Module 4 part 3

Types of splints

- rigid splint -soft splint - self-splint ( anatomic splint)

Dressings & Bandages: Uses

-->Dressings •Control bleeding •Reduce infection -->Bandages •Direct pressure •Securing dressings etc •Reduce swelling, support limbs •Restrict movement

Simple Fracture

A clean break or crack in the bone

Green-Stick Fracture

A split in a young, immature bone. Most common in children

Definition of a Fracture

Definition of a Fracture - a broken of cracked bone CAUSES: Direct force Indirect force Muscular action Disease TYPES Open/Closed Stable/Unstable Greenstick

Strains

Google photos of grade 1, 2 ,3

Open Fracture

In a open fracture, part of the bone breaks through the skin causing bleeding

Soft Tissue Injuries - Sprains

Sprains are injuries due to: •Stretching or tearing ligaments or other tissues at a joint. •Caused by a sudden twist or stretch of a joint beyond it's normal motion

Soft Tissue Injuries - Strains

The Symptoms of a strain are; •Intense pain •Moderate swelling •Painful movement •Difficult movement •Sometimes, discolouration •Cramping

Closed Fracture

The surrounding skin isunbroken.

Most common strains

The two most common strains are: •Back strain: a twisting, pulling, or tearing of the muscles supporting the spine. Hamstring muscle strain: a tear or stretch of a major muscle in the back of the thigh most likely caused by a muscle strength imbalance between the hamstrings and the quadriceps muscles in the front of the thigh. Hamstring injuries tend to recur

Classification based on severity

There are three classes of strains: •Mild strains, in which the muscle/tendon is slightly stretched or pulled. •Moderate strains, in which the muscle/tendon is overstretched and slightly torn, which results in some loss of function • •Severe strains, in which the muscle and/or tendon is partially or completely ruptured, often resulting in an incapacitating injury.

Comminuted Fracture

This is a type of fracture that produces multiple bone fragments

Dislocations

see slide 17 for photo of knee

Fractures

slide 31 for photos

Signs & Symptoms

•A dislocated joint can be: •Visibly deformed or out of place •Swollen or discolored •Intensely painful •Numbness •Tingling of the joint •Immovable •Visible bruising

Medical Interventions

•A dislocated joint usually can be successfully reduced into its normal position only by a trained medical professional. Trying to reduce a joint without any training could substantially worsen the injury. •X-rays are usually taken to confirm a diagnosis and detect any fractures which may also have occurred at the time of dislocation. A dislocation is easily seen on an X-ray •Once a diagnosis is confirmed, the joint is usually manipulated back into position. This can be a very painful process, therefore this is typically done either in the emergency department under sedation or in an operating room under a general anaesthetic.

Dislocation

•A dislocation also called luxation is an injury to a joint — a place where two or more bones come together — in which the ends of your bones are forced from their normal positions. This painful injury temporarily deforms and immobilizes the joint. •Dislocation is most common in shoulders and fingers. Other sites include elbows, knees and hips. If you suspect a dislocation, advise seek prompt medical attention to return the bones to their proper positions.

After care

•A dislocation, injured joints are usually held in place by a splint (for straight joints like fingers and toes) or a bandage (for complex joints like shoulders). Additionally, the joint muscles, tendons and ligaments must also be strengthened. •This is usually done through a course of physiotherapy, which will also help reduce the chances of repeated dislocations of the same joint.

Soft Tissue Injuries - Strains

•A strain is an injury to a muscle or tendon caused by over-exertion. •In severe cases muscles or tendons are torn and the muscle fibres are stretched.

The three most common spots for sprains are:

•Ankle sprain: This type of sprain typically happens when the foot turns inward as you run, turn or land on the ankle after a jump. •Knee sprain: Typically, this occurs after a blow to the knee or a fall. Sudden twisting of the knee may result in a sprain. •Wrist sprain: This sprain often happens when someone fall and land on an outstretched hand.

Myth

•Applying an elastic bandage to a severely sprained ankle is adequate treatment •Fact: Ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.

Approach and Action

•Assess the situation •Telephone for help •Assess any further danger •Can you cope •Do you need assistance •Begin Treatment

Complications

•Bone infections (osteomyelitis). Infections can occur when bacteria enter the body during a trauma. Less commonly, infections can happen during surgery to set a bone. •Bone deformities (malunions). Bones that are misaligned can heal in abnormal positions and cause malunions. •Delayed union and nonunion fractures. A fracture that takes longer to heal than usual is called a delayed union. A nonunion fracture is one that fails to heal. •Bone death (Avascular necrosis) - If the bone loses its essential supply of blood it may die.

Complications

•Complications of a joint dislocation can include: •Tearing of the muscles, ligaments and tendons that reinforce the injured joint •Nerve or blood vessel damage in or around the joint •Susceptibility to reinjury if one have a severe dislocation or repeated dislocations •Development of arthritis in the affected joint as a person age

General Splinting Guidelines

•Cover open wounds before applying splint. •Splint only if it will not cause further pain. •Splint the injured part in the position found. Splint should extend beyond joints above and below any extremity injury

First aid care for Open Fractures

•Cover wound, apply dressing •Place padding over and around the wound •Secure dressing and padding •Immobilise injured part •911 •Treat casualty for shock •N.B. Nothing to eat or drink

Late complications of fractures

•Delayed union (fracture takes longer than normal to heal). •Malunion (fracture does not heal in normal alignment). •Non-union (fracture does not heal). •Joint stiffness. •Contractures.

Causes of dislocations

•Dislocations can occur in contact sports, such as football and hockey, and in sports in which falls are common, such as downhill skiing, gymnastics and volleyball. Basketball players and football players also commonly dislocate joints in their fingers and hands by accidentally striking the ball, the ground or another player. •A hard blow to a joint during a motor vehicle accident and landing on an outstretched arm during a fall are other common causes.

General Rules for Bandaging

•Explain and reassure •Posture •Support •Your positioning --->Natural hollows -->Apply bandages firmly --->Exposure of digits -->Check circulation

Care for Joint Injuries

•For dislocations, splint and provide care as you would for fracture. •For sprains, use RICE procedure. •Seek medical care. -->Call 9-1-1 for difficult-to-transport injuries.

Care for Muscle Injuries

•For muscle strains and contusions •Rest. •Apply ice. •For muscle cramps •Stretch muscle. Apply pressure.

Treatment

•If the joint doesn't return to normal naturally, the doctor may use one of the following treatments: •manipulation or repositioning •immobilization •medication •rehabilitation

Recognizing Muscle Injuries

•Muscle strain (pull) •Sharp pain, tenderness, weakness, stiffness •Muscle contusion (bruise) •Pain, tenderness, swelling, bruising •Muscle cramp (spasm) •Spasms, pain, restriction, or loss of movement

Recognizing Joint Injuries

•Pain, swelling, inability to use •Similar to fractures •Main sign of dislocation is deformity.

Dislocations

•Partial or full displacement of bones at a joint •Tears ligaments •Associated fracture •External wrenching force •Violent muscle contraction •Do not attempt to replace joint

RICE Procedure

•R = Rest •I = Ice •C = Compression •E = Elevation

Soft Tissue injuries Treatment (RICER)

•Rest the injured part. •Apply Ice or cold compress. •(15-20mins) •Compress the injury. •Elevate the injured part. •Rehabilitate / Recuperation If in doubt treat as a fracture

Risk factors

•Risk factors for a joint dislocation include: •Susceptibility to falls. Falling increases one chance of a dislocated joint if a person use his arms to brace for impact or if one land forcefully on a body part, such as your hip or shoulder. •Heredity. Some people are born with ligaments that are looser and more prone to injury than those of other people. •Sports participation. Many dislocations occur during high-impact or contact sports, such as gymnastics, wrestling, basketball and football. •Motor vehicle accidents. These are the most common cause of hip dislocations, especially for people not wearing a seat belt.

Signs and symptoms

•Signs and symptoms may vary due to severity of injury. They may include: •Pain. •Swelling, which can indicate underlying inflammation within the joint or within the soft tissue surrounding the joint. •Bruising. •Instability, especially noted on weight bearing joints like the knee or ankle. •Loss of the ability to move and use the joint.

Care for Bone Injuries

•Stabilize injured part to prevent movement. -->Hold injured part. -->Splint if EMS is going to be delayed or you are transporting victim. •Cover any exposed bones without applying pressure. •Apply ice to prevent swelling. Call 9-1-1 for any open or large bone fractures

Splinting

•Stabilizes a bone or joint injury •Reduces pain •Prevents further damage to muscles, nerves, and blood vessels

First aid treatment

•Stop any bleeding: If the victim is bleeding, elevate and apply pressure to the wound using a sterile bandage, a clean cloth, or a clean piece of clothing. •Immobilize the injured area: If you suspect a broken bone in their neck or back, help them stay as still as possible. If you suspect they've broken a bone in one of their limbs, immobilize the area using a splint or sling. •Apply cold to the area: Wrap an ice pack or bag of ice cubes in a piece of cloth and apply it to the injured area for up to 10 minutes at a time.

Functions of the Skeleton

•Support •Movement •Protection •Produce blood cells

Signs & Symptoms

•The signs and symptoms of a fracture vary according to which bone is affected, the patient's age and general health, as well as the severity of the injury. However, they often include some of the following: •pain •swelling •bruising •discolored skin around the affected area

Types

•There are two types of strains: •Chronic strains that result from overuse (prolonged, repetitive movement) of muscles and tendons, or inadequate rest during intensive training •Acute strains that result from a direct blow to the body, overstretching, or excessive muscle contraction.

First aid treatment

•Treat them for shock: Help casualty get into a comfortable position, encourage them to rest, and reassure them. Cover with a blanket or clothing to keep them warm. •Get professional help: Call 911 or help them get to the emergency department for professional care.

Recognizing Bone Injuries

•Use DOTS -Deformity -Open wounds -Tenderness -Swelling

Rules for Applying Dressings

•Wear disposable gloves •If possible, wash hands •Correct size •Place pad directly onto wound •Avoid touching wound •Try not to cough or sneeze

Signs & Symptoms cont'd

•angulation - the affected area may be bent at an unusual angle •the patient is unable to put weight on the injured area •the patient cannot move the affected area •the affected bone or joint may have a grating sensation •if it is an open fracture, there may be bleeding

Common joint dislocations

•shoulder • elbow • knee • hip • finger • collarbone • jaw • wrist ankle and foot

When a large bone is affected, such as the pelvis or femur:

•the sufferer may look pale and clammy •there may be dizziness (feeling faint) •feelings of sickness and nausea. •If possible, do not move a person with a broken bone until a healthcare professional is present and can assess the situation and, if required, apply a splint. If the patient is in a dangerous place, such as in the middle of a busy road, one sometimes has to act before the emergency services arrive.