“Take your tuning fork and bang it and put it on the proximal tibia. Take your stethoscope and listen over the medial malleolus, the distal tibia. Then compare it to the other side,” instructed Dr. Weiss.
“Even if there is a nondisplaced linear fracture through that bone, that sound will be dampened significantly so that you will be able to tell the difference,” he said. “It works with a 99% sensitivity when tested in 100 patients.”
Pelvic Binder
Although not much can be done for pelvic fractures in remote settings, the pelvis can be bound to reduce bleeding.
“You can use a Therm-a-Rest pad and wrap it around the pelvis and inflate it,” Dr. Weiss said.
Alternatively, an article of clothing or a sheet can be wrapped around the pelvis, centering it over the greater trochanters of the femurs.
“Then take some tent poles or something, and tie it in there, then just kind of like a windlass, like you would turn a tourniquet, you wrap it until the patient feels some pressure,” he said.
Shoulder Immobilizer
In a pinch, an injured shoulder can be immobilized with just a few safety pins and the clothing a patient is wearing, according to Dr. Weiss.
“If you have a long-sleeve shirt, you can just safety pin the sleeve to [the shirt] itself,” he explained. “If you have a short-sleeve shirt, just take the shirt, fold it up, [and] make a little pouch with two safety pins.”
Wound Irrigator
In remote settings, a plastic sandwich bag can be filled with irrigation fluid, sealed, and squeezed hard to create adequate pressure for effective wound irrigation. “You don't need sterile normal saline,” Dr. Weiss added.
“If you are still using sterile normal saline, you need to go back to the literature because there are quite a few articles … showing that tap water works just as well” in terms of infection rates, because it is usually chlorinated.
Wound Closer
Although sutures or staples are ideal for closing wounds, glue or Dermabond can be used. For scalp lacerations, hair tying also works well.
For the hair-tying technique, a piece of dental floss or suture is oriented lengthwise along the laceration. “Take some hair on either side of the wound, twirl it in your fingers, and cross it over. Then use the dental floss or the suture to tie your square knot” around the crossed hair, he explained.
In particular, this technique “works great in children who have good heads of hair,” he noted. “There is no fuss or muss. They don't have to come back and have sutures removed or staples taken out. There is no pain.”
Topical Antibiotic
After a wound has been closed, physicians can apply honey, which Dr. Weiss referred to as “nature's Neosporin.”
Roughly 20 randomized, controlled trials have compared the substance with commercial topical antimicrobial agents and have generally found honey to be superior, he noted.
“When applied topically, honey reduces infection and promotes wound healing. It's safe, and it's effective,” he commented.
“It even has some antimicrobial properties that are due to its hypertonicity, its pH, and some inhibins that it has.”
In unconscious patients, use safety pins to keep the airway open by pinning the tongue to the lower lip, said Dr. Eric A. Weiss.
Source Courtesy Stanford University