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Emergency Treatment - Fractures


AarounPierce

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Greetings everyone and welcome to the first installment of my Emergency Treatment blog, this installment will cover bone fractures with primary emphasis on the extremities.

 

First things first, what is a fracture? What is the difference between a fractured bone and a broken bone? A bone is considered 'fractured' when the structural integrity of the bone has been comprimised in any way. A break and a fracture are actually the exact same thing, a broken bone medically is referred to as a compound fracture.

 

There are four common types of bone fractures and each require a different type of stabilization.

 

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Oblique fractures occur at an angle and are generally the resultant of a sharp-edged blow.

 

Comminuted fractures generally refer to a bone that has been splintered and/or crushed. This form of fracture is common in MVAs (motor vehicle accidents) and construction site accidents because of the increased risk of high-momentum blunt force trauma.

 

Spiral fractures result in a motion that twists the extremities into positions that are beyond anatomical norms. A number of times, these injuries occur as a result of falling injuries...falling out of a tree or down a flight of stairs.

 

Compound fractures (or complete breaks) are the most dangerous types of fractures where the bone itself perforates the skin and is exposed to the outside air. This type of fracture is generally the most dangerous to the individual for a number of reasons because of the mechanism of injury for this type of fracture, massive trauma. Shock is very common for individuals during the inital injury, when in doubt...always treat a patient as if they could go into shock at any moment. Compound fractures also have a tendency result open bleed wounds, so extra care must be taken when rendering first aid to stop the blood-loss. With compound fractures, there is a risk of bone matter entering the blood-stream as well.

 

----------------First Aid for Fractures--------------------------

 

When in doubt, always treat any fracture as the most serious type, a compound fracture. For the purpose of this article, we will concentrate on injuries in relation to the arms/legs (most common) and this will be the only major injury sustained.

 

When encountering a situation where a person is in need of medical aid, remember the ABC's first. Check the scene first to verify your own safety before rendering aid, PUT ON YOUR GLOVES. Talk to the person, gauge their responsiveness, make sure they are breathing, and check for a pulse.

 

When preparing to splint any fracture for medical transport...look and touch but do not force any large movements. Oblique, comminuted, and spiral fractures are all treated the same way from first aid standpoint. Compound fracture have one other step, which will be notated in the process listed below.

 

Notate the affected area and severity of pain, check for a pulse toward the body and away from the body in the affected area. If you notice a diminished pulse rate in the area away from the fracture, expediate transportation.

 

If responding to the injury fast enough, remove any constricting items before swelling begins. This includes jewelry (rings especially), watches, gloves, shoes, any clothing on the affected limb can be cut away. Anything that could constrict around the area once swelling really takes hold...

 

Here's the step for compound fractures...control the bleeding (PUT ON YOUR GLOVES). Irrigate and clean the wound while taking extreme care in not applying extreme pressure, the injured WILL respond to these actions, so be ready for it. Once the area has been cleaned of debris (glass shards and bits of plastic are very common in vehicular accidents), use plenty of gauze to pad around the point where the bone is protruding from the skin while applying gentle pressure. Once the free-flowing bleed has stopped, do not remove the soaked gauze pads. Simply apply more padding around the wound and over the bone. Use a gauze roll (not pressure bandages-ETDs) to secure the padding. Ace bandages are a bad idea to secure a compound fracture due to the swelling that the person will experience, gauze rolls are ideal...keep plenty in your aid-bags.

 

Prepare your splint on a limb that was not affected by the wound if possible, if not, prepare it on yourself or another person. Then transfer it to the injured. This helps in speeding up the process of securing the injury, as well as limiting the pain experienced by the patient from un-necessary "readjustments". Make sure your splint goes above and below the location of the fracture. If a splint it not available for an injury to a person's arm, pad the injury as much as possible (standard t-shirts and sweatshirts make great padding) and secure the arm in a sling. If no splint is available in the event of a lower body injury (leg), pad the injury in the same way, then secure the injured leg to the uninjured leg as best as possible.

 

When splinting a fracture, always check circulation before splinting and FREQUENTLY after splinting, about every 10 minutes. If circulation diminishes while enroute to medical aid or while awaiting EMS, check for swelling and loosen splint/padding as needed. As long as circulation is ok, you can help keep the swelling at bay by elevating the injury (as best as possible without injury). Have the patient lie on his/her back, a splinted arm laid across the person's chest is sufficient, and an injured leg can propped up just above chest-level to be effective. Applying cold-packs will aid in pain and swelling as long as they are not applied directly to the skin.

 

Remember, when dealing with fractures, always keep the risk of shock in mind. Keep going over the patient's ABC's while awaiting medical aid. Keep the patient warm with anything on hand, blanket...jacket...a few spare overshirts laid over them.

 

--------------Recommendations--------------------------

 

SAM Medical makes GREAT preform splints and they are not that expensive. Their site offers many free video tutorials on the use of their product. **I am in no way affiliated with SAM Medical**

 

Most first-aid courses that are readily available do not cover splinting, that being said, EMT-B schooling is something that is very cost effective for more advanced medical training (as well as a certification to put on your wall). Depending on your state's mandated requirements, most EMT-B training can be completed in one semester with reasonable class schedules for all walks of life. You can also check with your local fire department and sherriff's department, in some states, those organizations offer advanced first-aid classes to civilians...and if they don't, they can always point you in the proper direction for your region.

 

In closing, be smart and be safe.

 

**EDIT, PPE - Personal Protective Equipment...bare minimum are non-latex gloves.

 

Adding another link. Ring Cutter

 

 

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3 Comments


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Aaroun, Excellent Beginning! It was great to have this review! I've not read much about splints & breaks since I was in college.

 

I'm so glad you mentioned the SAM splints - definitely something every serious First Aid Kit should have!

 

Great job! I look forward to the next installment.

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Great job Aaroun. Preparing splint on opposite limb or another person I never thought about. Great suggestion! Something I did think of for another good lesson topic is pulse points. Some people might possibly only think of carotid or radial. :shrug:

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