CAPMEDIC-EMWFR Posted October 7, 2009 Share Posted October 7, 2009 Hello all! After coming here once only every few months, my life has stabalized to the point that I can come back! Annnndddd with that being said, on to the topic at hand! I decided to forgo prehospital education in favor of med school, and seeing as I kind of lazed around in high school (it wasn't so much like that as I opted to work and a long story... But that is most likely what medical schools will think of my transcript), I have decided to co-author 2 articles that I am going to try to get published. The main one, on the mechanism of apnea occuring secondary to oxygen administration in patients with associated COPD, does not really concern prehospital providers as much as the second one (that and I have a lot more work done and insight on it )... The effacacy and safety of traction splints versus manual traction and narcotic administration in suspected midshaft femur fracture. I got the idea for that after attending the 2009 Wilderness Medical Society's annual conference. Basically a review of the literature shows almost nothing about traction splints. Are they effective in reduction? Are prehospital providers in general capable of employing them effectively? In an urban setting do the pros outweigh the cons? How many patients are seen for soft tissue injuries secondary to traction splint application? How does the pain control compare to narcotic analgesics (fentanyl is what I am thinking specifically)? If you guys could let me know what you think the likely outcome of this study would be, or even if it would be something you would be interested in reading, let me know! Also, if any of you ER docs out there are going to be willing to partner with me to complete it, I would be eternally grateful! This goes for either study. 1 Link to comment Share on other sites More sharing options...
scubanurse Posted October 7, 2009 Share Posted October 7, 2009 Welcome back to the site!!! The second one really interests me. I am a WEMT (although not really anymore) and interested in wilderness type EMS. My parents are headed off for a 3 year circumnavigation in their sailboat and I have been helping them put together their medical kit and one of our biggest debates right now is whether or not to get a traction device. We saw one at the EMS today conference in Baltimore, and I'm blanking on the name, but it has the ability to be angulated and fully mobile for various other types of fractures. I'd be very interested in the outcome of your study as to the efficacy of the traction splints. Again welcome back, and good luck with med school! Link to comment Share on other sites More sharing options...
itku2er Posted October 7, 2009 Share Posted October 7, 2009 Hello all! After coming here once only every few months, my life has stabalized to the point that I can come back! Annnndddd with that being said, on to the topic at hand! I decided to forgo prehospital education in favor of med school, and seeing as I kind of lazed around in high school (it wasn't so much like that as I opted to work and a long story... But that is most likely what medical schools will think of my transcript), I have decided to co-author 2 articles that I am going to try to get published. The main one, on the mechanism of apnea occuring secondary to oxygen administration in patients with associated COPD, does not really concern prehospital providers as much as the second one (that and I have a lot more work done and insight on it )... The effacacy and safety of traction splints versus manual traction and narcotic administration in suspected midshaft femur fracture. I got the idea for that after attending the 2009 Wilderness Medical Society's annual conference. Basically a review of the literature shows almost nothing about traction splints. Are they effective in reduction? Are prehospital providers in general capable of employing them effectively? In an urban setting do the pros outweigh the cons? How many patients are seen for soft tissue injuries secondary to traction splint application? How does the pain control compare to narcotic analgesics (fentanyl is what I am thinking specifically)? If you guys could let me know what you think the likely outcome of this study would be, or even if it would be something you would be interested in reading, let me know! Also, if any of you ER docs out there are going to be willing to partner with me to complete it, I would be eternally grateful! This goes for either study. Welcome back CAP... Well as far as the traction split goes I have only seen it used once in my area all the years I have been in ems. Mostly the calls with the need for one that isnt the biggest priority at the time. Some times its better to keep them breathing than to take the time to use a traction splint. We normally go with manual traction and then stablize it with what ever we have that is quick and handy. For pain control in the event that it is used we use Morphine. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 7, 2009 Share Posted October 7, 2009 I've been in EMS for over 18 years (damn, that's a long time) and in that time the only occurrences of using a traction splint was on isolated femur fractures (not often) and also transfers from clinics and hospitals without orthopedic services to a receiving facility with ortho services. I can admit I've never placed one on a patient in the field. Like Terri says, usually the femur isn't the only thing broken on a call where you might put a traction splint on. Breathing and circulation are usually more pressing requirements. You can splint both legs with a long spine board if they ahve a fractured femur. As for the first study - I'm interested in it - I'd like to see just how often we knock out someone's resp drive with oxygen if they are COPD patients. I'm sure it's more prevalent in the hospital setting versus the EMS setting. Link to comment Share on other sites More sharing options...
paramedicmike Posted October 7, 2009 Share Posted October 7, 2009 What does medical school being so competitive have to do with either the two studies you're working on or your request for assistance in completing them? -be safe Link to comment Share on other sites More sharing options...
VentMedic Posted October 7, 2009 Share Posted October 7, 2009 COPD is a very broad category and quite a few conditions to isolate for variable factors in your study. Are you going to do the study on just CO2 retainers? And, in what disease category? What about those that are classified as hypoventilators with the COPD being a noncontributing factor but still present? Are you discussing long term or short term? For the hospital setting, are you going to include the interactions with the septic COPD patient and O2 management? Are you going to find a large enough sample size of just COPD patients without other complicating factors or disease processes? Sepsis? Pulmonary Hypertension? Acute lung infection with varying V/Q mismatch properties? Are you determining FiO2 by device or patient effort? Closed system? Continuous ABG monitoring? Expired ETCO2 with baseline knowns for hx and prior to administration? These are just a few of the issues we have faced in some of our studies on O2 delivery and COPD patients or any patient. These are also a few of the questions we ask at an article review to test for validity or rip it up. Link to comment Share on other sites More sharing options...
HERBIE1 Posted October 7, 2009 Share Posted October 7, 2009 I've used a traction splint about 15-20 times in my career, and other than a couple equipment malfunctions-ie a failure of the ratchet system used to apply the traction, it worked great. I am not surprised that there is a lack of literature on the device, and here's an example of why. A couple years ago we had a 10? year old boy who was struck by a car while on his bike, and his primary injury was to his leg. He had an obviously fractured and angulated femur, upper mid shaft, with compromised circulation. He was obviously in a lot of pain, and we applied the traction splint. We gave him some MS, and it worked like a charm- he was pretty comfortable after the splint was applied. We took him to a pediatric trauma center, and a few days later, we heard from the hospital he was doing fine. One of the ER docs was asked to relay an atta boy from the peds ortho guy. First, the surgeon had no idea we had the ability to use such a device in a prehospital setting, but thank gawd that we did. Apparently the fracture was a millimeter or so from severing his femoral artery, and unless the limb was reduced and immobilized, simple movement or even a strong muscle spasm could have cause him to bleed out. The fx was repaired and the boy will be fine. Although we appreciated the thank you, I was more concerned that a world famous children's hospital, known for their state of the art treatment, would know so little about prehospital care- especially with a device that has been around forever. Just a thought- I would contact trauma docs to get at least anecdotal information about their experiences with such devices. Good luck. I've used a traction splint about 15-20 times in my career, and other than a couple equipment malfunctions-ie a failure of the ratchet system used to apply the traction, it worked great. I am not surprised that there is a lack of literature on the device, and here's an example of why. A couple years ago we had a 10? year old boy who was struck by a car while on his bike, and his primary injury was to his leg. He had an obviously fractured and angulated femur, upper mid shaft, with compromised circulation. He was obviously in a lot of pain, and we applied the traction splint. We gave him some MS, and it worked like a charm- he was pretty comfortable after the splint was applied. We took him to a pediatric trauma center, and a few days later, we heard from the hospital he was doing fine. One of the ER docs was asked to relay an atta boy from the peds ortho guy. First, the surgeon had no idea we had the ability to use such a device in a prehospital setting, but thank gawd that we did. Apparently the fracture was a millimeter or so from severing his femoral artery, and unless the limb was reduced and immobilized, simple movement or even a strong muscle spasm could have cause him to bleed out. The fx was repaired and the boy will be fine. Although we appreciated the thank you, I was more concerned that a world famous children's hospital, known for their state of the art treatment, would know so little about prehospital care- especially with a device that has been around forever. Just a thought- I would contact trauma docs to get at least anecdotal information about their experiences with such devices. Good luck. Link to comment Share on other sites More sharing options...
HERBIE1 Posted October 7, 2009 Share Posted October 7, 2009 (edited) Mods- please delete duplicate posts. Having browser issues... Thanks. Edited October 7, 2009 by HERBIE1 Link to comment Share on other sites More sharing options...
logos Posted October 8, 2009 Share Posted October 8, 2009 Medical school is quite competitive. However, they do not care what your highschool grades were. They will expect your college grades to be quite good (typically 3.5 is cited as a minimum GPA, but there are ways to recover if less than this) and a good MCAT score. I can highly recommend www.studentdoctor.net especially their forums for leaning about the medical school admissions process. Link to comment Share on other sites More sharing options...
FireMedic65 Posted October 8, 2009 Share Posted October 8, 2009 Did you expect med school to be a cake walk? I used traction splint 2 times on real calls. Used them numerous times in training. Also used one for a Halloween costume, and MAST pants... 1 Link to comment Share on other sites More sharing options...
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