SPLINTING FRACTURES
BONES
BONES
a. The bones of your body form your skeleton. The skeleton forms the framework of your body. The bones that form the ribcage and the pelvis act to protect internal organs such as the heart, lungs, and intestines. The skull protects the brain. The spine (backbone) protects the spinal cord, a system of nerves that sends messages from the brain to all parts of the body and transmits messages from all parts of the body to the brain.
b. Muscles are attached to bones by tendons. These muscles contract and relax, causing your bones to move. This allows you to sit, stand, run, turn your head, pick up an object with your fingers, and so forth.
c. When two bones meet, they form a joint. The ends of the bones are covered with cartilage, which prevents the bones from actually rubbing against each other. The bones are connected to each other by ligaments. Most joints are mobile (allow movement). For example, your arm and forearm meet at the joint known as the elbow.
Some joints are relatively fixed, such as those in your coccyx (tailbone) and skull.
d. Bones are surrounded by blood vessels and nerves. When a bone is fractured (broken), damaged nerves and blood vessels cause pain and loss of blood.
6-2. TYPES OF FRACTURES
A fracture occurs when a bone is broken. The break may only be a crack in the bone (incomplete fracture) or the bone may be broken into two separate parts (complete fracture). Any fracture can be serious. A fracture of a large bone like the femur can result in a significant loss of blood that, in turn, can result in hypovolemic shock. Complete fractures are also dangerous because the sharp ends of the fractured bone can injure muscle tissues, nerves, and blood vessels. A fracture can cause discomfort, disability, and even death. An incomplete fracture is treated as though it were a complete fracture. Fractures are usually classified as open or closed.
a. Closed Fracture. A closed fracture (figure 6-1 A) is a fracture in which the skin is not broken. A closed fracture may result in significant loss of blood due to internal bleeding (bleeding into surrounding body tissues or into a body cavity) even though no blood is visible.
b. Open Fracture. An open fracture is one in which the skin is broken (penetrated). The source of the penetration may have been the sharp end of a fractured bone (figure 6-1 B) or a foreign object such as a bullet which penetrated the skin and fractured the bone (figure 6-1 C). If an open wound is caused by a fractured bone, the bone may remain visible or it may slip back below the skin and muscle tissues. An open fracture results in more blood loss than does a closed fracture since the blood can escape through the open wound. In addition, infection is a major concern.
6-3. COMMON CAUSES OF FRACTURES
Fractures may be caused by a direct blow to the body (such as being hit by a vehicle) or by indirect force that results in a fracture away from the point of impact (such as a hip fracture resulting from a person landing on his knee after a hard fall). A fracture can also result from a limb being twisted or even from powerful muscle contractions during a seizure. Fatigue (stress) fractures can result by repeated stress, such as a stress fracture of the foot during a long march. Certain diseases can weaken bones and make them easier to break. High-energy impacts, such as being hit by a speeding vehicle or by a bullet, may produce multiple fractures and cause severe damage to surrounding tissues. Falls are a common cause of fractures.
6-4. SIGNS AND SYMPTOMS OF FRACTURES
A fracture may be found when evaluating the casualty. Life-threatening injuries (lack of breathing and severe bleeding) should be treated first since they immediately threaten the casualty's life. A serious fracture, however, can also be life-threatening. A fracture can be identified by the following signs and symptoms.
NOTE: A sign is something that can be observed by someone other than the casualty. Bleeding, bruises, and pulse rates are examples of signs. A symptom is something which the casualty senses, but which cannot be observed directly by another person. Pain is an example of a symptom.
a. Visible Fracture. In an open fracture, the fractured bone or bone fragments may be visible.
b. Deformity. The body part may appear deformed due to the displacement of the bone, the unnatural position of the casualty, or angulation where there is no joint (for example, the casualty's forearm is "bent" instead of straight).
c. Pain. The casualty will probably experience pain at a particular location. The pain (point tenderness) usually identifies the location of the fracture. The casualty may be able to "feel" the fractured bones.
d. Swelling. There may be swelling (edema) at the suspected fracture site.
e. Discoloration. The area around the suspected fracture site may be bruised or have hemorrhagic spots (ecchymosis).
f. Crepitation. The fracture bones may make a crackling sound (crepitation) if they rub together when the casualty moves.
CAUTION: Do not ask the casualty to move the injured body part in order to test for crepitation.
g. Loss of Motion. The casualty may not be able to move the injured limb or have difficulty in moving the limb. If a spinal injury is present, paralysis may exist, especially paralysis of the legs.
NOTE: Do not have the casualty attempt to move the injured arm or leg to test this symptom. Rely upon what the casualty tells you.
h. Loss of Pulse. If the fractured bone is interfering with blood circulation, there may be no pulse distal to (below) the site of the fracture.
i. False Motion. There may be motion at a point where there is normally no motion. This movement at the fracture site is called false motion.
j. Massive Injury. There may be massive injury to an arm or leg accompanying the fracture.
k. Snap. A "snapping" sound may have been heard by the casualty at the time of the injury.
6-5. TREATING A SPINAL FRACTURE
Injury to the spine may cause paralysis and even death. Unless an immediate, life-threatening danger is present (fire, explosions, and so forth), you should not move a casualty with a suspected back or neck injury. Immobilize the casualty to prevent movement of his back and neck and seek medical help for the casualty. Treat any casualty which you think may have a spinal injury as though you were certain that he had a fractured spine.
a. Recognize a Possible Spinal Injury. Signs and symptoms of an injured spine include:
6-3. COMMON CAUSES OF FRACTURES
Fractures may be caused by a direct blow to the body (such as being hit by a vehicle) or by indirect force that results in a fracture away from the point of impact (such as a hip fracture resulting from a person landing on his knee after a hard fall). A fracture can also result from a limb being twisted or even from powerful muscle contractions during a seizure. Fatigue (stress) fractures can result by repeated stress, such as a stress fracture of the foot during a long march. Certain diseases can weaken bones and make them easier to break. High-energy impacts, such as being hit by a speeding vehicle or by a bullet, may produce multiple fractures and cause severe damage to surrounding tissues. Falls are a common cause of fractures.
6-4. SIGNS AND SYMPTOMS OF FRACTURES
A fracture may be found when evaluating the casualty. Life-threatening injuries (lack of breathing and severe bleeding) should be treated first since they immediately threaten the casualty's life. A serious fracture, however, can also be life-threatening. A fracture can be identified by the following signs and symptoms.
NOTE: A sign is something that can be observed by someone other than the casualty. Bleeding, bruises, and pulse rates are examples of signs. A symptom is something which the casualty senses, but which cannot be observed directly by another person. Pain is an example of a symptom.
a. Visible Fracture. In an open fracture, the fractured bone or bone fragments may be visible.
b. Deformity. The body part may appear deformed due to the displacement of the bone, the unnatural position of the casualty, or angulation where there is no joint (for example, the casualty's forearm is "bent" instead of straight).
c. Pain. The casualty will probably experience pain at a particular location. The pain (point tenderness) usually identifies the location of the fracture. The casualty may be able to "feel" the fractured bones.
d. Swelling. There may be swelling (edema) at the suspected fracture site.
e. Discoloration. The area around the suspected fracture site may be bruised or have hemorrhagic spots (ecchymosis).
f. Crepitation. The fracture bones may make a crackling sound (crepitation) if they rub together when the casualty moves.
CAUTION: Do not ask the casualty to move the injured body part in order to test for crepitation.
g. Loss of Motion. The casualty may not be able to move the injured limb or have difficulty in moving the limb. If a spinal injury is present, paralysis may exist, especially paralysis of the legs.
NOTE: Do not have the casualty attempt to move the injured arm or leg to test this symptom. Rely upon what the casualty tells you.
h. Loss of Pulse. If the fractured bone is interfering with blood circulation, there may be no pulse distal to (below) the site of the fracture.
i. False Motion. There may be motion at a point where there is normally no motion. This movement at the fracture site is called false motion.
j. Massive Injury. There may be massive injury to an arm or leg accompanying the fracture.
k. Snap. A "snapping" sound may have been heard by the casualty at the time of the injury.
6-5. TREATING A SPINAL FRACTURE
Injury to the spine may cause paralysis and even death. Unless an immediate, life-threatening danger is present (fire, explosions, and so forth), you should not move a casualty with a suspected back or neck injury. Immobilize the casualty to prevent movement of his back and neck and seek medical help for the casualty. Treat any casualty which you think may have a spinal injury as though you were certain that he had a fractured spine.
a. Recognize a Possible Spinal Injury. Signs and symptoms of an injured spine include:
(1) Pain or tenderness of the neck or back.
(2) Cut or bruise on the neck or back.
(3) Inability to move part of the body (paralysis), especially the legs.
(4) Lack of feeling in a body part. (Touch the casualty's arms and legs and ask if he feels your hand.)
(5) Loss of bladder and/or bowel control.
(6) Head or back in an unusual position.
(2) Cut or bruise on the neck or back.
(3) Inability to move part of the body (paralysis), especially the legs.
(4) Lack of feeling in a body part. (Touch the casualty's arms and legs and ask if he feels your hand.)
(5) Loss of bladder and/or bowel control.
(6) Head or back in an unusual position.
b. Seek Medical Help. Send someone to seek medical help, usually the combat medic. Special supplies, such as a spine board, should be used to prepare the casualty for evacuation.
c. Immobilize the Suspected Fracture.
c. Immobilize the Suspected Fracture.
(1) Tell the casualty to keep still. Any movement could cause additional injury.
(2) If the casualty is lying on his stomach, keep him from moving until medical help arrives. If the casualty is lying on his back, use padding to help immobilize his back, neck, and head as described below.
(a) Roll or fold padding (such as a blanket) so that it conforms to the shape of the arch of his back. Then carefully slide the padding under the arch of his back. This padding will help to support and immobilize his back. (2) If the casualty is lying on his stomach, keep him from moving until medical help arrives. If the casualty is lying on his back, use padding to help immobilize his back, neck, and head as described below.
(b) Prepare and slide a roll of cloth under the casualty's neck to help support and immobilize his neck.
(c) Place padded rocks, small padded logs, or filled boots on each side of the casualty's head to keep it from moving (figure 6-3). Filled boots are prepared by removing the casualty's boots, filling the boots almost to the top with sand or small rocks, place material (strip of clothing, sock, etc.) on top of the sand or rocks, and tying the top of the boots to keep the material and filler from coming out.
CAUTION: Do not remove the casualty's boots if you are in a chemical environment.
6-6. PREPARING TO SPLINT A FRACTURE OF AN EXTREMITY
Once you have located the site of the fracture, you must splint the injured arm or leg. If the fractured bone is not splinted, the sharp end of the broken bone could move and injure surrounding muscles, blood vessels, and nerves. Before applying the splint, however, you should prepare the casualty.
a. Reassure the Casualty. Tell the casualty that you are taking care of him. If you must leave the casualty to obtain materials for a splint, be sure to tell him that you will return quickly. Talk to the casualty even if he appears to be unconscious.
b. Loosen Clothing and Expose Wound. Loosen any clothing that is tight or which binds the casualty. Gently move clothing to expose the injury and to determine the site of the fracture.
CAUTION: In a chemical environment, do not loosen or remove any protective clothing. Apply any needed dressings over the casualty's clothing.
c. Locate the Site of the Fracture. If the fracture is open, the wound (with or without visible bone) usually identifies the site of the fracture. In a closed fracture, pain, point tenderness, bruising, swelling, deformity, and crepitation may be used to locate the site of the fracture.
d. Remove Jewelry. Remove any jewelry that is on the casualty's injured limb and put the jewelry into his pocket. Jewelry is removed because the limb may swell and cause the jewelry to interfere with blood circulation. If this happens, the jewelry may have to be cut off to restore adequate blood circulation. Be sure to tell the casualty what you are doing and why.
e. Check Circulation Below the Fracture Site. Evaluate the casualty's blood circulation in the limb below the fracture site. A person with poor circulation should be evacuated as soon as possible after the limb is splinted to prevent the loss of the limb.
Once you have located the site of the fracture, you must splint the injured arm or leg. If the fractured bone is not splinted, the sharp end of the broken bone could move and injure surrounding muscles, blood vessels, and nerves. Before applying the splint, however, you should prepare the casualty.
a. Reassure the Casualty. Tell the casualty that you are taking care of him. If you must leave the casualty to obtain materials for a splint, be sure to tell him that you will return quickly. Talk to the casualty even if he appears to be unconscious.
b. Loosen Clothing and Expose Wound. Loosen any clothing that is tight or which binds the casualty. Gently move clothing to expose the injury and to determine the site of the fracture.
CAUTION: In a chemical environment, do not loosen or remove any protective clothing. Apply any needed dressings over the casualty's clothing.
c. Locate the Site of the Fracture. If the fracture is open, the wound (with or without visible bone) usually identifies the site of the fracture. In a closed fracture, pain, point tenderness, bruising, swelling, deformity, and crepitation may be used to locate the site of the fracture.
d. Remove Jewelry. Remove any jewelry that is on the casualty's injured limb and put the jewelry into his pocket. Jewelry is removed because the limb may swell and cause the jewelry to interfere with blood circulation. If this happens, the jewelry may have to be cut off to restore adequate blood circulation. Be sure to tell the casualty what you are doing and why.
e. Check Circulation Below the Fracture Site. Evaluate the casualty's blood circulation in the limb below the fracture site. A person with poor circulation should be evacuated as soon as possible after the limb is splinted to prevent the loss of the limb.
(1) Check pulse. Palpate a pulse site below the fracture site. If no pulse or a weak pulse is found, the fracture may be putting pressure on the artery or may have damaged the artery. A weak pulse can be determined by comparing the pulse felt below the fracture with the pulse felt at the same location on the uninjured limb. A casualty with no pulse below the fracture site should be evacuated as soon as the limb is splinted.
(2) Check capillary refill. If the fractured limb is an arm, press on the casualty's fingernail, then release. If normal color does not return within two seconds, the limb may have impaired circulation. This is also called the blanch test.
(3) Check skin temperature. Place your hand on the area beneath the injury. Then place your hand on the corresponding area on the uninjured arm or leg. If the skin of the injured limb is cooler than the skin on the uninjured limb, the casualty probably has poor circulation in the injured limb.
(4) Check sensation. Ask a conscious casualty if he can feel your touch. Then lightly touch an area below the fracture. (If his arm is fractured, for example, touch the tip of the index and little fingers on the injured arm.) Ask the casualty if the injured limb feels numb or has a tingling sensation. If the area feels numb or tingling to the casualty, the area probably has poor circulation.
(5) Check skin color. In a light-skinned person, a pale, white, or bluish-gray skin color indicates poor circulation. To check the circulation in a dark-skinned individual, press on a nail on the injured limb and the corresponding nail on the uninjured arm or leg. Release both nails at the same time. If the color returns to the nail bed of the uninjured limb faster than it returns to the nail bed of the injured limb, the casualty probably has poor circulation in the injured limb.
(6) Check motor function. Ask a conscious casualty to try opening and closing the hand of an injured arm or moving the foot of an injured leg. If the attempt produces pain, have the casualty stop his efforts.
(7) Question casualty. Ask the casualty if the limb feels numb, cold, or unusual (tightness). These are symptoms of poor circulation.
(2) Check capillary refill. If the fractured limb is an arm, press on the casualty's fingernail, then release. If normal color does not return within two seconds, the limb may have impaired circulation. This is also called the blanch test.
(3) Check skin temperature. Place your hand on the area beneath the injury. Then place your hand on the corresponding area on the uninjured arm or leg. If the skin of the injured limb is cooler than the skin on the uninjured limb, the casualty probably has poor circulation in the injured limb.
(4) Check sensation. Ask a conscious casualty if he can feel your touch. Then lightly touch an area below the fracture. (If his arm is fractured, for example, touch the tip of the index and little fingers on the injured arm.) Ask the casualty if the injured limb feels numb or has a tingling sensation. If the area feels numb or tingling to the casualty, the area probably has poor circulation.
(5) Check skin color. In a light-skinned person, a pale, white, or bluish-gray skin color indicates poor circulation. To check the circulation in a dark-skinned individual, press on a nail on the injured limb and the corresponding nail on the uninjured arm or leg. Release both nails at the same time. If the color returns to the nail bed of the uninjured limb faster than it returns to the nail bed of the injured limb, the casualty probably has poor circulation in the injured limb.
(6) Check motor function. Ask a conscious casualty to try opening and closing the hand of an injured arm or moving the foot of an injured leg. If the attempt produces pain, have the casualty stop his efforts.
(7) Question casualty. Ask the casualty if the limb feels numb, cold, or unusual (tightness). These are symptoms of poor circulation.
f. Dress Wounds. Dress any open wounds on the injured limb before applying the splint. If a bone is sticking out, do not attempt to push the bone back under the skin. Apply the dressing over the bone and the wound. Do not attempt to straighten or realign the injured limb.
g. Obtaining Splinting Material. Gather the materials you will need to make the splint. You will need something to use as rigid objects, padding, and securing materials.
g. Obtaining Splinting Material. Gather the materials you will need to make the splint. You will need something to use as rigid objects, padding, and securing materials.
(1) Rigid objects. Tree branches, poles, boards, sticks, unloaded rifles, or other rigid objects can be used. Normally, two rigid objects (one for each side of the limb) are used. The rigid objects should be fairly straight and be long enough to extend beyond the joint above the fracture site and beyond the joint below the fracture site. Even the casualty's own body can be used when other materials are not available. His chest can be used to immobilize a fractured arm and an uninjured leg can be used to immobilize a fractured leg.
(2) Padding. Blankets, jackets, ponchos, extra clothing, shelter halves, or leafy plants can be used to pad the splint. In some cases, you may have to use the casualty's trouser leg or shirt sleeve as padding. Padding is necessary to keep the rigid object from rubbing against the skin on the injured limb. It can also help to prevent the end of the rigid object from pressing against an area on the casualty's body containing major blood vessels.
(2) Padding. Blankets, jackets, ponchos, extra clothing, shelter halves, or leafy plants can be used to pad the splint. In some cases, you may have to use the casualty's trouser leg or shirt sleeve as padding. Padding is necessary to keep the rigid object from rubbing against the skin on the injured limb. It can also help to prevent the end of the rigid object from pressing against an area on the casualty's body containing major blood vessels.
NOTE: If a SAM (splint, aluminum, malleable) universal splint is used, additional padding is not needed since the splint is coated with a synthetic padding.
(3) Securing materials. Rigid objects can be secured with strips of clothing, belts, pistol belts, bandoleers, cravats, or similar materials. The securing materials keep the rigid objects and padding in place. Cravats are preferred when possible. Narrow materials such as wire and cord should not be used to secure the rigid object in place since they could interfere with blood circulation. The steps for making cravats were given in Lesson 5.
6-7. SPLINTING THE FRACTURED EXTREMITY
NOTE: Even if the arm or leg is not broken, the pain caused by a wound may be lessened if the arm or leg is splinted after it has been dressed and bandaged.
a. Position the Securing Material.
NOTE: Even if the arm or leg is not broken, the pain caused by a wound may be lessened if the arm or leg is splinted after it has been dressed and bandaged.
a. Position the Securing Material.
(1) Push the securing material (cravat, etc.) under natural body curvatures, such as the knee. Then gently move the securing material up or down the limb until the material is in proper position.
(2) Place securing material under the limb both above and below the fracture site. If possible, place two cravats above the fracture site and two cravats below the fracture site (above the upper joint, between the upper joint and the fracture, between the fracture and the lower joint, and below the lower joint.)
(2) Place securing material under the limb both above and below the fracture site. If possible, place two cravats above the fracture site and two cravats below the fracture site (above the upper joint, between the upper joint and the fracture, between the fracture and the lower joint, and below the lower joint.)
CAUTION: Do not place securing material directly under the suspected fracture site. The pressure caused by the securing material when it is tightened could cause additional injury to the fracture site.
b. Position the Rigid Objects. Place the rigid objects over the securing material so that one rigid object is on each side of the injured limb. When possible, position the rigid objects so that the joint above the fracture and the joint below the fracture can be immobilized. If the fracture is in the lower leg, for example, the splint should extend above the knee and below the ankle. (Note: If a forearm is fractured, the wrist is usually immobilized by the splint and the elbow is usually immobilized by a sling and swathe.) Make sure that the ends of the rigid objects are not pressing against a sensitive area such as the armpit or groin. Pressure on these areas can interfere with blood circulation.
c. Apply Padding. Place padding between the rigid objects and the body part to be splinted. The padding helps prevent excessive pressure on the limb which could interfere with blood circulation. Extra padding should be used at bony body areas such as the elbow, wrist, knee, or ankle and extra-sensitive areas such as the groin and armpit.
SPECIAL NOTE: As a general rule, fractures are splinted in the position they are found ("splint them as they lie"). However, if there is no circulation below the fracture site or if the limb is so grossly angulated that you cannot effectively splint it, you may need to gently realign the limb. With one hand supporting the fracture site, use the other hand to grasp the part of the limb farthest from the fracture site and gently pull in the direction of the long axis of the bone, like extending a telescope. The realignment of the limb may help to restore blood circulation.
d. Secure Rigid Objects and Padding. Wrap the securing materials around the rigid objects and limb so that the rigid objects immobilize the limb. Tie the ends (tails) of each securing cravat in a nonslip knot on the outer rigid object and away from the casualty. (The knots are tied on the outer rather than the inner rigid object to make loosening and retying the cravats easier should that procedure become necessary.) The securing material should be tight enough to hold the rigid objects and padding securely in place, but not tight enough to interfere with blood circulation. Properly secured splints cannot be moved easily.
b. Position the Rigid Objects. Place the rigid objects over the securing material so that one rigid object is on each side of the injured limb. When possible, position the rigid objects so that the joint above the fracture and the joint below the fracture can be immobilized. If the fracture is in the lower leg, for example, the splint should extend above the knee and below the ankle. (Note: If a forearm is fractured, the wrist is usually immobilized by the splint and the elbow is usually immobilized by a sling and swathe.) Make sure that the ends of the rigid objects are not pressing against a sensitive area such as the armpit or groin. Pressure on these areas can interfere with blood circulation.
c. Apply Padding. Place padding between the rigid objects and the body part to be splinted. The padding helps prevent excessive pressure on the limb which could interfere with blood circulation. Extra padding should be used at bony body areas such as the elbow, wrist, knee, or ankle and extra-sensitive areas such as the groin and armpit.
SPECIAL NOTE: As a general rule, fractures are splinted in the position they are found ("splint them as they lie"). However, if there is no circulation below the fracture site or if the limb is so grossly angulated that you cannot effectively splint it, you may need to gently realign the limb. With one hand supporting the fracture site, use the other hand to grasp the part of the limb farthest from the fracture site and gently pull in the direction of the long axis of the bone, like extending a telescope. The realignment of the limb may help to restore blood circulation.
d. Secure Rigid Objects and Padding. Wrap the securing materials around the rigid objects and limb so that the rigid objects immobilize the limb. Tie the ends (tails) of each securing cravat in a nonslip knot on the outer rigid object and away from the casualty. (The knots are tied on the outer rather than the inner rigid object to make loosening and retying the cravats easier should that procedure become necessary.) The securing material should be tight enough to hold the rigid objects and padding securely in place, but not tight enough to interfere with blood circulation. Properly secured splints cannot be moved easily.
(1) Secure the rigid objects above and below the fracture site (normally, two cravats above the fracture site and two cravats below the fracture site). Normally, the joint above the fracture site and the joint below the fracture site are immobilized.
(2) If a joint is fractured, apply the splint to the bone above the joint and to the bone below the joint so the joint is immobilized.
(3) Pad the splint at the joints and at sensitive areas to prevent local pressure.
(4) If possible, immobilize the joint above the fracture site and the joint below the fracture site.
(5) Minimize movement of the limb until it has been splinted.
(2) If a joint is fractured, apply the splint to the bone above the joint and to the bone below the joint so the joint is immobilized.
(3) Pad the splint at the joints and at sensitive areas to prevent local pressure.
(4) If possible, immobilize the joint above the fracture site and the joint below the fracture site.
(5) Minimize movement of the limb until it has been splinted.
. APPLYING A SLING TO A FOREARM
A sling is used to support and immobilize the forearm. It also serves to immobilize the elbow and upper arm. A sling is normally made from a triangular bandage (see Lesson 5), but other slings can be improvised. A swathe is normally applied to further immobilize the casualty's injured arm.
a Insert the triangular bandage (figure 6-13 A) between the injured arm and the casualty's chest so the arm is in the center, the apex of the sling is beyond the elbow, and the top corner of the material is over the shoulder of the injured side (figure 6-13 B).
b. Position the forearm so the hand is slightly higher than the elbow (about a 10 degree angle).
c. Fold the material along the base (the long side opposite the apex) back to the casualty's fingers, forming a cuff.
A sling is used to support and immobilize the forearm. It also serves to immobilize the elbow and upper arm. A sling is normally made from a triangular bandage (see Lesson 5), but other slings can be improvised. A swathe is normally applied to further immobilize the casualty's injured arm.
a Insert the triangular bandage (figure 6-13 A) between the injured arm and the casualty's chest so the arm is in the center, the apex of the sling is beyond the elbow, and the top corner of the material is over the shoulder of the injured side (figure 6-13 B).
b. Position the forearm so the hand is slightly higher than the elbow (about a 10 degree angle).
c. Fold the material along the base (the long side opposite the apex) back to the casualty's fingers, forming a cuff.
d. Bring the lower portion of the material over the injured arm so the bottom corner goes over the shoulder of the uninjured side (figure 6-13 C). The elbow should be inside the sling.
e. Bring the top corner behind the casualty's neck.
f. Tie the two corners together in a nonslip knot at the "hollow" at the neck on the uninjured side (figure 6-13 D). If the casualty's right arm is fractured, for example, tie the knot so it will rest in the hollow on the left side of his neck.
g. Secure the apex of the sling to keep the elbow and forearm from slipping out of the sling. Twist (pigtail) the apex of the sling and tuck it in at the elbow (figure 6-13 E).
NOTE: Although the previous instruction used a triangular bandage as a sling, any nonstretching material, such as the tail of a coat or shirt or pieces of cloth torn from clothing or blankets, can be used. Figure 6-14 shows a jacket being used to make a sling. A stick or other rigid object is pushed through the flap and the upper portion of the jacket so the flap will not slip.
e. Bring the top corner behind the casualty's neck.
f. Tie the two corners together in a nonslip knot at the "hollow" at the neck on the uninjured side (figure 6-13 D). If the casualty's right arm is fractured, for example, tie the knot so it will rest in the hollow on the left side of his neck.
g. Secure the apex of the sling to keep the elbow and forearm from slipping out of the sling. Twist (pigtail) the apex of the sling and tuck it in at the elbow (figure 6-13 E).
NOTE: Although the previous instruction used a triangular bandage as a sling, any nonstretching material, such as the tail of a coat or shirt or pieces of cloth torn from clothing or blankets, can be used. Figure 6-14 shows a jacket being used to make a sling. A stick or other rigid object is pushed through the flap and the upper portion of the jacket so the flap will not slip.
APPLYING A SWATHE TO A FRACTURED ARM
a. A swathe is usually used to immobilize the arm against the casualty's body wall so that the arm does not move easily. The swathe is applied to help prevent additional injury to the arm or forearm. A large strip of cloth, blanket strip, pistol belt, trouser belt, bandoleer, or other material can be used as a swathe. The swathe should be three to six inches wide.
b. When a swathe and sling are used to immobilize a forearm, the sling is applied first, such as shown in figure 6-15.
CAUTION: Do not apply a swathe on top of the fracture site. The pressure of the swathe could cause additional damage to the nerves and blood vessels around the broken bone.
c. Swathes are also used to secure a fractured leg to an uninjured leg (anatomical splint).
a. A swathe is usually used to immobilize the arm against the casualty's body wall so that the arm does not move easily. The swathe is applied to help prevent additional injury to the arm or forearm. A large strip of cloth, blanket strip, pistol belt, trouser belt, bandoleer, or other material can be used as a swathe. The swathe should be three to six inches wide.
b. When a swathe and sling are used to immobilize a forearm, the sling is applied first, such as shown in figure 6-15.
CAUTION: Do not apply a swathe on top of the fracture site. The pressure of the swathe could cause additional damage to the nerves and blood vessels around the broken bone.
c. Swathes are also used to secure a fractured leg to an uninjured leg (anatomical splint).
Sling and swath applied to a splinted forearm.
d. To apply a swathe:
(1) Place one end of the swathe on the sling at the breast pocket near the uninjured arm. Hold this end at this location.
(2) Wrap the other end of the swathe across the sling (if used), around the upper arm on the injured side, behind the casualty's back, under the uninjured arm, and back to the breast pocket.
(2) Wrap the other end of the swathe across the sling (if used), around the upper arm on the injured side, behind the casualty's back, under the uninjured arm, and back to the breast pocket.
(a) You have now encircled the casualty's chest and injured arm. The uninjured arm, however, remains free to move.
(b) If the fracture is in the forearm and not the upper arm, make the swathe wide (about 12 inches) when it goes across the injured arm.
(c) If the casualty has a fractured humerus (upper arm), do not make the swathe as wide since the swathe should not be over a fracture site. If possible, apply two swathes--one above the fracture site and one below the fracture site.
(b) If the fracture is in the forearm and not the upper arm, make the swathe wide (about 12 inches) when it goes across the injured arm.
(c) If the casualty has a fractured humerus (upper arm), do not make the swathe as wide since the swathe should not be over a fracture site. If possible, apply two swathes--one above the fracture site and one below the fracture site.
(3) Tie the two ends of the swathe in a nonslip knot over the breast pocket on the uninjured side.
(4) Check the casualty's pulse below the swathe. If the casualty had a pulse before the swathe was applied but the pulse is no longer present, loosen and retie the swathe. If a pulse is still not present, evacuate the casualty as soon as possible.
(4) Check the casualty's pulse below the swathe. If the casualty had a pulse before the swathe was applied but the pulse is no longer present, loosen and retie the swathe. If a pulse is still not present, evacuate the casualty as soon as possible.
DISLOCATIONS
A dislocation occurs when the bones comprising a joint (elbow, knee, wrist, etc.) are forced out of their proper positions. The ligaments that hold the ends of the bones together may be torn. Other tissues surrounding the joint may also be injured. Joints frequently affected include the shoulder, elbow, fingers, hips, and ankles.
a. Signs and Symptoms. A dislocation results in a deformed appearance due to the bone being out of its normal position (see figure 6-17). A dislocation also causes pain and/or a feeling of pressure over the joint. The region around the joint usually swells and is tender. The casualty may not be able to move the joint (the joint is "locked"). If the end of the dislocated bone is pressing on a nerve or blood vessel, the casualty may experience numbness or paralysis distal to (below) the injury.
CAUTION: Do not ask the casualty to move the injured body part in order to test for a locked joint or pain.
A dislocation occurs when the bones comprising a joint (elbow, knee, wrist, etc.) are forced out of their proper positions. The ligaments that hold the ends of the bones together may be torn. Other tissues surrounding the joint may also be injured. Joints frequently affected include the shoulder, elbow, fingers, hips, and ankles.
a. Signs and Symptoms. A dislocation results in a deformed appearance due to the bone being out of its normal position (see figure 6-17). A dislocation also causes pain and/or a feeling of pressure over the joint. The region around the joint usually swells and is tender. The casualty may not be able to move the joint (the joint is "locked"). If the end of the dislocated bone is pressing on a nerve or blood vessel, the casualty may experience numbness or paralysis distal to (below) the injury.
CAUTION: Do not ask the casualty to move the injured body part in order to test for a locked joint or pain.
b. Treatment. Treat a dislocation as though it were a closed fracture.
(1) Check for pulse and sensation distal to the injury. If there is no pulse or if the casualty has no feeling distal to the injury, get medical help at once. A medic may be able to restore blood circulation by gentle manipulation of the limb.
(2) Immobilize (splint) the joint in the position in which it was found. Do not attempt to straighten the affected limb or put the bones back in alignment. Splint a dislocation using the same procedures as for a closed fracture. If the shoulder is dislocated, use a sling to support the forearm.
(3) Reduce swelling by elevating the joint and applying cold (a cold pack or ice compress), if available, for the first 24 hours after the musculoskeletal injury. After 24 hours, heat or warm soaks should be used to facilitate blood circulation to the injured area.
(2) Immobilize (splint) the joint in the position in which it was found. Do not attempt to straighten the affected limb or put the bones back in alignment. Splint a dislocation using the same procedures as for a closed fracture. If the shoulder is dislocated, use a sling to support the forearm.
(3) Reduce swelling by elevating the joint and applying cold (a cold pack or ice compress), if available, for the first 24 hours after the musculoskeletal injury. After 24 hours, heat or warm soaks should be used to facilitate blood circulation to the injured area.
6-11. SPRAINS
A sprain results when the ligaments connecting two bones are stretched or torn. Other tissues surrounding the joint may also be damaged. A sprain usually results when a joint is suddenly twisted beyond its normal range of motion. Skiing accidents often result in sprains. Sprains are most common in the knees and ankles. A sprain can result from a temporary dislocation in which the bones resume their normal position following the injury. A sprain may produce as much damage as a dislocation.
a. Signs and Symptoms. A sprain does not cause a deformed appearance since the bones are not out of their normal positions. A sprain causes pain (tenderness), swelling, and discoloration (bruise) at the injured joint. The casualty may be unable to move the joint due to pain.
CAUTION: Do not ask the casualty to move the injured body part in order to test for joint pain or immobility.
b. Treatment. Treat the sprain as though it were a closed fracture.
A sprain results when the ligaments connecting two bones are stretched or torn. Other tissues surrounding the joint may also be damaged. A sprain usually results when a joint is suddenly twisted beyond its normal range of motion. Skiing accidents often result in sprains. Sprains are most common in the knees and ankles. A sprain can result from a temporary dislocation in which the bones resume their normal position following the injury. A sprain may produce as much damage as a dislocation.
a. Signs and Symptoms. A sprain does not cause a deformed appearance since the bones are not out of their normal positions. A sprain causes pain (tenderness), swelling, and discoloration (bruise) at the injured joint. The casualty may be unable to move the joint due to pain.
CAUTION: Do not ask the casualty to move the injured body part in order to test for joint pain or immobility.
b. Treatment. Treat the sprain as though it were a closed fracture.
(1) Immobilize the joint.
(2) Reduce swelling by elevating the joint and applying cold, if available, during the first 24 hours following the injury. After this time, apply warmth to promote blood circulation to the injured area.
(2) Reduce swelling by elevating the joint and applying cold, if available, during the first 24 hours following the injury. After this time, apply warmth to promote blood circulation to the injured area.
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