CRUTCH WALKING

DEFINITION Crutches are orthopedic devices created to assist in weight bearing when a patient has a leg injury or weakness in the lower extremities. PURPOSE Used to assist in weight bearing when a patient has sustained an injury to the leg, knee, ankle, or foot, such as a fracture or severe sprain. To aid the user in walking while relieving weight from one foot or leg. Crutches are also used following surgery on the leg, knee, ankle, or foot.

EQUIPMENTS ADJUSTMENTS: To adjust height: -position axillary pad ~8cm (3" or 3-5 fingerwidths) below the axilla -the tip of the crutch should be ~5cm (2") anterior and 15cm (6") lateral to the foot To position hand grip: -adjust the hand grip to the level of the wrist crease (alternatively, adjust to height of the greater trochanter of the femur) -elbow angle should be ~20-30 degrees INDICATIONS Pain caused of abrasion on AV joints Inflammation of AV joints Postoperative or conservative treatment of AV injuries, After amputation and supplying of AV Aberration of AV Imbalance (disorder of balance), weakness or paralysis of AV.

PRECAUTIONS: Have someone nearby for assistance until accustomed to the crutches. Frequently check that all pads are securely in place and all hardware is tight. Check screws at least once per week. Clean out crutch tips to ensure they are free of dirt and stones. Remove small, loose rugs from walking paths.

Beware of ice, snow, wet or waxed floors, and telephone and extension cords. Avoid crowds; leave class early. Never carry anything in your hands; use a backpack. Watch for pets.

CRUTCH WALKING GAITS Four-Point Crutch Gait Indication: Weakness in both legs or poor coordination. Pattern Sequence: Left crutch, right foot, right crutch, left foot. Then repeat. Advantages: Provides excellent stabilty as there are always three points in contact with the ground Disadvantages: Slow walking speed

Three-Point Crutch Gait Indication: Inability to bear weight on one leg. (fractures, pain, amputations) Pattern Sequence: First move both crutches and the weaker lower limb forward. Then bear all your weight down through the cruthes, and move the stronger or unaffected lower limb forward. Repeat. Advantages: Eliminates all weight bearing on the affected leg. Disadvantages: Good balance is required.

Two-Point Crutch Gait Indication: Weakness in both legs or poor coordination. Pattern Sequence: Left crutch and right foot together, then the right crutch and left foot together. Repeat. Advantages: Faster than the four point date. Disadvantages: Can be difficult to learn the pattern

Swing-Through Crutch Gait Indications: Inability to fully bear weight on both legs. (fractures, pain, amputations) Pattern Sequence: Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time past the crutches .Advantage: Fastest gait pattern of all six. Disadvantage: Energy consuming and requires good upper extremity strength.

LIFTING AND MOVING

EMERGENCY RESCUE Is a rapid movement of patient from unsafe place to a place of safety

INDICATORS FOR EMERGENCY RESCUE Danger of toxic gases or asphyxia due to lack of oxygen Danger of fire or explosion Serious traffic hazards Risk of drowning Danger of electrocution Danger of collapsing walls

TRANSFER is moving a patient from one place to another after giving first aid. SELECTION OF PATIENTS DEPENDING UPON THE FOLLOWING: Nature and severity of the injury Size of the victim Physical capabilities of the first aider Number of personnel and equipment available Nature of evacuation route Distance to be covered Sex of the victim

POINTERS TO BE OBSERVED DURING TRANSFER Victims airway must be maintained open Hemorrhage is controlled Victim is safely maintained in the correct position Regular check of the victims condition is made Supporting bandages and dressing remain effectively applied The method of transfer is safe, comfortable and as speedy as circumstances permit. The patients body is moves as one unit The taller first aiders stay at the head side of the victim First Aiders/ bearers must observed ergonomics in lifting and moving of patient.

EQUIPMENTS: Stretcher (may be improvised) Wheel chair Straps/ slings

Method of Transfer A. DRAGS ANKLE PULL

The ankle pull is the fastest method for moving a victim a short distance over a smooth surface. This is not a preferred method of patient movement. 1. Grasp the victim by both ankles or pant cuffs. 2. Pull with your legs, not your back. 3. Keep your back as straight as possible. 4. Try to keep the pull as straight and in-line as possible. 5. Keep aware that the head is unsupported and may bounce over SHOULDER DRAG

The shoulder pull is preferred to the ankle pull. It supports the head of the victim. The negative is that it requires the rescuer to bend over at the waist while pulling.

1. Grasp the victim by the clothing under the shoulders. 2. Keep your arms on both sides of the head.

3. Support the head. 4. Try to keep the pull as straight and in-line as possible. BLANKET DRAG

This is the preferred method for dragging a victim. 1. Place the victim on the blanket by using the "logroll" or the three-person lift. 2. The victim is placed with the head approx. 2 ft. from one corner of the blanket. 3. Wrap the blanket corners around the victim. 4. Keep your back as straight as possible. 5. Use your legs, not your back. 6. Try to keep the pull as straight and in-line as possible.

A. ONE MAN CARRIES CARRY IN ARMS

This only works with a child or a very light person. 1. Place one arm around the victim's back and the other underneath his or her knees and lift the person into your arms. 2. Walk to safety. Have the victim place an arm around your shoulders while walking, if possible.

FIREFIGHTER CARRY

1. Crouch down and place one of the victim's arms across your shoulder. Wrap your arm around the victim's legs and grasp the other arm of the victim.

2.

Lift the person using your legs and carry the person to a safe place.

PACK STRAP

1. Crouch down in front of the victim and place both of his or her arms over your shoulders. 2. Cross the person's arms and grasp the opposite wrist with both of your hands. You should be holding onto his or her left wrist with your right hand and vice-versa. 3. Pull the injured person's arms close to your chest and squat slightly. 4. Push your hips into the victim while bending forward slightly. Balance the person's weight with your hips while walking.

FIREMANS CARRY

This technique is for carrying a victim longer distances. It is very difficult to get the person up to this position from the ground. Getting the victim into position requires a very strong rescuer or an assistant. 1. The victim is carried over one shoulder. 2. The rescuer's arm, on the side that the victim isbeing carried, is wrapped across the victim.

PIGGY BACK

Although this is an effective carry, how far you will be physically capable of moving the victim will depend on her size and weight. It is also reduces your ability to carry your won equipment, particularly if you are hiking with backpacks. 1. Crouch in front of the victim with your back toward her and ask her to put her arms over your shoulders. 2. Grasp the victims thighs, pull them in toward you and slowly stand up, remembering to keep your back straight.

B. TWO MAN CARRIES TWO-HANDED SEAT CARRY

1. Crouch down, facing each other on either side of the injured person. 2. Cross over your arms behind the victim and grab hold of her waistband or belt. 3. Pass your other hands under the victims knees and grasp each others wrists. 4. Bring your hands toward the middle of the victims thighs. 5. Get in close to the injured person and stand up slowly; you are now ready to move off.

HAND AS A LITER

The two-handed and, in particular, the four-handed seat carries can only be used with conscious people because they require the person being carried to have some control over her body and give some assistance to the rescuers. 1. With the person to be carried standing close to you, first hold your left wrist with your right hand, and ask your carrying partner to do the same. 2. Now, link hands, taking hold of your partners right wrist. This should form a square. 3. Allow the victim gently sit back onto your hands and get her to place her hands around your shoulders.

C. THREE MAN CARRIES HAMMOCK CARRY

Three or more rescuers get on both sides of the victim. The strongest member is on the side with the fewest rescuers. 1. Reach under the victim and grasp one wrist onthe opposite rescuer. 2. The rescuers on the ends will only be able to grasp one wrist on the opposite rescuer. 3. The rescuers with only one wrist grasped will use their free hands to support the victim's head and feet/legs. 4. The rescuers will then squat and lift the victim on the command of the person nearest the head, remembering to use proper lifting techniques.

BEARERS ALONGSIDE

1. Each person kneels on the knee nearest the victim's feet. 2. On the command of the person at the head, the rescuers lift the victim up and rest the victim on their knees. If the patient is being placed on a low stretcher or litter basket: On the command of the

person at the head, the patient is placed down on the litter/stretcher. If the victim is to be placed on a high gurney/bed or to be carried: At this point, the rescuers will rotate the victim so that the victim is facing the rescuers, resting against the rescuers' chests. 3. On the command of the person at the head, all the rescuers will stand. 4. To walk, all rescuers will start out on the same foot, walking in