Continuation....
Fractures and Splinting!
Initial Care for Fractures:
If you can, carefully cut away all clothing near the fracture site. You need to make sure the fracture hasn't broken the skin and you may be able to use the cut away material to aid in splinting. If you find an open fracture, protect the wound from contamination as you would any other.
No matter how soon you expect to get medical help, you should immobilize all fractures to prevent additional injuries due to accidental movement or muscle spasms. Immobilization can be achieved many ways; the key points being not to worsen the situation while immobilizing and making sure to also immobilize the joints above and below any limb fracture.
In general, don't try to reposition fractured limbs. Unless you know what you are doing, you could sever an artery or nerve. If out on the trail with help a long way off, practicality may necessitate slight repositioning in order to accommodate make-do splinting. In such situations if a limb has no pulse or is turning purple, repositioning may relieve some unnatural pressure which is pinching off an artery, however the rescuer must consider that a mishandled attempt could result in a jagged bone end severing the compressed artery, making a bad situation much worse!
To put this tricky situation in perspective, Brady's Emergency Care, 6th Edition states: "Angulations make splinting and transport more difficult. They can pinch or cut through blood vessels and are painful for the patient. They must, however, be repositioned so they can be splinted. Not to splint would be more dangerous."
DO NOT try to straighten angulations of the wrist, ankle or shoulder or attempt to straighten any dislocated joint!
When splinting using sticks or other "found" objects, try make padding between the injured limb and splint using a jacket, shirt filled with grass, anything which can be reasonably secured and can help fill in the gaps between the limb and the splint material. Don't get carried away with this concept, but if you can handily make something up without delaying the splinting process, it will be more comfortable to the patient.
Long bone fractures in the legs and arms can benefit from mild traction when splinting. For arm fractures where you have help during splinting, one person can grasp the arm above and below the fracture site and apply a smooth, steady pull until your helper can apply the splint. If you encounter a firm resistance, crepitus or the patient experiences a significant increase in pain, do not attempt traction. Do the best you can to splint in the position found. Once you successfully apply traction, do not release it until the splint is securely supporting the limb, otherwise the retracting bone end will cause additional tissue damage and possibly injure a nerve or artery.
A fractured forearm should be splinted from the hand through the elbow and can be secured across the chest with a sling if more comfortable for the patient. Upper arm fractures should be immobilized from shoulder through the elbow and can be secured against the body.
Traction for leg injuries is more difficult, and the risk of injury resulting from a failed traction attempt is even greater. Do not attempt leg traction until your helper is ready to apply a splint. Legs should be secured to splints using several ties from the ankle to the pelvis, but not directly over the fracture. If a long smooth board is available (e.g., a fence board), it can be secured all the way up to the armpit to improve stability.
Fractures and Splinting!
Initial Care for Fractures:
If you can, carefully cut away all clothing near the fracture site. You need to make sure the fracture hasn't broken the skin and you may be able to use the cut away material to aid in splinting. If you find an open fracture, protect the wound from contamination as you would any other.
No matter how soon you expect to get medical help, you should immobilize all fractures to prevent additional injuries due to accidental movement or muscle spasms. Immobilization can be achieved many ways; the key points being not to worsen the situation while immobilizing and making sure to also immobilize the joints above and below any limb fracture.
In general, don't try to reposition fractured limbs. Unless you know what you are doing, you could sever an artery or nerve. If out on the trail with help a long way off, practicality may necessitate slight repositioning in order to accommodate make-do splinting. In such situations if a limb has no pulse or is turning purple, repositioning may relieve some unnatural pressure which is pinching off an artery, however the rescuer must consider that a mishandled attempt could result in a jagged bone end severing the compressed artery, making a bad situation much worse!
To put this tricky situation in perspective, Brady's Emergency Care, 6th Edition states: "Angulations make splinting and transport more difficult. They can pinch or cut through blood vessels and are painful for the patient. They must, however, be repositioned so they can be splinted. Not to splint would be more dangerous."
DO NOT try to straighten angulations of the wrist, ankle or shoulder or attempt to straighten any dislocated joint!
When splinting using sticks or other "found" objects, try make padding between the injured limb and splint using a jacket, shirt filled with grass, anything which can be reasonably secured and can help fill in the gaps between the limb and the splint material. Don't get carried away with this concept, but if you can handily make something up without delaying the splinting process, it will be more comfortable to the patient.
Long bone fractures in the legs and arms can benefit from mild traction when splinting. For arm fractures where you have help during splinting, one person can grasp the arm above and below the fracture site and apply a smooth, steady pull until your helper can apply the splint. If you encounter a firm resistance, crepitus or the patient experiences a significant increase in pain, do not attempt traction. Do the best you can to splint in the position found. Once you successfully apply traction, do not release it until the splint is securely supporting the limb, otherwise the retracting bone end will cause additional tissue damage and possibly injure a nerve or artery.
A fractured forearm should be splinted from the hand through the elbow and can be secured across the chest with a sling if more comfortable for the patient. Upper arm fractures should be immobilized from shoulder through the elbow and can be secured against the body.
Traction for leg injuries is more difficult, and the risk of injury resulting from a failed traction attempt is even greater. Do not attempt leg traction until your helper is ready to apply a splint. Legs should be secured to splints using several ties from the ankle to the pelvis, but not directly over the fracture. If a long smooth board is available (e.g., a fence board), it can be secured all the way up to the armpit to improve stability.
