Femur fracture bleedout
Allison Turner-
about whether a patient can bleed out from a closed femur
fracture. My EMT-B (and NFR) training says yes. The WFR
(wilderness first responder) who just got back from his
recert training says no. Apparently, according to what he
was told last weekend, the tissue in one leg will become
saturated with a maximum of one liter of blood from a femur
fracture. So if there isn't an open wound, or the other
femur isn't broken, the person can't bleed out. According
to WFR training.
Anyone have an opinion? Seen anyone bleed out from a femur
fracture? My EMT-B status is very new; I've seen what were
probably two thoracic bleedouts, but no femur fractures of
any kind, yet. Thankfully. And wouldn't the pelvic cavity
be close enough to add, dangerously, to the volume available?
And while I do want to know the answer to my question, of
what value would this knowledge be to a WFR? I can't see
how it would change protocols .... although I admit to not
being very familiar with WFR training.
-Allison
--
..
Notan
Unless you've applied a tourniquet above the fracture, I'd
have to vote "Yes."
Notan
Ed Kostiuk
that would tamponade the bleeding-but then you have bigger problems
with tissue destruction, potential amputation, metabolic acidosis and
shock, and kidney failure from the large protein molecules released
from the tissue destruction. The femoral artery is not to be messed
with and I've seen death from exsangunation on open wounds many
times.
Femur fractures are rarely isolated-it takes a bit of force to
fracture the bone and displace it enough to tear the artery. Usually
there are other associated injuries-- some obvious and some hidden.
Even if the blood loss alone isn't enough to kill you, it could be
more than enough to tip the scales the wrong way when combined with
other stuff.
In my experience femur fractures come mainly from motorcycle accidents
where the rider goes over the handle bars and tags a femur, or auto
pedestrians. Auto accidents usually end up with a posterior
dislocation instead of a femur fracture. Only true isolated femur
fracture I saw was a lady who stepped onto a large drainage grate and
slipped through to mid thigh. Her body weight kept going and snapped
her femur midshaft. Fun extrication-any cutting tool either
transferred heat or vibration to her fracture. Ended up yanking her
out the way she went in.
The challenge in wilderness medicine is differentiating between deep
bruise and actual fracture-- especially if evacuation will compromise
mission or potentially compromise crew. You may have to hump this
patient out to an evac point. Long bone leg fractures will not be able
to bear weight-period. Another trick is to lie the patient down, and
strike the heel with a tool or your fist. The idea is to send a
vibration wave up along the long bone (tibia/femur) structure. If
there is a fracture, the patient will come off the ground. Far less so
with a deep bruise.
In wilderness medicine I would treat any suspected fractured femur as a
life-threatening injury. Alone, they could compromise or kill the
victim, and they will likely have other real or potential injuries.
They are extremely painful and management will be tough. In a triage
situation, I would not put any femur patient into an "expectant"
category-but would most likely keep them in a red category with a
priority for evacuation
Ed Kostiuk EMT-W
murphquake
pressured them for documentation of their claim. Perhaps they don't
see the same kind of femur fx that I've seen in NYC, often from MVAs
with overturns or ejections or pins, or from pedestrian strucks. I've
seen pts who's BP was down to 70 systolic (healthy adult males) with
hugely distorted and discolored thighs. Perhaps the instructors
haven't taken into account the possibility of the great femoral
vasculature being damaged in the initial trauma or by the jagged ends
of the bones. Fact is, people exsanguinate from closed femur fx, it
can and does happen, and is something EMS providers should be on the
lookout for. OOC where did this WFR do his training? Thanks.
-bill
Bill Murphy EMT-B
murph...@gmail.com
Ed Kostiuk
from...however....it is from a Level one trauma center/doctor response
to your inquiry..hope it helps
K
There is no exact limit on how much blood loss that can occur from a
closed femur fracture. How much loss depends on the associated soft
tissue damage, associated vascular injury, the type of fracture and
whether the fracture is splinted or not. If there is major soft tissue
injury and the compartments of the leg are disrupted blood can dissect
into different compartments and not tamponade and some one can "bleed
out" especially if there is an associated major arterial or venous
injury from the fracture. In addition if not splinted there can be
continued fracture bleeding and is not contained by the soft tissues
there can be major bleeding. These are not usual scenarios, most femur
fracture bleeding is contained in one compartment and not associated
with a major arterial or venous injury and as stated is somewhere
between 1-2 liter loss per side.
Grrly Girl
"Ed Kostiuk" <E...@health.ok.gov> wrote in message
news:1148565967....@i39g2000cwa.googlegroups.com...
> snipped stuff.
>
>. Another trick is to lie the patient down, and
> strike the heel with a tool or your fist. The idea is to send a
> vibration wave up along the long bone (tibia/femur) structure. If
> there is a fracture, the patient will come off the ground. Far less so
> with a deep bruise.
>
> In wilderness medicine I would treat any suspected fractured femur as a
> life-threatening injury. Alone, they could compromise or kill the
> victim, and they will likely have other real or potential injuries.
> They are extremely painful and management will be tough. In a triage
> situation, I would not put any femur patient into an "expectant"
> category-but would most likely keep them in a red category with a
> priority for evacuation
>
> Ed Kostiuk EMT-W
>
>
Hi Ed. In my experience, if there's any question, it's not necessary to to
do more than a gentle tap on the heel.
Lou
aka Grrly Girl
Mike Painter
Just squeezing an area well away from "where it hurts" and asking if that
increases the pain is a good indication with most fractures.
Rereading above "...lie the patient down". I've never seen a fractured femur
where this was needed...
Karen
On most people thats the exact height to take the full force of a kick, when
astride the horse the leg is also going to get crushed between
horse/saddle/ground in a fall,
and generally when a horse falls, unless he majorly incapacitated himself,
he will violently
try to get back to his feet.....rolling and twisting on the person pinned
beneath him.
WILLIAM BALDWIN JR
--
WILLIAM BALDWIN JR,BS,MD-S
MBA HCM program
Ground below Zero
New Orleans, La (central time zone)
www.coastguardauxiliaryfc61.org
"Allison Turner-" <beto...@sover.net> wrote in message
news:e527c...@drn.newsguy.com...
Grrly Girl
"Mike Painter" <mddotp...@sbcglobal.net> wrote in message
news:2ssdg.17349$fb2....@newssvr27.news.prodigy.net...
sure the child wasn't hurt and picked him up on to his feet. The child
wasn't vertical for long.
GG
Allison Turner-
>
>Might be helpful to give a more precise definition of "bleed out".
Lose enough blood to die relatively quickly.
That was the unspoken definition I was going on.
-Allison
--
..
WILLIAM BALDWIN JR
play with. I would place more priority on an open femoral fracture, sure;
but I would be hesitant to dismiss one just because it was closed.
--
WILLIAM BALDWIN JR,BS,MD-S
MBA HCM program
Ground below Zero
New Orleans, La (central time zone)
www.coastguardauxiliaryfc61.org
"Allison Turner-" <beto...@sover.net> wrote in message
news:e56qu...@drn.newsguy.com...