Dislocations
Dislocations involve the displacement of bone from a joint. These injuries are often underestimated and can have serious consequences in the form of damage to nerves and blood vessels. Many people have joints which dislocate easily due to a congenital condition or weak ligaments, stretched by previous repeated dislocations.
Sign and symptoms
- Sudden pain in the affected joint
- Loss of power and movement
- Deformity and swelling of the joint
- Tenderness
- May have some temporary paralysis of the injured limb
Care and treatment
- RICE (Rest, Ice, Compression, Elevate)
- Support limb in position of comfort
- Seek medical aid
Any attempt to reduce a dislocation is only to be made by a doctor
Slings
Use slings to support an injured arm or to supplement treatment for another injury such as fractured ribs. Generally, the most effective sling is made with a triangular bandage. Every first aid kit, no matter how small, should have at least one of these bandages as an essential item.
Although triangular bandages are preferable, any material, e.g. tie, belt or piece of thick twine or rope, can be used in an emergency. If no likely material is at hand, an injured arm can be adequately supported by inserting it inside the casualty's shirt or blouse. Similarly, a safety pin applied to a sleeve and secured to clothing on the chest may suffice.
There are essentially three types of sling; the arm sling for injuries to the forearm, the elevated sling for injuries to the shoulder and the 'collar-and-cuff' or clove hitch for injuries to the upper arm and as supplementary support to fractured ribs.
After applying any sling, always check the circulation to the limb by feeling for the pulse at the wrist or squeezing a fingernail and observing for change of colour in the nail bed.
All slings must be in a position that is comfortable for the casualty. Never force an arm into the 'right position'.
Care and treatment
Arm sling
- Support the injured forearm approximately parallel to the ground with the wrist slightly higher than the elbow
- Place an opened triangular bandage between the body and the arm, with its apex towards the elbow
- Extend the upper point of the bandage over the shoulder on the uninjured side
- Bring the lower point up over the arm, across the shoulder on the injured side to join the upper point and tie firmly with a reef knot
- Ensure the elbow is secured by folding the excess bandage over the elbow and securing with a safety pin
Elevated sling
- Support the casualty's arm with the elbow beside the body and the hand extended towards the uninjured shoulder
- Place an opened triangular bandage over the forearm and hand, with the apex towards the elbow
- Extend the upper point of the bandage over the uninjured shoulder
- Tuck the lower part of the bandage under the injured arm, bring it under the elbow and around the back and extend the lower point up to meet the upper point at the shoulder
- Tie firmly with a reef knot
- Secure the elbow by folding the excess material and applying a safety pin, then ensure that the sling is tucked under the arm giving firm support
'Collar-and-cuff'
- Allow the elbow to hang naturally at the side and place the hand extended towards the shoulder on the uninjured side
- Using a narrow fold triangular bandage, form a clove hitch by forming two loops - one towards you, one away from you
- Put the loops together by sliding your hands under the loops and closing with a "clapping" motion
- If you are experienced at forming a clove hitch, then apply a clove hitch directly on the wrist, but take care not to move the injured arm
- Slide the clove hitch over the hand and gently pull it firmly to secure the wrist
- Extend the points of the bandage to either side of the neck and tie firmly with a reef knot
- Allow the arm to hang comfortably. Should further support be required, e.g. for support to fractured ribs, apply triangular bandages around the body and upper arm to hold the arm firmly against the chest
Head injuries
Injuries to the head are always regarded as serious because they can inflict damage to the brain and spinal cord as well as damaging the bone and soft tissue. As a result head injuries can be devastating to the casualty.
Head injuries can be invisible to the eye. In many instances, a casualty who appeared unaffected after an incident suddenly collapses with life-threatening symptoms some hours later. This may be due to the sudden movement of the head forward and backward on impact which may cause a small bleed in the brain that eventually increases and applies excessive pressure on the brain tissue.
Such injuries can easily mislead the first aid provider by not exhibiting the expected signs and symptoms immediately after an incident. As a first aid provider you should always take head injuries seriously. Always check the patient's response and whether they have any alteration of consciousness.
Look at the history of the incident and the mechanism of injury. If in your opinion, the patient's conscious state is altered or the incident had the potential to cause serious injury, assume the worst and treat as a serious head injury.
Head injuries are generally classified as:
- Open. A head injury with an associated head wound.
- Closed. With no obvious sign of injury.
In some instances, serious head injury is readily identified by certain signs peculiar to the injury.
Clear fluid oozing from the nose or ears. This is cerebrospinal fluid (CSF), which surrounds the brain. When a fracture occurs, usually at the base of the skull, the fluid leaks out under pressure into the ear and nose canals.
Black eyes and bruising. The kinetic energy from a blow which is transmitted through the head and brain is expelled through soft tissue, e.g. the eyes and behind the ears (battle's sign). Bruising at these points indicates the head has suffered exposure to considerable force.
Remember, just because a casualty has two black eyes (raccoon eyes), this does not necessarily mean they were struck in the face. Raccoon eyes may indicate a forceful impact elsewhere on the skull.
Blurred or double, vision is common with concussed casualties. It indicates that the brain has been dealt a blow that has temporarily affected its ability to correctly process the sight senses.
Concussion is a closed head injury. Of all the head injuries, the severity of this is often underestimated and many casualties have succumbed several hours after the incident. Be especially observant during contact sports or activities involving children - the myth you can 'run off' your concussion by playing on is a dangerous attitude and has caused grief to many players, parents and coaches when the casualty eventually collapses. Concussion is potentially very serious and an indifferent attitude is to be discouraged.
Facial injuries are also head injuries and the first aid provider should not be unduly distracted by obvious facial injuries and forget to assess the casualty for associated brain injury. Facial injuries are also a complication where the airway is concerned.
Signs and symptoms:
Some or all of the following:
- Head wounds
- Deformation of the skull
- Altered/deteriorating level of consciousness
- Evidence of cerebrospinal fluid (CSF) leaking from ears or nose
- May have unequal pupils
- Headache
- Raccoon eyes or battle's sign
- Nausea and/or vomiting
- Restlessness and irritability, confusion
- Blurred or double vision
- 'Snoring' respirations if unconscious
Care and treatment
- Call Triple Zero (000) for an ambulance
- Apply a cervical collar only if trained to do so
- Treat any wounds
- Complete rest
- If unconscious or drowsy, put casualty in the recovery position while supporting the cervical spine
- Allow any CSF to drain freely - if in recovery position, put the injured side down with a pad over the ear to allow drainage
Do not allow concussed casualties to 'play on'
All head injured and unconscious patients potentially have spinal injuries as well