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Change of plan

Ok he’s got his radial pulse back. So if you could pop this splint around it. Luther we’re going to put this splint around it ok? Alright you keep going on that gas, if you’re in pain. Ok well done. So we’ll move this slightly. Nice and gentle alright. That’s it, well done. We’ve put this just to support his arm ok? Can you wiggle your fingers for me? Well done. Ok so it’s just going to go nice and tight around your arm. (Sound of air being pumped into the vac splint).

In this short clip we see Jordan and Cam putting Luther’s arm in a vacuum splint.

When they initially looked at Luther they made the pragmatic decision to immobilise his arm in the position that it was in (as this was comfortable). Then they did the most important thing in this situation which was to reassess the circulation in the limb. When they realised that the radial pulse was not palpable they repositioned the arm until they could once again feel the pulse. It’s never nice to have to move a broken limb, but far worse to not do so and leave the child without adequate circulation.

So what we have seen here is history taking and examination in minor injury of a limb. These are some of the commonest injuries to need to come to hospital with upper limb injuries being much more common than lower limb ones. Many children’s fractures will be more minor than adults, the more plastic bones in children tending to bend rather than break right through.

But we do see our share of serious limb injuries and management of these needs to take into account the specific features of growing bones. In most cases the pre-hospital management will be the same with priority being placed on a good history (often the key to predicting the pattern of injury) and an examination. During the examination we need to establish is this an open or closed fracture and is there any neuro-vascular deficit.

Now that we have looked at the management of a child with a limb injury, let’s look at another very common minor injury with children, burns.

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Emergency and Urgent Care for Children: a Survival Guide

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