Here is an extremely graphic picture of Kevin Ware's (the Louisville basketball player) leg injury. http://imgur.com/gallery/LiQQDug

The EMS provider in me can't get enough of this picture.

As a BLS provider, I'm trying to think through the best way to treat and transport. Is it an A-frame? to the compound fracture. Do you try to straighten it out and use long board splints?

The best I can come up with is you'd have to decide between the two based on the PT's position of comfort.

Tags: BLS, Compound, Fracture, Injury, Kevin, Leg, Ware

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I'd get some medical control on line (MY medical director, not some unknown on the radio) to talk about a combination of pain control and sedation.  Movement is going to HURT!

Then, I think that it has to be straightened before moving.  This guy is huge anyway; near to impossible to fit him in an ambulance with all of those angles (difficult even when all straight!).  I'm not sure why, but my imagination is trying to jury rig some sort of traction splinting device to keep bone ends separated while we get him to an orthopedic surgeon.

We have bariatric ambulances - does anybody have a special ambulance for near 7' patients?

As odd as its going to look/sound, if he had intact neuro and circulatory function, I would immobilize in the position found. His leg looks big enough to fit over our jump bag in the same position, or maybe with a small amount of padding. Pain control definitely prior to anything involving movement. I would wrap the injury with gauze/kling also. If he doesn't have intact PMS, then most definitely, pain management, sedation if necessary, reposition and secure with a board splint/traction device to keep movement to a minimum. No special ambulances here, but I have seen crews put a back boarded patient on the stretcher backwards and put the feet towards the captains chair in order to better accommodate the patient.
It was a proximal third of his tib wasn't it?

I'd use a Donway Traction Splint after a combination of morphine or fentanyl and methoxyflurane. If need be some midaz via online control to calm him down.

Antibiotics will be his friend.

And a supersize box of tissues for his crybaby team mates.

would a Donway fit - I don't know how tall this guy is but I'd imagine his legs are gonna be close or longer than the length of a Donway??

I was thinking that as I typed Mike.

Kevin Ware is 1.93m tall and the Donway per a web search works up to 2.08m tall.

Mike Bjarköy said:

would a Donway fit - I don't know how tall this guy is but I'd imagine his legs are gonna be close or longer than the length of a Donway??

I've done EMS for the NBA before. The teams have their own doctors and REALLY don't like you doing anything fancy. Also, the NBA now requires Paramedics as of (I think) 2011 court side and not EMTs. They also have special over-sized longboards but not stretchers or splints. Since I never actually had any of the players get injured, I didn't have to put them in the ambulance. I know from other patients though that they would not fit with a traction splint, let alone normal circumstances. I imagine you'd have to traction it as best as possible after medicating then go on the stretcher backwards so you have room for his legs. Maybe even do manual traction from the captains chair. Oh yeah, and drive very slow and careful.

Obviously nothing about this is ideal, but we only plan for the textbook 160lb male patient, so why should we be prepared?

Actually, unless that required traction, I'd splint it as close to what it was to maintain good CMS. I don't recall the lower leg muscles reacting the same as the upper leg to require traction, but it would still depend on what I'd see at the scene.

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