FRACTURES. \A break in a bone is called a fracture. There are two main types of fractures. A closed fracture is internal where the bone is broken but there is no break in the skin. With an open fracture, there is an open wound in the tissues and the skin where the bone has broken through. This type of break and wound is also referred to as a compound fracture. Figure 13-9 shows closed and open fractures.

When providing emergency medical treatment to a person who has suffered a fracture, you should follow these general rules:

1. If there is any possibility that a fracture has been sustained, treat the injury as a fracture.

2. Get medical aid at the first possible opportunity. All fractures require medical treatment.

3. Do not move the casualty until the injured part has been splinted.

Figure 13-9.\Closed and open fractures.

4. Treat for shock.

5. Do not attempt to locate a fracture by grating the ends of the bone together.

6. Do not attempt to set a broken bone.

7. When a long bone in the arm or leg is fractured, the limb should be carefully straightened so splints can be applied. Never attempt to straighten the limb by applying force or traction. Pulling gently with your hands in the direction of the long axis of the limb is permissible, and may be all that is necessary to get the limb back into position.

8. Apply splints. If the casualty is to be transported only a short distance, or if the patient will be seen very soon by a medical officer, it is probably better to leave the clothing on and place emergency splinting over it. If the casualty must be transported for some distance, or if a considerable period of time will elapse before the patient can be treated by a medical officer, it may be better to remove enough clothing so that you can apply well-padded splints directly to the injured part.

9. If the fracture is open, you must take care of the wound before you can treat the fracture.

SPRAINS. \A sprain is an injury to the ligaments that support a joint. A sprain usually involves a momentary dislocation, with a bone slipping back into place on its own accord.

Tearing of supporting ligaments is probably the most serious part of a sprain, but there is also a considerable amount of damage to the blood vessels and other soft tissues that surround the joint. When the blood vessels are damaged, some blood may escape into the joint itself and into the tissues. This causes the severe pain and marked swelling characteristic of a sprain.

Immobilize the injured joint with some type of irregular edges and masses of torn tissue underneath. splint or with a snugly fitting adhesive or elastic These wounds are usually made by blunt force, rather bandage. Remember that the injured part may continue than sharp objects. They are often complicated by to swell, so a bandage that is loose enough when crushing of the tissues as well. Because lacerations are applied may soon become too tight. frequently contaminated with dirt, grease, or other material that is ground into the tissues, they are very likely to become infected.

Elevate the injured part, if possible. This helps reduce the pain and swelling.

It is difficult to tell a sprain from a fracture. If you are not sure which injury is present, always treat it as a fracture until the casualty has been brought under the care of a medical officer.

STRAINS. \An injury caused by the forcible overstretching or tearing of a muscle or tendon is known as a strain. Strains may be caused by lifting excessively heavy loads, by sudden movements, or by any other action that pulls the muscles beyond their normal limits.

The chief symptoms of a strain are pain, lameness, stiffness (sometimes involving knotting of the muscles), moderate swelling at the place of injury, and discoloration because of escape of blood from the injured blood vessel into the tissue. Have the patient rest the injured part. If the injured muscle is in the arm or leg, elevate the part.

Wounds

Wounds may be classified according to their general condition, size, location, the manner in which the skin or tissue is broken, and the agent that caused the wound. You must usually consider some or all of these factors to determine what emergency treatment is necessary for a wound. There are six types of wounds: abrasion, incision, laceration, puncture, avulsion, and amputation.

ABRASIONS. \Abrasions are made when the skin is rubbed or scraped off. Rope burns, floor burns, and skinned knees or elbows are common examples of abrasions. This kind of wound is easily infected because dirt and germs are usually ground into tissues. There is usually minimal bleeding or an oozing of clear fluid.

INCISIONS.\Incisions, commonly called cuts, are wounds made by sharp cutting instruments such as knives, razors, or broken glass. Incisions tend to bleed freely because the blood vessels are cut straight across. There is relatively little damage to surrounding tissues. Of all the classes of wounds, incisions are the least likely to become infected, because the free flow of blood washes the wound.

LACERATIONS. \These wounds are wounds that are torn, rather than cut. They have ragged,

PUNCTURES.\Punctures are caused by objects that penetrate deeply into the tissues but leave a relatively small surface opening. Wounds made by nails, needles, wire, knives, and bullets are usually punctures. A puncture wound can be classified as penetrating or perforating. A perforation differs from a penetration in that it has an exit as well as an entrance site.

As a rule, small punctures do not bleed freely. But, large puncture wounds may cause severe internal bleeding. The possibility of infection is great in all puncture wounds.

AVULSIONS. \An avulsion is the tearing away of tissue from a body part. Bleeding is usually heavy. The torn tissue may be surgically reattached in certain situations. It can be saved for medical evaluation by wrapping in cool, moist toweling and rushing it, along with the victim, to a medical facility.

AMPUTATIONS.\A traumatic amputation is the nonsurgical removal of a limb. Bleeding is heavy and requires a tourniquet. Shock is certain to develop. The limb can often be successfully reattached. Wrap the limb in a cool, moist towel and transport to medical as soon as possible.

HEAD WOUNDS.\Head wounds can be open or closed. In open head wounds, there is an obvious injury. Closed head wounds may not be obvious, so you may have to base treatment on the history of how the accident happened. You may see only the delayed symptoms, such as a seizure, disorientation, or drastic personality changes.

In all injuries to the skull, check for these signs of an injury to the brain:

Unequal size of the pupils

Deformity of the skull

Blood or sticky fluid coming from the ears and nose

Any time there is blunt trauma to the skull, keep the casualty's neck immobilized in case there is damage to the spine or the neck area.

The emergency care of an individual with a head injury consists of the following:

1. Maintain an open airway.

2. Control the bleeding.

3. Cover skull wounds with sterile dressings.

4. Keep the casualty lying down.

5. Give no medications.

6. If necessary, administer cardiopulmonary resuscitation (CPR).

When controlling bleeding, do not use direct pressure or tie any knots over the wound. If there is a skull fracture, you would not want to force parts of the skull into the brain. When laying a person down, try to keep the head slightly elevated. If there is an injury to the back of the head or bleeding into the throat and mouth, position the casualty on his side so that blood can drain out of the mouth, not down the throat. (Try to keep the neck stiff.) Never raise the feet of a head injury victim.