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Summary of Contents for Konig KNLEDFLDRL10W
- Page 1 Instructor’s Manual Model SX404; Sager Extreme Compact Bilateral Models; S301 Form III Single, S300 Infant Bilateral, S304 Form III Bilateral, Super Sager Combo Pacs #1 and #2, and the MINTO FRACTURE KIT J. M. Fikes, BSN, MSN • A.G. Borschneck, M.D. •...
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Page 2: Table Of Contents
Table of contents Section One: Instruction guidelines Section Two: The anatomy and physiology of fractures Section Three: Sager’s Application for splinting femoral fractures Section Four: Sager’s features, advantages and benefits Section Five: Sager® components Section Six: Sager® Questions and answers Section Seven: Contraindications and cleaning Section Eight, Appendix A:... -
Page 3: Section One
Section One: Instruction guidelines The following lecture guidelines were developed to assist ALS and BLS Instructors in their endeavor to introduce Sager® Emergency Traction Splints and the Minto Fracture Kit to students participating in EMT and Nursing/Paramedic programs. These guidelines are only intended for use as a basic reference tool. - Page 4 Introduction to Sager® Emergency Traction Splints: Introduce the (SX404) Sager Extreme Compact Bilateral, (S304) Sager Form III Bilateral, the (S301) Form III Single and the(S300) Sager Infant Bilateral Emergency Traction Splints to the class using your training samples. Have the class review the training video “The Science Of Traction Splinting™ — Application Guidelines for Sager models SX404 Sager Extreme Bilateral, S304 Form III Bilateral, S301 Form III Single and S300 Infant Bilateral”.
- Page 5 Model S301, Sager Form III Single Button Latch Operation. Application of Model S301, Sager Form III Single Leg Traction Splint is similar to that of its bilateral cousin — Model S304. However, the unilateral nature of the S301 requires that when positioning the Splint, the Traction (Pulley) Wheel be placed on it’s side and towards the injured limb.
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Page 6: Section Two
Section Two: Anatomy, physiology and treatment of femoral fractures The human pelvis is a closed bony ring that is strong and massively constructed. It is the found a tion for the torso and provides support for the lower limb attachment and locomotion. It is shaped so that the ischial tuberosity forms a platform for sitting in an upright position. -
Page 7: Fig 1
Each Tuberosity is medial to the shaft of the Femur, and is located half the distance between the midline Symphysis Pubis and the Femoral Shaft. They form the base-line of the Uro-genital triangle which slopes anterior and cephelad. The external Genitalia in both sexes are attached at the apex of the Uro-genital triangle, and because of this both sexes can sit straddling seats and saddles without discomfort or injury. -
Page 8: Fig 3
Comparative application of traction Application of traction breaks the spasm and eliminates much of the pain. It also causes alignment of the bone fragments and subsequent increased tissue pressure. This reduces and controls bleeding and shock, and prevents further nerve, vascular and tissue damage. It is clear that properly applied traction and immobilization of a fractured Femur helps control shock and reduces mortality. - Page 9 Safe traction Safe traction for field use should be traction in a known amount prescribed by protocol or a medical consultant. It should also be traction that is dynamic in nature using a resilient member that permits graded reduction of traction force as the muscle spasm decreases and leg length increases.
- Page 10 Consider the anatomy of the Pelvis and Femur. In an AP view, the Ischial Tuberosity is located about half the distance from the mid-line to the Femur. In a lateral view, the Ischial Tuberosity’s lower edge is no more than ⁄...
- Page 11 Summary Sager® Emergency Traction Splints are the most anatomically correct traction splints available on the world market today. They apply countertraction against the ischial tuberosity medial to the shaft of the femur in a manner consistent with the original Thomas Full and Half Ring Splints.
- Page 12 Cadaver Study: Comparison between Sager® Emergency Traction Splints and Ischial Pad Traction Splints. Abstract: A traction and alignment comparison between the Sager® Emergency Traction Splint and the Hare Traction Splint was made on a Cadaver with an exposed Intertrochanteric Femur fracture.
- Page 13 Load Cell Study: Forces acting on an intact femur with Hare Traction Splint and a Sager® Emergency Traction Splint. Abstract: A Load Cell Study documenting forces acting on the Proximal Femur in real time was made comparing Sager® Emergency Traction Splints with the Hare Traction Splint. Range of force acting on the Femur with Sager®...
- Page 14 CAT SCAN Study: The Ischial Tuberosity protrudes at most 1-2 cms. below the level of the shaft of the Femur. Reprinted with permission from A.G. Borschneck, M.D. fig 10 Survey Radiograph of CAT SCAN Study through Pelvis and upper Thigh of adult male. Note male Genitalia is not interposed between Sager’s Ischial Perineal Cushion (splint cushion)
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Page 15: Section Three
Section Three: Mechanism of action and Sager’s application for splinting femoral fractures When a patient suffers a fractured femur, the large muscles surrounding the bone react by going into spasm which causes severe pain. Traction splinting prevents further injury and breaks the spasm which eliminates the major source of pain. - Page 16 Quantifiable, Dynamic Traction™, mechanism of action. The spring within the inner shaft of a Sager® Splint is dynamic. It continuously reacts to changes in the amount of muscle spasm. The amount of pain felt by the patient is in part related to the amount of muscle in spasm as well as the degree of spasm.
- Page 17 fig 15 Close-up of Sager® Traction (Pulley) Wheel and Scale. (Sager® models S300 Infant Bilateral and S301 Form III Single) fig 16 Close-up of Sager® Traction Handle and Scale. (Sager® models SX404 Compact Bilateral and S304 Form III Bilateral) fig 17 Paramedic applying Sager®...
- Page 18 Attention: Read first – prior to application SX404 Model Sager® Extreme Compact Bilateral Security Sliding Lock 1. Slide the Security Sliding Lock over hinge of the Inner Shaft Important: Follow these additional and cover the yellow indicator with the red knob. steps to ensure correct assembly and usage of Sager Extreme Compact Bilateral Traction Splints.
- Page 19 Training application sheet #1: Model SX404 traction splint. Rapid one person assembly and application. The splint can be semi-attached design that ensures that no major parts will be lost assem bled and applied in under 2.5 minutes. To assemble the splint, or incorrectly assembled.
- Page 20 Training application sheet #2: For model Traction Splint. SX404 Step 1 Position Position the Sager® SX404 between the patient’s legs, resting the ischial perineal cushion (the saddle) against the ischial tuberosity, with the shortest end of the articulating base towards the ground. In the case of a unilateral fracture, the splint should be placed in the perineum on the side of the injury.
- Page 21 Training application sheet #3: For model Traction Splint. S304 Step 1 Position Position the Sager® S304 between the patients’ legs, resting the Ischial Perineal Cushion (the saddle) against the ischial tuberosity, with the shortest end of the Articulating Base towards the ground. In the case of a unilateral fracture, the splint should be placed in the perineum on the side of the injury.
- Page 22 Training application sheet #4: For model Traction Splint. S301 Step 1 Position Position the Sager® S301 between the patient’s legs, resting the Ischial Perineal Cushion (the saddle) against the Ischial Tuberosity, with the shortest end of the Articulating Base towards the ground. When positioning, note that the Pulley Wheel should be on the same side and towards the injured limb.
- Page 23 Training application sheet #5: Sager® Model S300 – Infant Bilateral. Size guidelines The multi-patented Form III Series will fit patients ranging from a splinting aligns the fragments, four-year-old to an adult well over 2m (7 feet) in height. With the restores near normal tissue Sager’s unique design the patient’s weight is not a problem in pressure in the limb, reducing...
- Page 24 Training application sheet #6: Sager® Facts. How much traction should I apply? Shock Trousers Apply the amount of traction recom - If shock trousers are used in cases of ® mended by your medical consultant, multiple trauma, Sager Splints may or that required by protocol.
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Page 25: Section Four
Section Four: Features, advantage and benefits Will fit patients ranging from a 4 year old to an adult well over 2m (7 feet) in height. With the Sager's unique design the patient's weight is not a problem in application. For infants, model Sager®... -
Page 26: If The Patient Fits, The Sager® Fits
Feature Advantage Benefit Quantifiable, Dynamic, Traction™ Designed to continuously show the exact Reduces further trauma and pain. amount of safe, quantifiable traction Increased patient comfort. applied — with no possibility of overtraction. Safe Paramedic use. Permits documentation of the traction Continuous overtraction never occurs. - Page 27 Model Advantage Benefit SX404 Sager® Extreme Bilateral Indicated for treatment in proximal third Has a much broader range of application and mid-shaft femoral fractures. and use than other traction splints. Is radio lucent to all areas of a femoral Radio lucent design enables Xrays fracture.
- Page 28 Super Sager® Combo Pacs S300-1 Super Sager® Combo Pac #1 Includes 1 each S300 Sager® Infant Bilateral and S301 Sager® Form III Single. Both units store in a single carry case. Model S300 Sager® Infant Bilateral treats infants and children up to age six (6), and treats single or bilateral fractures.
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Page 29: Section Five
Section Five: Sager ® components The splint proper is manufactured from 303 stainless steel. Sager® Form III Series Articulating Base is comprised of Dupont’s Crastin Polyester Resin. The Form III Shaft Cushion is manufactured from Closed Cell CPE (Chlorinated Polyethylene) Foam. The S300 ’s outer shaft is encased in a vinyl form fitting cover. - Page 30 Sager® Emergency Traction Splints have six (6) basic components consisting of; • The Carrying Case • The Abductor Bridle (Thigh Strap) • The Splint Proper • The Leg Cravat Kit • The Pedal Pinion (Figure Eight (8) Strap) • The Malleolar Harness (Ankle Harnesses) Carrying Case The Carrying Case has been designed to provide easy access and storage of all Sager®...
- Page 31 The Outer and Inner Shafts act as the splint and also contain the traction mechanism. The Shaft Cushion, which covers the length of the outer shaft, provides added comfort and cushioning. The outer shaft includes a Button Latch at the distal end that acts as a one-way lock. The splint may be lengthened and locked by simply pulling on the Inner Shaft.
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Page 32: Section Six
Section Six: Questions and answers (PowerPoint #12) Sager® Emergency Traction Splints and the Minto Fracture Kit... - Page 33 What advantage is there to using Sager’s revolutionary Malleolar (Ankle) Harness? • There is less chance of cutting off circulation with the Sager® Malleolar Harness (ankle harness) because it is applied above the Malleoli of the ankle away from the posterior Tibial and Dorsalis Pedis Arteries.
- Page 34 Is there a danger that external rotation of the fractured femur can occur using a Sager® Splint? • No, not when the Sager® Splint is properly applied and the Pedal Pinion (figure 8 strap) One cannot bind the feet is used to bind the feet together. External rotation of a fractured femur can and does together unless the good happen using Ischial Pad Traction Splints that have the foot end raised on a tri-pod –...
- Page 35 Are Sager® Splints contraindicated in the case of massive fractures of the pelvis? • Yes, but so are all traction splints – including Ischial Pad Traction Splints since they also Ischial Pad and Half Ring can compress and deform the Ischial Tuberosity which is part of the pelvis and subject to movement.
- Page 36 What advantage is there to using a Sager® Splint with Anti-Shock Trousers? Sager® Splints are so versatile that Anti-Shock Trousers can be applied over the leg of a patient wearing a Sager® Splint just as easily – probably easier – than on a patient not wearing a splint at all.
- Page 37 Sager® Splints provide medial splinting and traction as well as prevention of internal and external rotation. Is this less desirable than posterior splinting? No, not at all. One might consider posterior splinting as most desirable if one was transporting a patient without the use of a basket, spine board, and/or stretcher. This never happens, so why provide posterior support on a device that requires posterior support to be effective? Remember: •...
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Page 38: Section Seven
Section Seven: Contraindications and cleaning All operators should receive full and proper initial and refresher instruction sessions from a qualified person on detailed use of this equipment and regarding the particular situations in which it should be used. Sager® Emergency Traction Splints and the Minto Fracture Kit... - Page 39 Indications: Sager® splints are indicated for use on Proximal Third and Mid-Shaft femoral fractures. Contraindications for the use of tractions splints for femoral fractures. A fracture of the Pelvis occurring with a fracture of the Femur is generally a contraindication for the use of a traction splint of any type.
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Page 40: Section Eight
Section Eight: Appendix A. Practical examination for use by Sager® Emergency Traction Splints students. Includes test paper and a certificate for successful candidates. Sager® Emergency Traction Splints and the Minto Fracture Kit... - Page 41 Practical Examination (1) Sager® Emergency Traction Splints Name: Student i.d. #: Date: Course: Questions 1 - 25, 2 points each. If elevation of a femur fracture is desired, the only method to truly elevate the femur above the level of the heart is: ▫...
- Page 42 You have a 6’6” tall patient with a fractured femur needing transport in a Stokes basket. Which of the following features and benefits are most critical to the patient? Choose only one. ▫ A revolutionary manual ratchet traction mechanism. ▫ Straight in-line traction.
- Page 43 In the case of massive fractures of the pelvis, which type of traction splints are contraindicated? ▫ Sager ® Emergency Traction Splints ▫ Hare Traction Splints ▫ Donway Traction Splints. ▫ Ferno Traction Splints. ▫ Reel Traction Splints. ▫ All of the above. The Ischial Tuberosity is a structure that is _________ to the shaft of the femur.
- Page 44 The most important action of applying traction to a fractured femur in a patient who is hypovolemic and/or is developing shock from multiple injuries is: ▫ Align the fragments. ▫ Pain relieft. ▫ Prevent damage to nerve and vascular structures ▫...
- Page 45 The Sager® Articulating Base and Cushion bends laterally for seating and exacting conformance to the: ▫ Inner thigh. ▫ Ischial tuberosity. ▫ Symphysis pubis ▫ Groin. It only applies to Models SX404, S304 and S301 The American Academy of Orthopedic Surgeons recommends gentle traction to a maximum of ____ per fractured femur on an adult patient: ▫...
- Page 46 Ischial Pad traction splints are indicated for _________ percent of femoral fractures: ▫ ▫ ▫ about 78 ▫ About 9 Bleeding to some degree is a common problem with fractured femurs. The average amount of blood loss is: ▫ 1000 c.c. ▫...
- Page 47 Practical examination : Answer Key Sager® Emergency Traction Splints If elevation of the femur fracture is desired, the only method to truly elevate the femur above the level of the heart is: (b) Trendellenberg positioning of the patient. What is the best method of preventing external rotation of a fractured femur? (c) Properly apply a Sager®...
- Page 48 The various modes for traction can be divided into three broad groups. Which is the safest for prehospital care? (c) Dynamic traction (spring traction). Manual traction by a first responder or paramedic falls in the category of dynamic traction. It has one serious drawback as well as one serious limitation. These are: (g) —...
- Page 49 Student Excercise Sager® Emergency Traction Splints. Parts identification. (place the correct letter by the part) Splint Proper. Shaft Cushion. Leg Cravat Kit. Malleolar Harness Set. Abductor Bridle. Pedal Pinion. Articulating Base and Cushion. Carrying Case. Traction Handle and Scale. Sager® Emergency Traction Splints and the Minto Fracture Kit...
- Page 50 Student Excercise: Answer Key Sager® Emergency Traction Splints. Parts identification. Splint Proper. Shaft Cushion. Leg Cravat Kit. Malleolar Harness Set. Abductor Bridle. Pedal Pinion. Articulating Base and Cushion. Carrying Case. Traction Handle and Scale. (PowerPoint #9) Sager® Emergency Traction Splints and the Minto Fracture Kit...
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Page 52: Section Nine
Section Nine: Minto Fracture Kit (MFK). From field to hospital. When applied, the MFK™ is radiolucent to all areas of immobilization. Radiolucent design enables X-rays, MRI and CATSCANS to be taken without removing the splint. Sager® Emergency Traction Splints and the Minto Fracture Kit... - Page 53 Minto Fracture Kit (MFK700) Components: Kit Case Made of 1000 denier Cordura® with MOLLE attachments for easy field carry. Universal The Multi-Angle Connector, or MAC™, allows the splint to be applied in any position. No movement of the fracture site means less injury and pain. Weight and Size 2.8 lbs, Kit Case 12”...
- Page 54 Student Exercise: Minto Fracture Kit (MFK700) Parts Identification: Carrying Case The Multi-Angle Connector, or MAC™ Padded Outer Shafts Cushioned Extender Bars 32” Cravats 24” Cravats 18” Cravats 24” Security Cravats Sam Splints (PowerPoint #10) Caution: This product contains Natural Rubber Latex, which may cause allergic reactions.
- Page 55 Student Exercise: Minto Fracture Kit (MFK700) Parts Identification: Answer key Carrying Case The Multi-Angle Connector, or MAC™ Padded Outer Shafts Cushioned Extender Bars 32” Cravats 24” Cravats 18” Cravats 24” Security Cravats Sam Splints (PowerPoint #10) Sager® Emergency Traction Splints and the Minto Fracture Kit...
- Page 56 Training application sheet #5 MFK700 The Minto Fracture Kit™. One system to treat most extremity fractures. Assembly The MAC™ Multi-Angle Connector, or MAC™ hinge has been The Multi-Angle Connector, or MAC™, allows the splint to be designed for rapid assembly and rapid application. The unit can be applied in any position.
- Page 57 Training application sheet #1. Lower Limbs: The Minto Fracture Kit™. MFK700 Extraction Procedure ® SPLINTS: After clearing obstruction with Jaws of Life; position the splint (The C-Curve): Curve the length-wise to create ® SPLINT in preparation for extraction splinting of limb in position found. a longitudinal bend which gives the splint strength.
- Page 58 Training application sheet #2. Fracture/dislocation of the knee: The Minto Fracture Kit™. MFK700 Splint position for fracture Place Tensor Cravats as Alternate splint placement. dislocation knee injury. shown. Knee immobilized. Ankle Injury Splint position for ankle injury. Place Tensor Cravats as shown. (PowerPoint #20, 21) Ankle immobilized.
- Page 59 Training application sheet #3. Upper limbs: MFK700 The Minto Fracture Kit™. Dislocated Shoulder Dislocation of shoulder splinted in position found. Arm is immobilized. Forearm Injury Anterior view forearm injury. Splinted forearm. Fractured Wrist or Forearm Immobilized wrist or forearm. Fractured Elbow •...
- Page 60 Training application sheet #9. MFK700 The Minto Fracture Kit™. Features, Advantages and Benefits. Feature Advantage Benefit Rapid Assembly, Rapid Application. Assembles in under 60 seconds. Application Fast Rescue, less pain. on fracture in less than 2 minutes. Comprehensive Tensor Cravat System. 3 widths, 16 lengths.
- Page 61 Section Ten: Appendix B. Practical examination for use by students. MFK700 Includes test paper and a certificate for successful candidates. Sager® Emergency Traction Splints and the Minto Fracture Kit...
- Page 62 Practical Examination (ii) : One system treats most extremity fractures. MFK700 Name: Student i.d. #: Date: Course: Questions 1 - 17, 2 points each. The fracture response kit will splint any fracture in the human body in position found. ▫ ▫...
- Page 63 The MAC™ is manipulated free of the patient and mimics the shape and angle of a fracture. To apply the MAC™, the arms should be lightly placed or centered over the fracture site and the arms aligned with each side of the fracture. When applying the MAC™, it is important to make sure that the arms are applied parallel to: ▫...
- Page 64 Tensor Cravats can be placed over an open wound: ▫ ▫ True False The total number Tensor Cravats used per injury should be: ▫ (a) two, ▫ (b) three or less, ▫ (c) as many needed to stabilize and support the limb, or, ▫...
- Page 65 Practical examination (ii) Answer key : Complete Fracture Response System MFK700 Questions 1 - 17, 2 points each. The fracture response kit will splint any fracture in the human body in position found; (True). Security Cravats should only be applied when; (c) the patient is uncooperative, or struggling and agitated due to brain injury or drug use.
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