BONE JOINT AND MUSCLE INJURIES BERNA GUVEN Ph

BONE, JOINT AND MUSCLE INJURIES BERNA GUVEN, Ph. D

Main parts of the skeleton The Spine /Backbone

Main parts of the skeleton THE SKULL

Main parts of the skeleton THE BONES

Muscles and joints THE MUSCLES

THE JOINTS

FRACTURES Aims: ■ To prevent movement at the injury site ■ To arrange transportation to the hospital, with comfortable support during transit

OPEN AND CLOSED FRACTURES

STABLE AND UNSTABLE FRACTURES

WHAT TO DO FOR A CLOSED FRACTURE 1. Advise the casualty to keep still. Support the joints above and below the injury with your hands until it is immobilized with a sling or bandages, in the position in which it is found. 2. Place padding around the injury for extra support. Take or send the casualty to the hospital; a casualty with an arm injury may be transported by car; call 112 for emergency help for a leg injury. 3. For firmer support secure the injured part to an unaffected part of the body. For upper limb fractures, immobilize the arm with a sling. For lower limb fractures, move the uninjured leg to the injured one and secure with broad-fold bandages. 4. Treat for shock if necessary. Do not raise an injured leg. Elevate an uninjured limb if shock is present. Check the circulation beyond a sling or bandage every ten minutes. If the circulation is impaired, loosen the bandages.

Caution! ■ Do not move the casualty until the injured part is secured and supported, unless she is in immediate danger. ■ Do not allow the casualty to eat or drink because an anesthetic may be needed.

WHAT TO DO FOR AN OPEN FRACTURE 1. Cover the wound with a sterile dressing or large, clean, gauze pad. Apply pressure around the injury to control bleeding; be careful not to press on a protruding bone. 2. Carefully place a sterile wound dressing or more clean padding over and around the dressing. 3. Secure the dressing and padding with a bandage. Bandage firmly, but not so tightly that it impairs the circulation beyond the bandage. 4. Immobilize the injured part as for a closed fracture, and arrange to transport the casualty to the hospital. 5. Treat the casualty for shock if necessary. Do not raise the injured leg. Monitor and record vital signs—level of response, breathing, and pulse-- while waiting for help to arrive. Check the circulation beyond the bandage every ten minutes. If the circulation is impaired, loosen the bandages.

DISLOCATED JOINT There may be: ■ “Sickening, ” severe pain ■ Inability to move the joint ■ Swelling and bruising around the affected joint ■ Shortening, bending or deformity of the area

DISLOCATED JOINT 1. If, for example, the casualty has a dislocated shoulder, advise the casualty to keep still. Help him support the injured arm in the position he finds most comfortable. 2. Immobilize the injured arm with a sling. 3. For extra support for an injured arm, secure the limb to the chest by tying a broad-fold bandage around the chest and the sling. 4. Arrange to take or send the casualty to the hospital. Treat for shock if necessary. Monitor and record vital signs—level of response, breathing, and pulse—while waiting for help. 5. Check the circulation beyond the bandages every ten minutes.

STRAINS AND SPRAINS Strains and sprains should be treated initially by the “RICE” procedure: R—Rest the injured part; I—Apply Ice pack or a cold pad; C—Provide comfortable support with mild Compression from an elastic bandage; E—Elevate the injured part.

STRAINS AND SPRAINS 1. Help the casualty sit or lie down. Support the injured part in a comfortable position, preferably raised. 2. Cool the area by applying a cold compress, such as an ice pack in a towel to the injury. This helps reduce swelling, bruising, and pain.

STRAINS AND SPRAINS 3. Apply comfortable support to the injured part. Leave the cold compress in place or wrap an elastic bandage around the area. Secure it with a support bandage that extends to the next joint; for an ankle injury, the bandage should extend from the base of the toes to below the knee. 4. Support the injured part in a raised position to help minimize bruising and swelling in the area. Check the circulation beyond the bandages every ten minutes. If the circulation is impaired, loosen the bandages.

HEAD INJURY Head injuries are common. They are potentially serious because they can lead to damage to the brain. There may also be injuries to the spine in the neck, scalp wounds and/or a skull fracture.

ASSESSING THE LEVEL OF CONSCIOUSNESS Assess a casualty’s level of consciousness using the AVPU scale. Check the casualty at regular intervals. Make a note of your findings at each assessment, paying particular attention to any change—the casualty’s condition may improve or deteriorate while you are looking after him. A—Is the casualty Alert? Are his eyes open and does he respond to questions? V—Does the casualty respond to Voice? Can he answer simple questions and obey commands? P—Does the casualty respond to Pain? Does he move or open his eyes if pinched? U—Is he Unresponsive?

HEAD INJURY 1. Sit the casualty down and give him a cold compress to hold against the injury. Carry out an assessment of the casualty’s level of consciousness using the AVPU scale. Treat any scalp wounds by applying direct pressure to the wound. 2. Regularly monitor and record vital signs—breathing, pulse and level of response. Watch especially for changes in his level of response. 3. When the casualty has recovered, ask a responsible person to look after him. 4. If a casualty’s injury is the result of a sporting accident, do not allow him to return to the sport until he has been fully assessed by a medical practitioner.

HEAD INJURY Advise the casualty to seek medical help or arrange transportation to a hospital if he develops signs and symptoms of a worsening head injury or if ANY of the following apply: v. He is over 65 years of age v. He has had previous brain surgery v. He is taking anticoagulant (anticlotting) medication v. The head injury is accompanied by drug or alcohol intoxication v. There is no responsible person to look after him

FACIAL INJURY-Jaw, Cheekbone and Nose Injuries 1. Help the casualty sit down and make sure the airway is open and clear. 2. Gently place a cold Compress 3. Arrange to take or send the casualty to the hospital The main danger with any facial fracture is that blood, saliva or swollen tissue may obstruct the airway and cause breathing difficulties.

Upper Arm and Shoulder Injuries To support and immobilize the injured limb. 1. Help the casualty sit down. 2. Support the arm on the injured side with an arm sling

FOREARM AND HAND INJURIES To immobilize the arm 1. Ask the casualty to sit down 2. Slide a triangular bandage in position between the arm and the chest / Wrap the hand in soft, nonfluffy padding for extra protection. 3. Support the arm

SPINAL INJURY WHAT TO DO FOR A CONSCIOUS CASUALTY 1. Call 112 2. Kneel or lie behind the casualty’s head. Rest your elbows on the ground or on your knees to keep your arms steady. Grasp the sides of the casualty’s head. Spread your fingers so that you do not cover his ears, so he can hear you. Steady and support his head in this neutral position, in which the head, neck, and spine are aligned 3. Ask a helper to place rolled up blankets, towels, or items of clothing on either side of the casualty’s head and neck, while you keep his head in the neutral position. Continue to support the casualty’s head until emergency services take over, no matter how long this may be.

SPINAL INJURY WHAT TO DO FOR AN UNCONSCIOUS CASUALTY 1. Kneel or lie behind the casualty’s head. Rest your elbows on the ground or on your knees to keep your arms steady. Grasp the sides of her head. Support her head so that her head, trunk, and legs are in a straight line. 2. Open the casualty’s airway using the jaw-thrust technique. Place your fingertips at the angles of her jaw. Gently lift the jaw to open the airway. Take care not to tilt the casualty’s neck. 3. Check the casualty’s breathing. If she is breathing, continue to support her head. Call 112 for emergency help 4. If the casualty is not breathing, begin CPR

LOWER LEG INJURIES WHAT TO DO 1. Help the casualty lie down, and gently steady and support the injured leg. If there is a wound, carefully expose it and treat the bleeding. 2. Call 112 3. Support the injured leg by splinting it to the other leg. Bring the uninjured leg alongside the injured one and slide bandages under both legs. Position a narrow-fold bandage at the feet and ankles (1), then broad-fold bandages at the knees (2) and above and below the fracture site (3 and 4). Insert padding between the lower legs. Tie a figure-eight bandage around the feet and ankles, then secure the other bandages, knotting them on the uninjured side.

REFERENCES The American College Of Emergency Physıcıans (Acep)-First Aid Manuel 5 th Edition The Everything First Aid Book STAY HOME SAFE