ABOUT BROKEN BONES Essential Question: How Do We Fix Bones? Learning Targets: Students will: Use a variety of media to develop and deepen understanding of a topic or idea. Practice a standard splinting technique, revising work when needed. Justify thinking using evidence to solve x-ray mysteries. Lesson Overview When dealing with broken bones, the First Responder needs to be able to do a quick assessment of the break and then stabilize the injury for transport to the emergency room. Being able to create a safe and effective splint is essential for this work in caring for patients. In this lesson, the young professionals will practice a standardized splinting technique. When our patient arrives at the emergency room, an x-ray technician takes images of the break, and the young professionals must interpret these images to determine the best next step to help the bones heal. 1
Lesson Agenda Opening (10 min) Injury Assessment Work Time Modeling the Standard Form (10 min) Splinting Practicum (20 min) Reading X-rays (15 min) Closure (15 min) Venn Diagram/Quick Write Materials Splinting practicum (1 set per group) Splint (magazine/notebook) Wrapping bandage Two triangle bandages Padding (can be t-shirts, cut up towels, etc.) Supportive materials (SAM splint) <Getting an X-ray> and <How Dangerous Are X-rays> videos to project <X-ray Images> to project FACILITATION NOTES Background Knowledge. Familiarize yourself with information on x-rays: https://www.youtube.com/watch?v=gsv7sjddcy4. IN ADVANCE Preview the videos on splinting: https://www.youtube.com/watch?v=ot7c3syptr4 and https://www.youtube.com/watch?v=0dzk5rossxi cover how to properly splint an extremity arm fracture. Please review these BEFORE assisting students. One video models using stabilizers other than SAM splints (http://www.sammedical.com/products/sam-splint/). Not all students have had an x-ray; this video provides a visual so that they can understand the process you go through when you see an x-ray technician. Show to 1:30- https://www.youtube.com/watch?v=dhvkdhtkbfe. Are x-rays dangerous? https://www.youtube.com/watch?v=vmdemmnksko helps to answer commonly asked questions about x-rays. 2
Vocabulary Content x-ray, radiology, fractures, splint, joint, extremity, oblique, avulsion, impacted, comminuted, greenstick Tier II synthesize, remodeling, compare & contrast, immobilize, stabilize, secure, evidence, illustrate Opening (5 min) Injury Assessment On the scene of the emergency, it was clear that the skateboard accident patient had a facial laceration and a visibly injured limb. Given the patient was unconscious, he was loaded into the ambulance and splinted on the way to the hospital. When patients are stable, first responders are often able to make a quick injury assessment at the scene of the emergency, and they can act with preventative care before the EMTs arrive. For conscious patients, this means assessing the area where they are experiencing pain and may be injured. With a partner, you are going to practice a quick injury assessment technique first responders use prior to splinting. 1. Model with a volunteer the following steps in the assessment process. Think aloud through each step: o Inspection: Do a quick visual scan of the injured area for any obvious breaks or wounds. o Palpation: Check to see if the patient has sensation in the injured area. Assess the joints located above and below the injury. o ROM (Range of Motion): Assist the patient in moving the injured area gently through its range of motion. Do not force motion. Have them stop if they feel pain. o Strength Testing: Assess the strength of the injured area by having them push or grip gently with the limb. 2. Have the YPs who did not act as first responders in the previous lesson switch roles and become the first responder. 3
3. Explain that they will be assessing their partner s arm as if it were injured. 4. Circulate and assist pairs as needed in following the injury assessment technique. Work Time Modeling the Standard Form (15 min) Allied health professionals are trained to deal with emergencies. They spend time practicing standard ways of treating emergencies in the field. We are now going to learn how professionals apply a splint and then practice a more standard approach. 1. Project selected video: https://www.youtube.com/watch?v=ot7c3syptr4 or https://www.youtube.com/watch?v=0dzk5rossxi. Say: We are going to practice splinting based on a simplified checklist an EMT uses in their practicum test this is in your Young Allied Health Professional packet. Before you start splinting, I want to model the key steps that first responders do in the splinting process. After each one, I would like someone to share why this is critical, or very important, to the splinting process. 1. Model each step as you state it aloud. Then ask why the step is important. 2. Select a volunteer patient. 3. Say or show safety precautions (I am putting on gloves or act it out, etc.). o Ask: Why do this? 4. Keep the extremity still and stabilized with a SAM splint or magazine (to reduce pain and further damage to site). 5. Immobilize the joint above and below the injury (to reduce pain and further damage to the site). 6. Place something under the hand (for comfort and circulation). 7. Wrap the forearm using an ace bandage (to stabilize injury). 8. Access motor, sensory, and circulation before and after splinting (to ensure blood flow is not cut off from fingers and that the wrap is not too tight). 9. Use a triangle bandage to create a sling (to support and protect injury in transport and reduce pain). It may be temping to tell students the reason for each step. Instead, encourage them to think with a problem-solving approach. Use wait time if needed to encourage participation. 4
Splinting Practicum (20 min) 1. Provide time for partners to splint each other. o Students can work in their same groups from the Splinting Design Challenge, but they should now switch roles. 2. Circle and provide support. o o Students should support and provide padding to the wound! Provide formative assessment so students meet criteria using the <Splinting Practicum Checklist>. 3. Sign off on each young First Responder s sheet. Say: It is important to note that practicing splinting once does not make you a real Allied Health Professional. From First Responders to EMTs to Paramedics, our health care professionals go through rigorous training and practice before they work in the field. Reading X-rays (15 min) What happens once a patient with a suspected broken bone arrives at the hospital? Often, they go to have the bone x-rayed. X-ray or radiology technicians learn how take different kinds of x- rays. These images are then read by radiologists, or doctors who use medical images to diagnose diseases and injuries. For our patient, it is important to know the bones that are fractured and the type of fracture, or the break, in order to treat it correctly and effectively. Today, we will experience this as a radiologist s mystery, where you will problem solve to match the x-ray image to the cause/definition. Say: We are going to take a moment to learn about x-rays and the allied health career of X-ray Technician. What are x-rays? Are they dangerous? Project video: https://www.youtube.com/watch?v=vmdemmnksko. Say: Now let s learn how x-rays are used and the role of the X-ray Technician. Since not everyone has had an x-ray, this video will help share the process. Show to 1:30: https://www.youtube.com/watch?v=dhvkdhtkbfe. 1. Review the common types of fractures with students, asking them to follow along on their <Types of Fractures> student sheet. Share some observations on what makes each fracture unique. This short activity provides the YPs an opportunity to apply contextualized critical thinking skills. Push students to supply the reasoning behind their answers, justifying their ideas by using evidence when possible. 5
2. Model the problem solving: reading an x-ray of a transverse fracture. 3. Project x-ray of the transverse fracture. o o Ask: What do you notice about this break? What evidence suggests it is a transverse fracture? Listen for: There is a clean, horizontal break in the bone. 4. Project each x-ray image. o Answer Key: Oblique, Avulsion, Impacted, Comminuted, Greenstick 5. Ask: What kind of fracture is illustrated? What is your evidence? o Students should use the images on the <Types of Fractures> sheet as a basis for comparison. The power of this activity is as a reasoning/mystery activity. Push students to move from making guesses to finding evidence or clues to support their thinking. Closure (15 min) Venn Diagram: X-ray Tech & Radiologist What is the difference between an x-ray technician and a radiologist? Both have important roles in helping patients on the road to recovery. 1. Highlight the <Career Venn Diagram>. 2. Ask: Who here knows how to use a Venn diagram? 3. Explain that they will compare and contrast the two careers. 4. Model inputting information that is shared by each career and information that is specific to one or the other. o Use the Lenses on the Future language when possible. 5. Ask students to work individually or in assigned pairs to complete the Venn diagram. 6. Debrief with the class, ensuring key points are called out. 7. Invite students to reflect on the <What Are Bones? Quick Write> questions privately and record their answers. The closure activity has students comparing and contrasting two careers. While both work with medical imaging, one is a technical career that provides a familysustaining wage and requires less investment in terms of years of education. Highlighting technical careers as well as the more recognized doctors and nurses demonstrates the diverse professional opportunities in the growing sector of Health Science. Ensure that during the activity one career is not presented as more important or better than the other. 6
Name: Date: LESSON TOPIC: How Do We Fix Bones? Today s Learning Objectives: I can: Use a variety of media to develop and deepen understanding of a topic or idea. Practice a standard splinting technique, revising work when needed. Justify thinking using evidence to solve x-ray mysteries. When dealing with broken bones, the First Responder needs to be able to do a quick assessment of the break and then stabilize the injury for transport to the emergency room. Being able to create a safe and effective splint is essential for this work in caring for patients. In this lesson, I will practice a standardized splinting technique. When our patient arrives at the emergency room, an x-ray technician takes images of the break, and I must interpret these images to determine the best next step to help the bones heal. Today s Activities: Injury Assessment Splinting Practicum X-ray Mysteries Career Venn Diagram and Quick Write Exit Ticket 7
EMT Splinting Practicum Checklist Directions: With your group, use this chart to check each step of splinting a broken limb. Score each section; scores below 7 will try again. Long Bone Immobilization Points Possible Points Earned Say or show safety precautions (I am putting on gloves or act it out, etc.). 1 Keep the extremity still and stabilized with a SAM splint or magazine (to reduce pain and further damage to site). 1 Immobilize the joint above and below the injury (reduce pain and further damage to the site). 1 Place something under the hand (for comfort and circulation). 1 Wrap the forearm using an ace bandage (stabilizes injury). 1 Access motor, sensory, and circulation before and after splinting (to ensure blood flow is not cut off to fingers and that the wrap isn t too tight). 1 Use triangle bandage to create a sling (to support and protect injury in transport and reduce pain). 1 TOTAL 7 8
Types of Fractures The type and severity of a fracture is dependent on the strength and direction of the forces that cause a bone to break. The following image summarizes the common types of fractures. X-Ray Image Type of Fracture Evidence 9
X-Ray Image Type of Fracture Evidence 10
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What are Bones? Quick Write Summarize what you learned about bones in today s activities. Which activity was the most challenging? What are some reasons it was challenging? What did you do to persist through those challenges? 12
Facilitator Documents: X-ray Images to Project 13
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Venn Diagram to Project 16