Splinting

Common Errors

Critical errors in prehospital application of splinting:

• Failing to reassess after intervention. Vital signs must be rechecked every 5 minutes for unstable patients
• Incorrect medication dosing. Always use length-based estimation (Broselow tape) for pediatric patients
• Tunnel vision on one finding while missing the complete clinical picture
• Not communicating changes to receiving facility during transport

Differential Diagnosis

When assessing splinting, use structured assessment tools to differentiate between possible causes:

SAMPLE: Components: Signs/symptoms, Allergies, Medications, Past history, Last intake, Events. Scoring: Mnemonic for patient history gathering.

APGAR: Components: Appearance, Pulse, Grimace, Activity, Respiration. Scoring: 0-10 at 1 and 5 minutes, under 7 needs intervention.

Clinical Significance

In prehospital care, understanding splinting can mean the difference between a positive patient outcome and a critical miss. A 65-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea. 12-lead shows ST elevation in leads II, III, aVF (inferior MI).

Related pharmacology: adenosine at 6mg rapid IV push, then 12mg if needed, indicated for SVT (narrow complex tachycardia).

Safety Considerations

Field safety for splinting includes scene assessment before patient contact. Ensure BSI (body substance isolation) precautions are in place. PPE selection depends on the mechanism and suspected pathogens. Gloves are the minimum; add mask and eye protection for splash risk, N95 for airborne pathogens.

Never approach a scene involving hazardous materials, violence, or structural instability without proper resources and clearance from incident command.

Practical Example