When the ribs are broken, the victim should be kept comfortable and quiet so the greatest danger-the possibility of further damage to the lungs, heart, or chest wall by the broken ends-is minimized.

The common finding in all victims with fractured ribs is pain localized at the fracture site. By asking the patient to point out the exact area of pain, you can often determine the location of the injury. There mayor may not be a rib deformity or chest wall contusion or laceration of the area. Deep breathing, coughing, or movement is usually painful. The patient generally wishes to remain still and may often lean toward the injured side, with one hand over the fractured area to immobilize the chest and to ease his pain.

TREATMENT. In general, rib fractures are not bound, strapped, or taped when the victim is reasonably comfortable; however, they may be splinted by the use of external support. If the patient is considerably more comfortable with his chest immobilized, the best method is to use a swathe bandage (fig. 10-53) in which the arm on his injured side is strapped to his chest with the palm flat, the thumb up, and with the forearm raised to a 45-degree angle. Immobilize his chest, using wide

Figure 10-53.-Swathe bandaging of fractured rib victim.

strips of bandage to secure the arm to his chest. Wide strips of adhesive plaster applied directly to the skin of his chest for immobilization should not be used, since the adhesive tends to limit the ability of his chest to expand and thus interferes with proper breathing. Treat the victim for shock, and obtain medical care as soon as possible.

FRACTURE OF THE NOSE

A fracture of the nose usually causes localized pain and swelling, a noticeable deformity of the nose, and extensive nosebleed.

TREATMENT. First, stop the nosebleed. Have the victim sit quietly, with his head tipped slightly backward. Instruct the patient to breathe through his mouth, not his nose. If the bleeding does not stop within a few minutes, apply a cold compressor ice bag over his nose.

Treat the victim for shock and obtain medical care as soon as possible. A permanent deformity of the nose may result if the fracture is not treated promptly.