Femur fractures can be successfully immobilized using a traction splint. A femur fracture is complicated due to the amount of bleeding that can occur from the broken bone. In addition, the thigh muscles will contract and pull the fractured ends so they overlap or pass each other. This increases the size of the thigh, which leads to more blood loss, pain and internal soft tissue injury.

Traction splints provide a counter-pull to reduce the size of the thigh and realign the fractured femur. This helps reduce blood loss, alleviate pain and minimize further injury. The most common traction splints you’ll see in the field are the Hare (bipolar) and the Sager (unipolar).

Hare Traction Splint (Bipolar Traction Splint)

The Hare is a bipolar traction splint, which means it uses two external poles to support the injured leg.

Indications

• Suspected femur fracture

Contraindications

• The injury is within 1-2″ of the knee or ankle
• The knee is injured
• The hip is injured
• The pelvis is injured
• There’s a partial amputation or avulsion with bone separation and the distal limb is connected by only marginal tissue

How to Apply

1. Assess distal PMS.
2. Stabilize the injured leg by applying manual traction.
3. Measure the splint on the uninjured leg and adjust the length accordingly.
4. Position the splint under the injured leg until the ischial pad rests against the bony prominence of the buttocks. Once the splint is in position, raise the heel stand.
5. Attach the ischial strap over the groin and thigh.
6. Secure the ankle strap with the patient’s foot in an upright position.
7. Attach the “S” hook to the “D” ring and apply mechanical traction; continue until it’s equal with the manual traction and the pain and muscle spasm are reduced.
8. Attach the leg support straps.
9. Recheck the ischial strap and ankle hitch to ensure both are securely fastened.
10. Reassess distal PMS.

For unresponsive patients, apply mechanical traction until the injured leg is the same length as the uninjured leg.

Sager Traction Splint (Unipolar Traction Splint)

The Sager is a unipolar traction splint, which means it uses one external pole to support the injured leg.

Indications

• Suspected femur fracture

Contraindications

• The injury is within 1-2″ of the knee or ankle
• The knee is injured
• The hip is injured
• The pelvis is injured
• There’s a partial amputation or avulsion with bone separation and the distal limb is connected by only marginal tissue

How to Apply

1. Assess distal PMS.
2. Position the splint on the inside of the injured leg and adjust the length so it extends approximately 4″ beyond the heel.
3. Attach the strap to the thigh.
4. Secure the ankle strap with the patient’s foot in an upright position and attach it to the splint.
5. Apply traction by extending the splint to 10% of the patient’s body weight.
6. Attach the leg support straps.
7. Recheck the ischial strap and ankle hitch to ensure both are securely fastened.
8. Reassess distal PMS.

Remember, you don't have to be certain the patient has a femur fracture. If the thigh is painful, swollen or deformed you should assume it's fractured and splint accordingly.

The oropharyngeal airway (OPA) and nasopharyngeal airway (NPA) are basic airway adjuncts. They are designed to secure the airway once it has been opened by either a head-tilt, chin-lift or jaw-thrust manuever, and any objects or secretions have been removed by suctioning. The OPA and NPA keep the tongue from occluding the airway and extend to, but do not pass the larynx.

Oropharyngeal Airway (OPA)

The OPA comes in two forms: one is tubular with a hollow center and the other has channeled sides. Both types of OPA’s allow for suctioning and come in various sizes for infants, children and adults.

Indications

• Unresponsive patient with no gag reflex

Contraindications

• Responsive patient or has a gag reflex

How to Insert

1. Select an OPA and measure from the level of the teeth to the angle of the jaw.
2. Open the patient’s mouth by using the crossed-finger or scissor technique.
3. Insert the OPA upside down and when it touches the roof of the back of the mouth, rotate it 180 degrees while continuing to advance the airway until the flange is resting on the patient’s front teeth. You can also insert the OPA sideways and rotate it 90 degrees.

Remove the OPA immediately if the patient becomes responsive or begins to gag.

Nasopharyngeal Airway (NPA)

The NPA comes in various sizes based on the diameter of the tube and allows for suctioning as well.

Indications

• Unresponsive patient with a gag reflex
• Patient will not tolerate an OPA
• Patient has clenched teeth or damage to the maxilla

Contraindications

• Responsive patient
• Suspected fracture to the base of the skull or mid-face
• Infants less than one year

How to Insert

1. Select a NPA and measure from the tip of the nose to the tip of the earlobe.
2. Lubricate the NPA with a sterile, water-soluble lubricant.
3. Insert the NPA with bevel facing the septum and continue until the flange is resting on the the flare of the nostril. If you meet resistance, gently rotate the NPA from side to side and continue to insert. If you still meet resistance, remove the NPA and try inserting in the other nostril.

A head-tilt, chin-lift or jaw-thrust maneuver must still be maintained, even when an OPA or NPA is inserted.

Are you interested in becoming an EMT? As an Emergency Medical Technician (EMT), your primary responsibility is to provide care for medically ill and traumatically injured patients in both emergency and non-emergency situations. A career as an EMT can be very rewarding and allows you to work in various settings. For instance, EMT’s can work on an ambulance, as a firefighter, in the hospital, or even for a company that provides first aid services at events. The steps below outline the entire process on how to become an EMT. Please note, there might be some variations depending on the state in which you live.

Step 1: CPR Certification

As a first step, you’ll need to obtain your CPR certification. This is a requirement for the National Registry of Emergency Medical Technicians (NREMT) and might also be a prerequisite for your EMT class. There are a few levels of CPR certification and it’s extremely important you select the correct one. For instance, you need to be trained at the level of basic life support (BLS) or healthcare provider (sometimes referred to as professional rescuer).

It is recommended you obtain your CPR certification through one of the following agencies:

• American Heart Association
• CPR Certification Course: BLS for Healthcare Providers

• American Red Cross
• CPR Certification Course: First Aid, CPR, AED for Professional Rescuers

Step 2: EMT Certification

EMT Courses are typically offered at most junior colleges and take approximately one semester to complete. Some colleges or businesses offer accelerated programs; however, this is not recommended. You want to ensure you have enough time to thoroughly understand all of the concepts and skills. EMT Courses consist of a didactic (classroom) portion, clinical rotations and practical skill labs. The classroom portion is a minimum of 110 instructional hours with the following curriculum:

• Preparatory: Introduction to emergency medical care, legal and ethical issues, anatomy, baseline vital signs, and SAMPLE history
• Airway: Airway management, ventilation and oxygen therapy
• Medical: Pharmacology, medical emergencies and obstetrics
• Patient Assessment: Scene size-up, initial assessment, focused history, detailed physical exam, communications and documentation
• Trauma: Bleeding control, shock treatment, soft tissue and musculoskeletal injuries
• Infants and Children: Abuse, anatomy, development and respiratory emergencies
• Operations: Ambulance operations, gaining access and extrication

The clinical rotations are typically one ride-along with either an ambulance or fire department and one shift in an emergency room. At the end of the course, you’ll need to successfully pass a psychomotor exam, which consists of 10 practical skills.

Step 3: NREMT Certification

Once you have your EMT course completion certificate you can apply for the NREMT. In most cases, the place where you completed your EMT certification will help you start the application process. The NREMT has specific entry requirements, but primarily you’ll need to provide proof that you’re CPR certified and completed a state-approved EMT course and psychomotor exam. Once your application has been approved, the NREMT will send you instructions on how to schedule an appointment to take their cognitive exam. After successfully completing the cognitive exam, the NREMT will send you a certificate and you’re now registered as an EMT at the national level.

Step 4: Register with your State EMS Agency

After receiving your NREMT certificate you need to register with your state EMS agency to work as an EMT. You should also check with your city or county if you need to register with them as well. If so, you might need to provide proof of your NREMT certification and pay a registration fee.

Vital signs can vary between a patient’s age and gender, so it’s important to know the difference in values. Below is a list of normal vital signs for each age range and gender.

Pulse

• Elderly (over 75 years): 90 bpm
• Adults: 60-100 bpm
• Adolescents: 60-105 bpm
• Children (5-12 years): 60-120 bpm
• Children (1-5 years): 80-150 bpm
• Infants: 120-150 bpm

Respirations

• Adults: 12-20 per minute
• Children: 15-30 per minute
• Infants: 25-50 per minute

Blood Pressure

• Adults (Male): 100 + age in years to age 40 / 60-90 mmHg
• Adults (Female): 90 + age in years to age 40 / 60-90 mmHg
• Adolescents: 90 (lower limit of normal) / ^2/3 of systolic pressure
• Children (1-10 years):
• 90 + (2 x age in years) (upper limit of normal) / ^2/3 of systolic pressure
• 70 + (2 x age in years) (lower limit of normal) / ^2/3 of systolic pressure
• Infants: 70 (lower limit of normal) / ^2/3 of systolic pressure

Capillary Refill

• Elderly: 4 seconds
• Adults (Male): 2 seconds
• Adults (Female): 3 seconds
• Children: 2 seconds
• Infants: 2 seconds

Eyes

• Adults, Children and Infants: PERL at 3-4 mm

Skin

• Adults, Children and Infants: Pink, warm and dry

O₂ Saturation (SpO₂)

• Adults, Children and Infants: 97-100%