Jan 30 • Daily TACMED Trainings
Broken Bones, and what you need to know!
Framework: MARCH → then Secondary Injury Management
🩸 M — Massive Hemorrhage (FIRST, ALWAYS)
Fractures love to bleed—especially femur, pelvis, open fractures.
- Look for life-threatening bleeding
- Apply: Tourniquet (high & tight if needed) Pressure dressing Wound packing if open + bleeding
- Do not splint before bleeding is controlled
👉 Remember: A broken bone can kill via blood loss.
🫁 A / R — Airway & Respiration
Usually intact with isolated fractures, but:
- High-energy trauma = reassess
- Rib fractures? Watch for: Shallow breathing Increasing pain Signs of pneumothorax
🩸 C — Circulation / Shock
Fractures can cause internal bleeding.
- Check: Skin (cool, pale, clammy) Mental status Radial pulse
- Treat for shock: Lay flat (if safe) Keep warm Control pain if within scope
🧠 H — Hypothermia / Head Injury
- Exposed patients lose heat fast
- Use: Emergency blanket Jackets / vehicle heat
- Head injury + fracture = higher priority
🦴 FRACTURE IDENTIFICATION
Suspect a fracture if you see:
- Deformity or unnatural angle
- Swelling / bruising
- Pain with movement
- Loss of function
- Bone visible = open fracture (medical emergency)
⚠️ If it looks broken, treat it as broken.
🔒 SPLINTING: THE GOLD STANDARD
Rule: Immobilize the injury and the joints above and below
Steps:
- Expose the injury
- Check CSM (Circulation, Sensation, Movement)
- Realign only if needed to restore circulation (and trained to do so)
- Pad generously
- Splint & secure
- Recheck CSM
🧠 Field-expedient splints:
- Rifles (safe & unloaded)
- Tourniquet windlass rods
- Sticks / trekking poles
- Cardboard / magazines
- SAM splint = king 👑
🚫 WHAT NOT TO DO
- ❌ Don’t ignore bleeding
- ❌ Don’t force realignment unless circulation is compromised
- ❌ Don’t leave jewelry on (swelling risk)
- ❌ Don’t forget reassessment
🎯 SCENARIO (Think It Through)
You respond to a vehicle vs pedestrian.
Patient has:
- Obvious lower leg deformity
- Bleeding controlled with pressure
- Complains of severe pain
Question:
Do you splint first or reassess MARCH?
👉 Answer: Reassess MARCH → then splint.
🧠 TAKEAWAY:
Fractures aren’t just orthopedic problems—they’re bleeding, shock, and survival problems.
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Broken Bones, and what you need to know!
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