Breaks, strains, and sprains
Facilitator:
Time: 55 mins; 1555-1650
Actual time:
Learning Objectives:
Materials: SAM splint, cardboard, newspaper, magazines, padding, ace bandages, coban, vet wrap, triangle bandages, safety pin.
What is it?
On the street we do not distinguish among these injuries: all are splinted and the person is encouraged to get more care
Fracture -- broken bones
Sprain -- tear of tendons or ligaments, may be of all the fibers of a tendon or ligament, or only of some fibers
Strain -- stretch of tendons, ligaments or muscles
Can be caused by rubber bullets, wooden dowels, batons, horses, motorcycles, cars, people running
Older people are at higher risk for any injury, and their injuries are generally more serious
Prevent by wearing good shoes with ankle support, body armor
Red Flags
Facial fractures may cause airway problems
Skull fractures may cause loss of consciousness, and subsequent airway problems
Rib fractures may cause breathing problems
Possible fractures of the upper leg, the hip or the pelvis need more help fast because of risk of internal bleeding
Disability a big issue for any leg injuries
These injuries can distract from other injuries; don't forget to do full initial assessment and whole body exam if you have consent
For any major fracture think shock
Any major bone break, or situation in which someone cannot move broken part without pain, should get more care
Assessment and First Aid
Symptoms: pain, deformity, bleeding internal or external, inability to bear weight, inability t go through normal range of motion
Basic first aid: splint and get to further care
If person can bear weight, or go through normal range of movement, without significant pain, they can probably go without a splint
IF you don't splint, the injury may get more painful over time, so be sure the person know to get more help if this happens
To evaluate must be able to see. May have to cut clothing if have consent (cut along seams if you can) -- EXCEPT if clothing is stuck to burned skin, if cutting clothing will cause an environmental risk (weather), or if the clothing/shoes are helping decrease swelling (high boots specifically)
Look for open fractures -- cut skin over the area of the bone break, may or may not be able to see bone
For bone injury, palpate joints above and below area of pain
For joint injury, palpate bones above and below area of pain
Soft splint: Ace bandage, coban or vet wrap. All are elastic bandages; coban and vet wrap adheres to itself.
Hard splint: We'll talk more about splinting in a moment.
Decrease pain
Minimize risk for further damage
Allow for mobility and access to further care
For open fractures:
Place sterile gauze over the cut/bone ends
Moistened with sterile saline if available
Do not put any pressure over break with splint or anything else
Splinting is an art
We will give you basic principles and some chances to practice here, but true skill is developed with practice: splint your friends! practice with medic buddies!
Steps of splinting:
Gather all needed supplies:
Something to use as splint: SAM splint, cardboard, wood stick or board, newspaper, magazines. In leg injuries can sometimes use other leg as splint; this will cause total immobility.
Something to hold splint on to person: ace bandages, coban, vet wrap, triangle bandages
For arm injury, materials for sling and possibly swath: triangle bandages; can use person's shirt or coat, with safety pins, if necessary
Remove any rings, watches, anklets or other objects on the extremity past the point of the injury. Swelling may cause these to become tight, cutting off circulation.
For bone breaks, immobilize the joint above and the joint below the injury. For example, for a forearm injury, immobilize the elbow and wrist; for an upper arm injury, immobilize the elbow and shoulder.
For joint injuries, immobilize bones above and below injured joint: for knee injury, immobilize lower and upper leg; for elbow injury, immobilize upper and lower arm; for hip injury, immobilize torso and upper leg
Check for good circulation (nailbed filling), normal feeling and movement. This may be painful but it IS necessary.
Splint in position found: Could cause more damage by moving injured bones.
For arm splints, place something in hand for "grasping a cup" position
Pad pad pad pad and pad some more. Over time hard splint material presses against body and can cause lots of pain. Also pad "empty spaces" for support -- under elbow, knee, wrist
Wrap or tie:
If using ace wrap, coban or vetwrap wrap from far to near. Think pushing swelling towards heart, rather than towards hand or foot, where there is nowhere for swelling to be relieved.
With each wrap around extremity overlap with ¬Ω of previous wrap
Complete with bow knot so person can easily remove split if necessary
After splint completed, check circulation, feeling and movement. Check again periodically while you are with this person
If upper extremity: sling and swath can also help immobilize: sling immobilizes elbow, swath immobilizes shoulder. Using triangle bandage, tie knot in corner of bandage with right angle for elbow pocket Place triangle bandage over chest, with upper corner (not the right angle corner, which is where the elbow will be) draped over shoulder nearest the injury. Place injured arm in sling, with elbow in handy pocket. Pull loose end up and over shoulder farthest from injured arm, pull tight until wrist is at upper chest level, and tie at neck, and adjust sling if person feels choked. Pad neck tie if necessary, so it does not cause pain. Can also use clothing for makeshift sling: shirt: pull up bottom part of shirt over arm and safety pin in place; shirt: use safety pin to attach splint material to near shoulder; jacket: button all the way up, then unbutton upper middle buttons, and slip arm through so hand is inside jacket
For swath (to immobilize shoulder for upper arm and shoulder injuries)
Wrap triangle bandage or ace bandage around chest and back, holding arm to chest
Make sure that triangle bandage is wide, so it does not bite into skin
Not too tight! make sure breathing is comfortable
Aftercare
RICE: R est, I ce, C ompression, E levation, a good general treatment for any injury that does not need further care.
First 24 hours: use infused arnica flower (Arnica montana) oil, cream, or salve to decrease pain and swelling and speed healing of bruises.
Apply to wherever it hurts, is discolored, or is swollen
Do not put on open skin
Do not give Arnica tincture by mouth unless you have consulted with a herbalist
After first 24 hours: use infused St Johns Wort flower (Hypericum perforatum) oil to decrease pain and swelling and speed healing of bruises. Good for burns, nerve injury (handcuff compression injury), general wound/bruise/sprain healing (after 24 hours)
Apply to wherever it hurts, is discolored, or is swollen
Do not give St Johns Wort tincture by mouth unless you have consulted with a herbalist