spoke “to fish a member”.
Various splints
Scarves
The scarves are Triangle S right-angled of fabrics of approximately a meter on side. They can be posed in three manners:
- right scarf to support a fracture of the front armlever or wrist (provisional immobilization) or to support a splint of upper limb;
- right scarf and against-scarf, for a fracture of the arm;
- diagonal scarf for a traumatism with the shoulder.
See the detailed article Scarf.
Inflatable splints
The inflatable splints are splints in plastic washable. Rigidity is ensured by the pressure of the air. It are maintained around the member with a system of buttonhole or zipper.
Their advantages are:
- low costs;
- the lightness and facility of arrangement (they take little place);
- they are invisible with the X-rays and can thus be left in place for the Radiographie S.
- they are fragile;
- they can not to adapt to deformation, and for lower extremities leg and thigh must to be aligned, which can require a reduction of the fracture and a realignment of the member, which will be done only under control of a Médecin and after Sédation (the operation being extremely painful), before the installation of the splint.
Preformed splints modelables
Preformed splints modelables, sometimes said “Aluform” (trade mark, there exist also the Aluderm , Blue Splint …), consist of deformable blades of Aluminum surrounded by upholstering. The splint takes the shape of a gutter, possibly bent, which one places around the member. Vis-a-vis the contact with the member is plasticized (washable and désinfectable), the other is out of velvet to allow to fix straps Velcro (scratch).
The first models (harnesses of Kramer, harnesses of Zimmer) consisted of a goutière out of aluminum netting; for having deformed the splint, it was necessary to furnish it, stuff it, then to attach it to the member with bonds.
The splint is deformed in order to respect the position of the member and his possible deformations. If that is not enough, the member will have to be realigned or the reduced fracture, which will be done only under control of a Médecin and after Sédation (the operation being extremely painful).
Once the splint installation, one positions the straps. Those should not be last where the person feels a pain (supposed seat of the traumatism).
On the parts which are likely to bend, one poses the straps in cross (crossing in the hollow of the elbow for the upper limb, on the knee and in the kick for the lower extremity). Then one finishes so that the ends are held. That is to say:
- lower extremity:
- 2 straps in cross in the kick,
- 2 straps in cross on the knee,
- a transverse strap in top of the thigh
- upper limb:
- 1 transverse strap with the wrist, possibly which makes the turn of the inch to avoid a rotation (Pronation/Supination), it is the narrowest strap
- 2 straps crossed in the hollow of the elbow
- a transverse strap in top of the arm.
Once all straps posed, one recontrôle their tightening (the more one poses of strap, the more the first slacken oneself). Tightening will have to be sufficient to ensure a good immobilization, but not excessive in order not to compress the member.
The preformed splints undoubtedly represent the best functionality ratio/price and are robust. On the other hand, they are not invisible with x-rays, and cannot adapt to the great deformations.
Splints of traction
The fracture of the Fémur (Os of the Thigh) is a delicate traumatism to deal with, in particular because of the risk of hemorrhage, the femoral Artère passing along this bone. The assumption of responsibility is normally medical: the realignment of the member is delicate and requires a sedation.
Transport requires usually the installation of a splint of traction: this splint takes support on the hip or the top of the thigh, and on the foot or ankle, and exerts a force maintaining the straightness of the lower extremity.
There exist several devices to exert this force. The most modern systems are systems with Piston, the force being adjustable by the Pression that one puts at it.
There exist model plusiers: harnesses of Thomas-Lardennois, harnesses of Donway, harnesses of Davis, Kendrick traction device (KTD).
The principal disadvantages are:
- need for sédater, the setting in traction being able to be extremely painful (but that relates to all réducitons them of fracture);
- because of the exerted force, the risk of Necroses parts where the splint rests;
- it should not be kept more 6:00
Cervical collar
The cervical collar is used to immobilize the cervical Vertèbre S, i.e. the neck: it restricts the movements of the head compared to the shoulders. It is complementary to a device of immobilization of the spinal column (Matelas immobilisator with depression, hard Plan or harnesses extraction)
See the detailed article cervical Collar.
Splints with depression
The splint with depression most commonly used is the Matelas immobilisator with depression (MID, or mattress “cockles (R)” invented by Jean LOEB), for the immobilization of the back and the basin. There exist also splints of member.
It is an envelope tight in plastic-coated cloth (washable) containing polystyrene chips and closed by a tap valve. When it contains air, the balls move freely and one can mould the splint around the member. When one aspires the air with a pump (one “makes the vacuum” in the splint), the depression plates the balls the ones against the others (with a force of a ton per square meter) what rigidifies the splint.
These splints make it possible to adapt to the great deformations, which is the principal limitation of the other splints. On the other hand, they are expensive and fragile, and their time of implementation is more important. They are very effective for the lower extremities, less for the upper limbs, in particular because of difficulties to block the elbow.
Hard plan
The hard plan is a rigid board (of wood, aluminum or plastic) which one slips under the back of a victim in order to immobilize the spinal column. The immobilization is complete only with a cervical Collier, a side chock and straps to plate the victim. It is an alternative to the Matelas immobilisator with depression.
See the detailed article Plane hard.
Extraction harnesses
This splint is a corset which allows the immobilization of the spinal column and facility the operations of Désincarcération.
See the detailed article Splint of extraction.
Impromptu splints
review to form a gutter
immobilization of a finger by another
use of ends of wood and bonds
Precautions for use
To maintain the member during the installation.
In the event of suspicion of fracture of a member, to immobilize the higher and lower articulation.
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the inflatable splints should not be installation on an open fracture.
- do not inflate too the splint; it must immobilize but not be used as garrot
Problem of the reaxation of the member and the reduction of the fractures
External bonds
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provisional fixed assets, an article of the site Infirmiers.com
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