Transcript Chapter 15

Chapter 15
Extremity Injuries
Extremity Injuries
• Injuries to the extremities are
common because people are
involved in active lifestyles that
include sports and wilderness
activities.
Extremity Injury Assessment
(1 of 2)
• Look for signs and symptoms of
fractures and dislocations.
• Examine the extremities, using the
mnemonic D-O-T-S.
• Compare one extremity with the other
to determine size and shape
differences.
• Use the “rule of thirds” for extremity
injuries.
Extremity Injury Assessment
(2 of 2)
• 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.
• Contusions
• Strains
• Sprains
• Tendinitis
• Dislocations
• Fractures
Care for Extremity Injuries
• Use the RICE procedures.
• Apply a splint to stabilize
fractures and dislocations.
RICE Procedure (1 of 2)
• R= Rest.
• Injuries heal faster if rested.
• I= Ice.
• Ice should be applied to the inured area as
soon as possible after the injury.
• C= Compression.
• Compressing the injured area squeezes fluid
out of the injury site.
• E= Elevation.
• Gravity slows the return of blood to the heart
from the lower parts of the body.
RICE Procedure (2 of 2)
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R = Rest
I = Ice
C = Compression
E = Elevation
Shoulder Injuries
• Three bones come together at
the shoulder:
• Scapula
• Clavicle
• Humerus
• The shoulder is the most freely
movable joint in the body.
Shoulder Dislocation
• A dislocation of the shoulder
occurs when the bones of the
shoulder comes apart.
• Shoulder dislocation is second
in frequency only to finger
dislocations.
Recognizing Shoulder
Dislocation (1 of 2)
• Victim holds the upper arm away from
the body, supported by the uninjured arm
• 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.
Recognizing Shoulder
Dislocation (2 of 2)
• 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.
• Place a pillow between the upper arm
and the chest.
• Apply an arm sling and swathe.
• Apply an ice pack for 20 minutes.
• Seek immediate medical care.
Clavicle Fracture
• Fractures of the clavicle are
common and usually are the
result of falling with the arm and
hand outstretched.
• 80% of clavicle fractures occur
in the middle third of the bone.
Recognizing a Clavicle
Fracture (1 of 2)
• Usually the fracture is easy to detect
because the clavicle lies immediately
under the skin.
• The victim:
• Fell on an outstretched arm
• Received a direct blow to the
clavicle or shoulder
Recognizing a Clavicle
Fracture (2 of 2)
• AND if the victim has:
• Severe pain over the injured area
• Not moved the arm because of pain
• Swelling
• Visible deformity
• Tenderness
• “Dropped” or drooped shoulder
• Bruising
Care for a Clavicle Fracture
• Treat for shock.
• Apply an arm sling and swathe.
• Apply ice to the area for 20
minutes, three to four times during
the next 24 hours.
• Seek immediate medical care.
Contusions
• Direct blows cause contusions
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
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
• General cause of tendinitis in
the shoulder is continuous
overuse or unusual use.
• Examples include many of
the throwing sports, such as
baseball, and in swimming.
Recognizing Tendinitis
• Constant pain or pain with
motion of the shoulder
• Limited motion of the shoulder
• “Crackling” sound when the joint
is moved
• Tenderness over the area
Care for Tendinitis
• Use an ice massage for 10
minutes before and after exercise.
• Use a sling and swath to rest the
shoulder.
• Use pain medication such as
ibuprofen.
• Seek medical advice if needed.
Humerus Fracture
• The shaft of the
humerus can be felt
throughout its entire
length along the
inner side of the
upper arm.
Recognizing a Humerus
Fracture (1 of 2)
• The victim received:
• Direct blow to the area
• Twist or fall on the outstretched arm
• AND any one or combination of these
occurred:
• Severe pain
• Swelling
Recognizing a Humerus
Fracture (2 of 2)
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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.
• Apply an arm sling and swathe.
• Seek immediate medical care.
Elbow Injuries
• All elbow fractures and
dislocations should be
considered serious and
treated with extreme care.
• 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.
• Apply an ice pack for 20 minutes.
• Seek immediate medical care.
Tennis Elbow
• Results from sharp, quick twists of
the wrist (not just from playing
tennis)
• An inflammation of the tendons on
the outer side of the elbow
• Can be very painful whenever
the wrist and elbow are used
Recognizing Tennis Elbow
• Pain increases while using the arm
• Causes gradual grip weakness
• 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 on
the sore elbow.
• Apply ice for 20 minutes after
completion of the activity.
• Seek medical advice for
appropriate rehabilitation
program.
Golfer’s Elbow
• The equivalent of the more common
tennis elbow but with pain on the
inside of the elbow
• It is tendinitis affecting the tendons
attached to the bony protrusion, on
the inside of the elbow.
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 on the
tender 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.
• When only one bone is broken, the
other acts as a splint and there may
be little or no deformity.
• When both bones are broken, the
arm usually appears deformed.
Recognizing Radius and Ulna
Fractures (1 of 2)
• The victim has pain in the forearm or
wrist from:
• A direct blow
• Falling on an outstretched hand
• AND has:
• A visible deformity
• Severe pain radiating up and down
from the injury site
Recognizing Radius and Ulna
Fractures (2 of 2)
• An inability to move the wrist
or it is painful while moving
the wrist.
• OR
• The wrist is painful on the
thumb side and pain
continues into next day
Care for Radius and Ulna
Fracture
• Treat for shock.
• Apply an ice pack to the area for 20 minutes.
• Apply two rigid splints on both sides of the
arm from the tip of the elbow to the fingers.
• 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:
• Pain
• Swelling
• Loss of motion
• Open wounds
• Broken bones
Care for a Crushed Hand
• Control the bleeding.
• Apply an ice pack for 20
minutes.
• Seek medical care.
Finger Injuries
• The three bones that make up each
finger are the most commonly
broken bones in the body.
• 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
(1 of 2)
• The finger or thumb has:
• A visible deformity
• Immediate pain and hurts with or
without movement
• Numbness
• Swelling
• Pinpointed tenderness
Recognizing Finger Fractures
(2 of 2)
• Test for a finger fracture:
• If possible, straighten the fingers and
place them on a hard surface.
• 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 one of two methods:
• Buddy taping the fractured finger to
another for support
• Keeping the hand and fingers in the
position of function with extra padding in
the palm
Finger Dislocation
• Finger dislocations are
common.
• Same causes of fractured
fingers can also cause a
dislocated finger.
Recognizing Finger
Dislocation
• The finger or thumb has:
• A visible deformity
• Immediate pain
• Swelling
• Shortening of the finger
• May be unable to bend the finger
in the injured area
Care for Finger Dislocation
• Do not try to realign the dislocation.
• Apply an ice pack.
• Splint the finger by one of two methods:
• Buddy taping the fractured finger to
another for support
• 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:
• “Jammed” or compressed
• Stepped on
• Forced or twisted sideways
• AND the victim:
• Has pain and swelling
• Is unable to make a fist
• Has weakness while curling the finger or
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
• When a nail is partly or completely
torn loose
• Recognizing a nail avulsion:
• 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 of all of the nail has been
completely torn away, apply antibiotic
ointment.
• Do not trim away the loose nail.
• Consult a physician for further
advice.
Splinters
• Sharp splinters can be impaled into
the skin or under a fingernail or
toenail.
• Recognizing splinters:
• Small puncture wound
• Sliver may be seen or in other
cases, not seen nor can it be felt
Care for Splinters
• If embedded in the skin, use tweezers to
remove it.
• In some cases, you may need to tease it
out with sterile needle.
• Clean the wound with soap and water.
• If the splinter is impaled under a fingernail
or toenail and breaks off flush, cut a Vshaped notch in the nail to gain access to
the splinter.
Blood Under a Nail
• Blood collects under a nail when
underlying tissues are bruised.
• Recognizing blood under a nail:
• Excruciating pain exists because of
the blood pressure against the nail
• Pain does not disappear until the
collection of blood is drained
Care for Blood Under a Nail
• Apply an ice pack
with the hand
elevated.
• Relive the pressure
using a knife or a
red-hot metal
paperclip or needle.
• Apply a dressing.
Ring Strangulation
• Can be a serious problem
if it cuts of the blood
supply long enough
• Recognizing ring
strangulation:
• The ring has become
tight on the finger after
an injury or swelling.
Care for Ring Strangulation
(1 of 2)
• Try one of the following methods to
remove a ring:
• Lubricate the finger with soap and water
or some other slippery substance.
• Immerse the finger in cold water or
apply an ice pack to reduce swelling.
• Liberally spray window cleaner onto the
finger, then try to slide the ring off.
Care for Ring Strangulation
(2 of 2)
• Massage the finger from the tip toward
the hand to move the swelling
• Lubricate the finger again and try
removing the ring
• Cut the narrowest part of the ring with a
ring saw, jeweler’s saw, or fine hacksaw
blade, taking care to protect the exposed
parts of the finger.
Hip-Joint Injuries
• Hip Dislocation
• Hip Fracture
Hip Dislocation
• A hip can be dislocated by a fall, a
blow to the thigh, or direct force to
the foot or knee.
• 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
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Treat for shock.
Stabilize the injury.
Check for an ankle pulse.
Seek medical care.
• This injury is best transported
by EMS.
Hip Fracture
• Fracture of the upper end of
the femur, not the pelvis
• Elderly people, especially
women, are susceptible to this
type of injury because of brittle
bones.
Recognizing a Hip Fracture
• Severe pain in the groin area
• Inability to lift the injured 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.
• This injury is best transported
by 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 fractures often include
open wounds and external
bleeding may be severe.
Recognizing a Femur Fracture
• Severe pain at the injury site
• Deformity may occur
• Swelling comes from severe
damage to blood vessels
• Victim may report having heard or
felt a severe pop or snap at the time
of injury.
Care for a Femur Fracture
• Treat for shock.
• Cover a wound with a sterile
dressing.
• Stabilize the injured leg against
movement.
• Monitor the ankle pulse.
• Seek immediate medical care.
• This injury is best transported by
EMS.
Muscle Contusion
• The muscle group on the front of the
thigh is the quadriceps group and
often gets bruised.
• Depending upon the force of impact
and muscles involved, the contusion
may be of varying degrees of
severity.
Recognizing a Muscle
Contusion
• Victim received a direct hit
producing:
• Swelling
• Pain and tenderness
• Tightness or firmness of site
when pressed
• Visible bruise that may appear
hours later
Care for a Muscle Contusion
• Follow the RICE
procedures.
• 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.
• Different degrees of strains
occur, but first aiders will be
unable to determine their
degree.
Recognizing a Muscle Strain
• While running or jumping, the victim:
• Feels a pop or pulling sensation
• And later has:
• Tenderness
• Stiffness and pain during movement
• Swelling
• A visible bruise appearing days later
Care for a Muscle Strain
• Follow the RICE procedures.
• Stretch the muscle but do not
force stretching.
Knee Injuries
• 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
• Generally occurs as a result of a
fall or a direct blow
• 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
discoloration.
• Other signs include:
• Deformity
• Tenderness
• Swelling
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.
Knee Dislocation
• A knee dislocation is a serious injury.
• Recognizing a knee dislocation:
• Excruciating pain
• Deformity
• Pulse may be absent in the ankle
• 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
dislocations.
• A dislocated patella most commonly
occurs in teenagers and young adults
who are engaged in athletic activities.
Recognizing a Patella
Dislocation
• Possible swelling
• An inability to bend or
straighten the knee
• Pain
• Deformity
Care for a Patella Dislocation
• Follow the RICE procedures.
• Do not try to relocate a
dislocated kneecap.
• 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 ligament injury,
ranging from mild
sprains to complete
tearing.
Recognizing a Knee Sprain
• At the time of injury the victim has:
• Severe pain
• The feeling of a pop or snap
• A locking sensation
• The victim may not be able to walk
without limping, or 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:
• Pain
• Swelling
• Tenderness
• Bruise marks
• Care for a knee contusion:
• Follow the RICE procedures.
Lower-Leg Injuries
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Tibia and fibula fractures
Tibia and fibula contusion
Muscle cramps
Shin splints
Ankle and foot injuries
Toe injuries
Tibia and Fibula Fractures
• Tibia and fibula injuries 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, and the pain is usually
severe.
Recognizing Tibia and Fibula
Fractures
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•
Severe pain
Swelling
Visible deformity
Tenderness when touched
Care for Tibia and Fibula
Fractures
• Stabilize the leg using a splint.
• Apply an ice pack.
• Seek medical care.
Recognizing Tibia and Fibula
Contusion
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•
Victim received a hit directly on the shin.
Tender when touched
Sharp pain
Later has:
• Discoloration
• Difficulty moving ankle up and down
• Numbness or coldness in toes or foot
Care for a Tibia and Fibula
Contusion
• Expose the injury.
• Apply the RICE
procedures.
• 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
• Try one or more of the following:
• Have the victim gently stretch the affected
muscle.
• Relax the muscle by applying pressure to it.
• Apply ice to the cramped muscle.
• Pinch the upper lip hard to reduce calf-muscle
cramping.
• Have the victim drink lightly salted, cool water.
Shin Splints
• Describes pain in the front of
the lower leg
• Caused by repetitive stress in
the leg such as running or
walking
Recognizing Shin Splints
• The shin aches during activity, but:
• Ache subsides significantly after
activity stops
• Ache is a result of an increase in the
workout routine
• Usually a chronic problem that gets
worse
Care for Shin Splints
• Apply an ice pack before an activity.
• Apply pressure with a 3-inch elastic
bandage over the sorest point.
• Apply an ice pack for 20 minutes after the
activity.
• Curtail activity until the shin is pain free.
• Pain medications that are anti-inflammatory
drugs may be taken.
Ankle and Foot Injuries
• The ankle and foot frequently are
injured, mainly by twisting.
• In some cases, the damage requires
surgical correction.
• Most ankle injuries are sprains; about
85% of sprains involve the outside
ligaments.
Recognizing Foot and Ankle
Injuries
• Press along the bones to check for pain
and tenderness.
• Ask the victim, “Have you tried standing on
it?”
• If the victim hops on the good foot and the
injured ankle cannot tolerate the jarring,
suspect a fracture.
• Ankle sprains tend to swell on only one
side of the foot; swelling on both sides
usually accompanies fractures.
Care for Foot and Ankle
Injuries
• Controversy exists about whether to
remove a shoe from an injured foot.
• Shoe may act as a splint and retard
swelling; however, taking the shoe off
allows for better examination and care.
• Use RICE procedures to reduce
swelling.