Med school is so competitive...

[JPINFV]

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.

Medical schools won't even see your high school transcripts. At most, AACOMAS (DO application system) requests your ACT and/or SAT scores, but even those are self reported and I doubt will have any effect. The AMCAS (MD application system) doesn't ask for it even as an option. Neither system will ask for high school transcripts and no school will want them unless you're applying for a dual BS/[MD or DO] program.

[jeremybright]

I'm a 15 year vet from a small rural service. Our local hospital does have an ortho but no relief when he is out. I have used traction in the field about 7 times and put it on for transport on an ER pateint about 4 more. We're hospital based so occasionally have to help out with stuff in the ER. Specifically things like traction that they don't do in the ER.

On every occasion that I have used a traction splint the patient's pain was drastically reduced. These have all benn isolated femur injuries. Rare I know but being a southern state Lots of outdoor activities here and more orthopedic injuries. One specific case was a 10 y/o girl in the ER she had been thrown from her horse no other injuries and severe pain. Pt had come in POV. She was high on the pain scale 8-9 sweating, tears, pale skin. My partner and I went and got a traction splint and we still have Hare's placed splint reduces deformity and the 10 y/o told me that the pain was now tolerable and she did not need medication.

Don't get to use them much but when I do well worth it normally take an adult pt from needing 10 to 20 mg of morphine to 4-5mg for pain control and often no meds required at all.

[Jwade]

Ok, Let me give you the real deal on traction splints.

First, I spent 8 years as a Surgical First Assistant in Trauma Surgery at Detroit Receiving Hospital. Combine that with my 17 years of EMS experience, I can give you an educated and experienced opinion.

Here is what happens when a fractured femur comes into the ER and then to Operating Room.

If patient is on a traction splint, the splint is removed, xrays taken, and usually a traction pin will be inserted into the tibia or distal femur and 20 pound of traction will be applied until patient goes into surgery.

NOW, here is where it gets really interesting and very FEW people know this information.

When the patient comes into the OR, all the traction is removed, the patient is put to sleep, and the desired surgical anatomy is prepped and draped for surgery. Now, imagine if you will YOUR broken leg hanging from the end of a weighted IV pole with kerlex wrapped around your ankle to the IV pole. This is how the legs are prepped with Beta dine and then draped. The legs sits and whatever angle it is broken in on the IV pole.

Someone had mentioned that if the bone would have moved a little the patient would have bleed out....Well, this is not exactly an accurate statement. IF the bone transects ANY major vessel during the INITIAL injury period, then potential huge blood loss is a probability. The chances of an already broken bone causing an IATROGENIC injury during bone reduction and or placement of a splint, or moving to a backboard are statistically NOT significant. Hence, the broken limbs get hung from IV poles.

Once the limb is prepped and draped, we will determine using the C-ARM and xrays, what the best course of action is to fix said bone... Femur fractures will almost 90% of the time receive a femoral nail via the Retrograde or Ante grade approach. If the injury occurs high on the Femur such as the Femoral Neck, then a Hip Screw is needed or a combination of screws, if the Greater Trochanter or Sub-Trochanter is involved, then it gets very complicated, and a combination of a nail, and a blade plate might be required to achieve perfect reduction. The same things goes for the distal femoral condyles, if there is one place you dont want to break on your leg, it is the top or very bottom of your femur........If it is my leg, PLEASE make it a mid-shaft....LOL....

The FEMORAL NECK Fracture is really the only one that must make it to the OR in 6 hours to be fixed emergently or AVN will develop. Any open FX must also go to the OR for at LEAST a washout, and then can return in a couple days to have a definitive fix applied.

fx

Moving on to my Pre-Hospital usage, I might have used them 3 times during 17 years, I think it definitely helps the conscious patient with pain control once properly reduced. Along with generous amounts of Fentanyl and Versed......Fentanyl is the drug of choice due to it's synthetic properties, and the potential transient BP drops associated with MS and the pathophysiology behind it..

Having flown in a few different helicopters, I have had to remove traction splints to be able to get then in the aircraft....This is always entertaining.....Lots of premedication need to happen before you try this maneuver at home.....

Drop me a line if you need any more help, I collaborated with some of my previous surgeons on journal articles, so I am very familiar with the process involved.....

Respectfully,

JW