Download LESSON 6: BLEEDING AND WOUNDS

Lesson Outlines
Chapter 15
Lesson 15: Extremity Injuries
Lesson Objectives
After completing this lesson, participants should be able to:
 List signs of a possible bone fracture.
 Describe the care for a possible fracture.
 Describe the proper care for joint and muscle injuries.
 Describe the RICE (rest, ice, compression, and elevation) procedures for bone,
joint, and muscle injuries.
Points
Extremity Injuries
 Injuries to the extremities are common because people are involved in active
lifestyles that include sports and wilderness activities.
Extremity Injury Assessment
 Look for signs and symptoms of fractures and dislocations.
 Examine the extremities, using D-O-T-S.
 Compare one extremity with the other to determine size and shape differences.
 Use the “rule of thirds” for extremity injuries.
 Consider the cause of injury (COI) when evaluating the possibility of a fracture
and its location.
 Use the mnemonic CSM as a reminder to check for Circulation, Sensation, and
Movement of fingers or toes.
Types of Injuries
 Types of injuries to the extremities range from simple contusions to complex open
fractures:
o Contusions
 Bruising of tissue
o Strains
 Muscles are stretched or torn
o Sprains
 Involves the tearing or stretching of the joints, causing mild to severe
damage to the ligaments and joint capsules
o Tendinitis
 Inflammation of a tendon due to overuse
o Fractures
 Breaks in bones that may or may not be accompanies by open wounds
Care for Extremity Injuries
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Use the RICE procedure.
Apply a splint to stabilize fractures and dislocations.
RICE Procedure for Bone, Joint, and Muscle Injuries
 R = Rest.
o Injuries heal faster if rested.
o Rest means the victim does not use or move the injured part.
 I = Ice.
o An ice pack should be applied to the area as soon as possible after the
injury for 20 to 30 minutes every 2 or 3 hours during the first 24 to 48
hours.
 C = Compression.
o Compressing an injured area squeezes fluid out of the injury site.
o Compression limits the ability of the skin and of other tissues to expand
and reduces internal bleeding.
 E = Elevation.
o Gravity slows the return of blood to the heart from the lower parts of the
body.
o Elevating the injured area, in combination with ice and compression,
limits circulation to that area, which in turn helps limit internal bleeding
and minimize swelling.
RICE Procedure
 R = Rest
 I = Ice
 C = Compression
 E = Elevation
Shoulder Injuries
 Three bones come together at the shoulder:
o The scapula
o The clavicle
o The humerus
 The shoulder is the most freely moveable joint in the body.
Shoulder Dislocation
 A dislocation of the shoulder occurs when the bones of the shoulder come apart as
a result of a blow or a particular movement.
 Shoulder dislocation is second only to finger dislocations.
Recognizing Shoulder Dislocation
 In about 95% of shoulder dislocation, the victim holds the upper arm away from
the body, supported by the uninjured arm.
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The dislocated arm cannot be brought across the chest wall to touch the opposite
shoulder.
Extreme pain in the shoulder area
In a dislocation, the shoulder looks squared off, rather than rounded.
An injury to the shoulder resulting in complete loss of function is more apt to be a
dislocation than a fracture.
The victim may describe a history of previous dislocations.
Numbness or paralysis in the arm from pressure, pinching blood vessels or nerves
Care for a Shoulder Dislocation
 Do not try to force, twist, or pull the shoulder back in place because it may cause
bone, nerve or blood vessel injury.
 Place folded or rolled blankets or a pillow between the upper arm and the chest to
support the arm.
 Apply an arm sling and swathe (binder).
 Apply an ice pack for 20 minutes.
 Seek immediate medical care.
Clavicle Fracture
 Fractures of the clavicle (collarbone) are common and usually are the result of
falling with the arm and hand outstretched.
 Most clavicle fractures (80%) occur in the middle third of the bone.
Recognizing a Clavicle Fracture
 Usually the fracture is easy to detect because the clavicle lies immediately under
the skin and a deformity can be seen.
o The victim fell on an outstretched arm.
o The victim received a direct blow to the clavicle or shoulder.
o AND if the victim has:
 Severe pain over the injured area
 Been holding the injured arm against the chest with the uninjured arm
to stabilize the injury
 Not moved the arm because of the pain
 Swelling
 Visible deformity
 Tenderness
 Dropped or drooped shoulder
 Bruising
Care for a Clavicle Fracture
 Treat for shock.
 Apply arm sling and swathe.
 Apply an ice pack to the area for 20 minutes, three to four times during the next
24 hours.
 Seek immediate medical care.
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Contusions
 Direct blows cause contusions, or bruises, around the shoulder.
 Often called shoulder pointers, contusions of this type may cause severe
discomfort.
Recognizing Contusions
 Swelling
 Pain at the injury site
 Feeling of firmness when pressure is exerted on the shoulder
 Tenderness
 Discoloration under the skin (black and blue)
Care for Contusions
 Apply an ice pack to the area for 20 minutes, three to four times during the first
24 hours.
 Place the arm in a sling and swathe.
Tendinitis
 The general cause of tendonitis (inflammation) in the shoulder is continuous
overuse or unusual use.
o Repeated movement often results in painful shoulders
o Examples include throwing sports and swimming
Recognizing Tendinitis
 Constant pain or pain with motion of the shoulder
 Limited motion of the shoulder
 “Crackling” sounds when the joint is moved
 Tenderness over the area
Care for Teninitis
 Use an ice massage for 10 minutes before and after exercise.
 Use a sling and swathe to rest the shoulder.
 Use pain medication such as ibuprofen.
 Seek medical advice if needed.
Humerus Fracture
 The shaft of the humerus (upper arm) can be felt throughout its entire length along
the inner side of the upper arm.
Recognizing a Humerus Fracture
 The victim received a:
o Direct blow to the area
o Twist and feel on the outstretched arm
 AND any one or a combination of these occurred:
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Severe pain
Swelling
Visible deformity
Tender if touched
May be unable to move the arm
Will hold the arm against the chest for comfort
Care for a Humerus Fracture
 Treat for shock.
 Apply an ice pack for 20 minutes
 Stabilize the arm by applying one rigid splint on the part of the arm away from the
body.
 Seek immediate medical care.
Elbow Injuries
 Elbow Fractures and Dislocations
o All elbow fractures and dislocations should be considered serious and
treated with extreme care.
o Inappropriate care can result in injury to the nearby nerves and blood
vessels.
Recognizing Elbow Fractures and Dislocations
 Immediate swelling
 Severe pain
 Possible visible deformity; compare it with the uninjured elbow
 Restricted, painful motion
 Numbness or coldness of the hand and fingers below the elbow
Care for Elbow Fractures and Dislocations
 Do not move the elbow.
 Treat for shock.
 Splint the elbow in the position found in order to prevent nerve and blood vessel
damage:
o If straight, keep the splinted elbow straight
o If bent, keep the elbow bent
 Apply an ice pack for 20 minutes.
 Seek immediate medical care.
Tennis Elbow
 Tennis elbow results from sharp, quick twists of the wrist (not just from playing
tennis).
 It is an inflammation of the tendons on this outer side of the elbow
o Can be very painful whenever the wrist and the elbow are used
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Recognizing Tennis Elbow
 Pain increases while using the arm
 Causes gradual grip weakness
 The injured elbow fatigues quicker than normal
 Very tender on outer protrusion of elbow
Care for Tennis Elbow
 Apply heat before an activity; the victim might wear a brace or rubber sleeve on
the sore elbow.
 Apply an ice pack for 20 minutes after completion of the activity.
 Seek medical advice for appropriate rehabilitation program.
Golfer’s Elbow
 Repetitive motion produces pain.
 This injury is the equivalent of the more common tennis elbow but with pain on
the inside of the elbow.
 It is tendonitis affecting the tendons attached to the bony protrusion.
Recognizing Golfer’s Elbow
 Pain increases while using the arm
 Causes gradual grip weakness
 The injured elbow fatigues quicker than normal.
Care for Golfer’s Elbow
 Apply heat before an activity; the victim might wear a brace or rubber sleeve on
the sore elbow.
 Apply an ice pack for 20 minutes after completion of the activity.
 Seek medical advice for appropriate rehabilitation program.
Radius and Ulna Fractures
 The radius and ulna are the two large bones in the forearm, and either or both may
be broken.
 When only one bone is broken, the other acts as a splint and there may be little or
no deformity.
 When both these bones are broken, the arm usually appears deformed.
Recognizing Radius and Ulna Fractures
 The victim has pain in the forearm or wrist from:
o A direct blow
o Falling on an outstretched hand
 AND has:
o A visible deformity
o Severe pain radiating up and down from the injury site
o An inability to move the wrist or it is painful while moving the wrist
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o The wrist is painful on the thumb side and pain continues into next day.
Care for Radius and Ulna Fractures
 Treat for shock.
 Apply an ice pack to the area for 20 minutes.
 Apply tow rigid splints on both sides of the arm from the tip of the elbow to the
fingers.
o Place the arm in a sling and swathe with the hand in a thumb-up position.
 Seek medical care.
Wrist Fracture
 The wrist is usually broken when the victim falls with the arm and hand
outstretched.
Recognizing a Wrist Fracture
 Injury to the wrist associated with a snapping or popping sensation within the
wrist
 Pain in the wrist that is aggravated by movement
 Tenderness
 Swelling
 Unable or unwilling to move the wrist
 Lump-like deformity on the back of the wrist
Care for a Wrist Fracture
 Use the RICE procedures.
 Stabilize the wrist with a splint.
 Seek medical care.
Hand Injuries—Crushed Hand
 The hand may be fractured by a direct blow or by a crushing injury.
 Recognizing a crushed hand
o Pain
o Swelling
o Loss of motion
o Open wounds
o Broken bones
Care for a Crushed Hand
 Control the bleeding.
 Apply an ice pack for 20 minutes.
 Seek medical care.
Finger Injuries
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The three bones that make up each finger are the most commonly broken bones in
the body.
Many of the tendons attached to the finger bones can tear with or without a
fracture and the three joints can also be injured.
A so-called finger sprain may be a complicated fracture or dislocation.
Finger Fracture
 Contrary to popular belief, broken bones—especially the fingers—can move
when they are broken.
Recognizing Finger Fractures
 The finger or thumb has:
o A visible deformity; finger has a twisted look
o Immediate pain and hurts with or without movement
o Numbness
o Swelling
o Pinpointed tenderness that usually indicates a fracture
 Test for a finger fracture:
o If possible, straighten the fingers and place them on a hard surface.
o Tap the tip of the injured finger toward the hand.
 Pain lower down in the finger or into the hand can indicate a fracture.
Care for Finger Fractures
 Do not try to realign the finger.
 Gently apply an ice pack.
 Splint the finger by either:
o Buddy taping the fractured finger to another for support.
o Keeping the hand and fingers in the position of function with extra
padding in the palm. Secure the hand, fingers, and arm to a rigid splint.
 Seek medical care.
Finger Dislocation
 Finger dislocations are common.
 The same causes of fractured fingers can also cause a dislocated finger.
Recognizing Finger Dislocation
 The finger or thumb has:
o A visible deformity
o Immediate pain
o Swelling
o Shortening of the finger
o May be unable to bend the finger in the injured area; motion is impossible
Care for Finger Dislocation
 Do not try to realign the dislocation.
 Apply an ice pack
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If possible, splint the finger by either:
o Buddy taping
o Keeping the hand and fingers in the position of function with extra
padding in the palm.
Seek medical care.
Sprained Finger
 The upper joints of the fingers have a ligament on each side of the joint.
Recognizing a Sprained Finger
 The finger or thumb has been:
o Jammed, or compressed
o Stepped on
o Forced or twisted sideways
 And the victim:
o Has pain and swelling over a joint—especially tenderness on both sides of
a joint
o Is unable to make a fist
o Has a weakness while curling the injured finger alone
o Experiences a weakness or pain when gripping
Care for a Sprained Finger
 Apply an ice pack for 20 minutes.
 Reevaluate after the ice pack application and seek medical care if pain and
weakness exist.
 Tape fingers with buddy taping.
Nail Avulsion
 An injury in which a nail is partly or completely torn loose is known as a nail
avulsion.
 Recognizing a nail avulsion
o The nail may be completely detached or partially held in place by the skin.
Care for a Nail Avulsion
 Secure the damaged nail in place with an adhesive bandage.
 If part or all of the nail has been completely torn away, apply antibiotic ointment.
 Secure a partly torn loose nail with an adhesive bandage.
 Do not trim away the loose nail.
o Consult a physician for further advice.
Splinters
 Sharp splinters can be impaled into the skin or under a fingernail or toenail.
 Recognizing splinters
o There is a small puncture wound.
o The sliver may be seen or in other cases, not seen nor can it be felt.
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Care for Splinters
 If embedded in the skin, use tweezers to remove it.
o You may need to tease it out with a sterile needle until the end can be
grasped with tweezers or fingers.
 Clean the wound with soap and water.
 If the splinter is impaled under a fingernail or toenail and breaks off flush, cut a
V-shaped notch in the nail to gain access to the splinter.
o Remove the embedded splinter by grasping its end with tweezers.
Blood Under a Nail
 Blood collects under a fingernail when underlying tissues are bruised.
 Recognizing blood under a nail
o Excruciating pain exists because of the pressure of the blood pushing
against the nail.
o Pain does not disappear until the collection of blood is drained.
Care for Blood Under a Nail
 Immerse the finger in ice water or apply an ice pack with the hand elevated to
reduce pain and swelling.
 Relieve the pressure under the injured nail by using one or more of the following
methods:
o Straighten the end of a metal paper clip or use the blunt end of a sewing
needle.
 Hold the paper clip or needle with pliers, and use a match or cigarette
lighter to heat it until the metal is read hot.
 Press the glowing end of the paper clip or needle against the nail so it
melts through.
 Little pressure is needed.
o By using a rotary action, carefully drill through the nail with sharp point of
a knife.
o Apply a dressing to absorb the blood and protect the nail.
Ring Strangulation
 Ring strangulation can be a serious problem if it cuts off the blood supply long
enough.
o Permanent damage may result within 4 or 5 hours.
 Recognizing ring strangulation
o The ring has become tight on the finger after an injury or other cause of
swelling such as a bee sting.
Care for Ring Strangulation
 Try one or more of the following to remove a ring:
o Lubricate the finger with oil, butter, or some other slippery substance, and
try to remove the ring.
o Immerse the finger in cold water or apply an ice pack for several minutes
to reduce swelling.
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o Liberally spray window cleaner onto the finger, and try to remove the ring.
o Massage the finger from the tip toward the hand to move the swelling;
lubricate the finger again.
o Cut the narrowest part of the ring with a ring saw, hacksaw, or jeweler’s
saw, taking care to protect the exposed parts of the finger.
Hip-Joint Injuries
 Hip Dislocation
o A hip can be dislocated by a fall, a blow to the thigh, or direct force to the
foot or knee.
o Often a hip is dislocated when the knee strikes the dashboard during a
motor vehicle crash.
 It is difficult to differentiate a hip dislocation from a hip fracture.
Recognizing Hip Dislocation
 Severe pain at the injury site
 Swelling at the injury site
 Hip is flexed and the knee bent and rotated inward toward the opposite hip
 Injury usually quite visible
Care for Hip Dislocation
 Treat for shock.
 Stabilize the injury
 Check for an ankle pulse (posterior tibial).
 Seek medical care.
o This injury is best transported by EMS.
Hip Fracture
 A hip fracture is a fracture of the upper end of the femur (thighbone), not the
pelvis.
 A fractured hip is usually caused by a fall.
 Elderly people, especially women, are susceptible to this type of injury because of
brittle bones (osteoporosis).
Recognizing a Hip Fracture
 Severe pain in the groin area
 Inability to lift the leg
 Leg may appear shortened and be rotated with the toes pointing abnormally
outward
Care for a Hip Fracture
 Treat for shock.
 Stabilize the injured leg against movement.
 Monitor the ankle pulse.
 Seek immediate medical care.
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o This injury is best transported by the EMS.
Thigh Injuries
 Femur fracture
 Muscle contusion
 Muscle strain
Femur Fractures
 Because the femur is the largest bone in the body, considerable force is required
to break it.
 Femur injuries can occur in any part of the femur, from the hip to just above the
knee joint.
 A fracture of the femur is usually caused by a fall or a direct blow.
 Femur fractures often include open wounds and external bleeding may be severe.
Recognizing a Femur Fracture
 Severe pain at the injury site
 Deformity may occur.
o The leg may appear shorter.
 Swelling comes from severe damage to blood vessels.
 Victim may report having heard or felt a severe pop or snap at the time of the
injury.
Care for a Femur Fracture
 Treat for shock.
 Cover a wound with s sterile dressing.
 Stabilize the injured leg against movement.
 Monitor the ankle pulse.
 Seek immediate medical care.
o This injury is best transported by the EMS.
Muscle Contusion
 The muscle group on the front of the thigh is the quadriceps group and often gets
bruised.
 Depending on the force of impact and muscles involved, the contusion may be of
varying degrees of severity.
Recognizing a Muscle Contusion
 The victim received a direct hit producing:
o Swelling
o Pain and tenderness
o Tightness or firmness of site when pressed
o Visible bruise that may appear hours later
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Care for a Muscle Contusion
 Follow the RICE procedures.
o Apply an ice pack for 20 minutes, three to four times daily for the next 48
hours.
 Stretch the muscle by bending the knee toward the victim’s chest.
Muscle Strain
 When a muscle is overstretched, it can result in a tear, called a strain.
 Difference degrees of strains occur, but first aiders will be unable to determine
their degree.
Recognizing a Muscle Strain
 While running or jumping the victim:
o Feels a pop or pulling sensation
 And later has:
o Tenderness
o Stiffness and pain during movement
o Swelling
o A visible bruise appearing days later
Care for a Muscle Strain
 Follow RICE procedures.
o Apply an ice pack for 20 minutes, three to four times daily for the next 48
hours.
 Stretch the muscle but do not force stretching.
Knee Injuries
 Knee injuries are among the most serious joint injuries.
 Their severity is difficult to determine, thus medical care is necessary if the injury
is from being hit or twisted and not from overuse.
Knee Fracture
 A fracture of the knee generally occurs as a result of a fall or a direct blow.
 Fractures about the knee may occur at the end of the femur, at the end of the tibia,
or in the knee cap.
Recognizing a Knee Fracture
 Determining if a fracture exists is difficult.
 Some fractured knees may look like a dislocation.
 Other signs include:
o Deformity
o Tenderness
o Swelling
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Care for a Knee Fracture
 If a pulse can be felt in the ankle with no deformity, splint the leg with the knee
straight.
 If a pulse can be felt in the ankle with significant deformity, splint the knee in the
position found.
 Seek medical care.
o However if a pulse is absent in the ankle, immediately seek medical care.
Knee Dislocation
 A knee dislocation is a serious injury.
 Recognizing a knee dislocation
o Excruciating pain
o Deformity
o Pulse may be absent in the ankle
o Do not confuse a knee dislocation with a patella dislocation.
Care for a Knee Dislocation
 Stabilize the knee in the position found.
 Seek medical care immediately.
Patella Dislocation
 A dislocated patella can be a very painful injury and must be treated immediately.
 Some people have repeated kneecap dislocation, just as others have a tendency for
shoulder dislocations.
 A dislocated patella most commonly occurs in teenagers and young adults who
are engage in athletic activities.
Recognizing a Patella Dislocation
 A blow or twisting cause the kneecap to be moved outside of the knee joint and
there is:
o Possible swelling
o An inability to bend or straighten the knee
o Pain
o Deformity; compare with other kneecap
Care for a Patella Dislocation
 Follow the RICE procedures.
 Do not try to relocate a dislocated kneecap (sometimes the kneecap replaced
itself).
 Splint the knee in the position found.
 Seek medical care.
Knee Sprain
 Ligament injuries occur most often in sports.
 The knee is very prone to injury, ranging from mild sprains to complete tearing.
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Recognizing a Knee Sprain
 At the time of injury, the victim has:
o Severe pain
o The feeling of a pop or snap
o A locking sensation
 Or, the victim may not be able to walk without limping, or may not be able to
bend the knee.
 Later there may be swelling in the knee and bruising.
Care for a Knee Sprain
 Follow the RICE procedures.
 Seek medical care.
Knee Contusion
 Contusions of the knee are caused by a direct blow or by falling on the knee.
 Recognizing a knee contusion
o Pain
o Swelling
o Tenderness
o Bruise marks
 Care for a knee contusion
o Follow the RICE procedures.
Lower-leg Injuries
 Tibia and fibula fractures
 Tibia and fibula contusions
 Muscle cramps
 Shin splints
 Ankle and foot injuries
 Toe injuries
Tibia and Fibula Fractures
 Tibia and fibula fractures can occur at any place between the knee joint and the
ankle joint.
 Injuries to the blood vessels, caused by extreme deformity, are common with
injuries of the tibia and fibula.
 The pain is usually severe.
Recognizing Tibia and Fibula Fractures
 Severe pain
 Swelling
 Visible deformity
 Tenderness when touched
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Care for Tibia and Fibula Fractures
 Stabilize the leg using a splint, either improvised by tying the legs together or a
rigid splint.
 Apply an ice pack.
 Seek medical care.
Recognizing a Tibia and Fibula Contusion
 Victim received a hit directly on the shin
 Tender when touched
 Sharp pain
 Later has:
o Discoloration
o Difficulty moving ankle up and down
o Numbness or coldness in toes or foot
Care for a Tibia and Fibula Contusion
 Expose the injury.
 Apply the RICE procedures.
o Use an ICE pack for 20 minutes, three or four times daily for first 48
hours.
 If numbness or tingling exists, seek medical care.
Muscle Cramp
 Muscle spasm or cramping usually occurs in the calf and sometimes in the thigh
or hamstring. It is a temporary condition of little consequence.
Recognizing a Muscle Cramp
 Happens during or after intense exercise sessions
 Painful, muscle contraction or spasm which disables the victim
Care for Muscle Cramps
 There are many treatments for cramps. Try one or more of the following:
o Have the victim gently stretch the affected muscle.
o Relax the muscle by applying pressure to it.
o Apply ice to the cramped muscle to make it relax (unless you are in a cold
environment).
o Pinch the upper lip hard (an acupressure technique) to reduce calf-muscle
cramping.
o Drink lightly salted, cool water or a commercial sports drink.
Shin Splints
 Shin splints is a term that describes pain in the front of the lower leg, also called
the shin.
 Shin splints are caused by repetitive stress in the leg such as running and
extensive walking.
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Recognizing Shin Splints
 The shin aches during activity but:
o The ache subsides significantly after activity stops
o The ache is a result of an increase in the workout routine
o Usually a chronic problem that gets worse
Care for Shin Splints
 Apply an ice pack before an activity.
o Heat can be applied later, when the victim is well on the way to recovery.
 Apply pressure with a 3-inch elastic bandage over the sorest point (start below the
sore area and spiral wrap up and around the leg).
 Apply an ice pack for 20 minutes after the activity.
Ankle and Foot Injuries
 The ankle and foot are frequently injured, mainly by twisting, which stretches or
tears the supporting ligaments.
 In some cases, surgical intervention is required.
 Most ankle injuries are sprains; about 83% of sprains involve the outside
ligaments and are caused by the ankle having turned or twisted inward.
Recognizing Foot and Ankle Injuries
 Press along the bones to check for pain and tenderness.
 Ask the victim, “Have you tried standing on it?”
o Putting some weight on the foot may hurt a little, but if the victim is able
to do that and take four or more steps, most likely the ankle or foot is
sprained.
 A few additional signs and symptoms may help determine whether an injured
ankle or foot is sprained or fractured.
o If the victim hops on the good foot and injured ankle cannot tolerate the
jarring, suspect a fracture.
 Foot injuries usually lead to substantial swelling.
o It has been observed that ankle sprains tend to swell on only one side of
the foot, whereas swelling on both sides of the foot usually accompanies
fractures.
Care for Foot and Ankle Injuries
 Controversy exists about whether to remove a shoe from an injured foot it may act
as a splint and help retard swelling.
 Taking the shoe off allows for better examination, better checking of the CSM,
and better care.
 In addition, footwear left in place will thwart efforts to apply an ice pack and an
elastic bandage.
 Use RICE procedures to limit the swelling.
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Lesson Outlines
Chapter 15
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