OsteoBlog: First Aid Series 4 - Best of the Rest.
In the last three 'first aid series' blog posts, I have covered management of the unconscious patient, CPR for cardiac arrest in adults and children and choking.
Not professing to replace first aid manuals, I propose to summarise the rest of the more important and common incidents you may come across.
Please get yourselves booked onto a first aid course if you have not already, as it is important to take part in the practical element of first aid in order to consolidate learning.
For everyone else, use these blogs as revision and possibly for filling in gaps in knowledge!
In this last blog of the series I will cover the following topics:
Burns & scalds
Sprains, strains & fractures
Wounds & bleeding
Assume for all these scenarios that we have checked for danger, assessed the patient to be conscious and breathing, called 999 and are ready to treat the injury.
Burns & Scalds:
Basically the difference between these two is the agent that caused the injury. Scalds are a result of hot liquid such as boiling water or oil.
Burns are a result of fire, hot surfaces, the sun, chemicals or ice. The injury amounts to the same thing - pain, redness, blistering/skin damage.
First, remove the patient from the environment if there is fire or smoke. If the patient has been in a house fire and has sooty deposits around the nose or mouth then assume they have inhaled smoke. They need oxygen and treatment in hospital for possible airway burns.
The key to managing burns is the 4 C's - Cool it, Cover it in Clingfilm or a Clean sheet.
Burns of one limb area or less, need to be put under cold running water for at least 20-30 mins maybe longer. Do not use ice or iced water. If there are extensive burns then do not do this as the patient may go into shock and suffer hypothermia. Just cover them in a clean cotton bed sheet.
The main complication of burns/scalds is infection from broken skin as a result of blistering and fluid loss if the burn area is large enough. If there is blistering to the skin and the burn is bigger than the palm of the patients hand then they need to be seen at the doctors. Do not burst any blisters and cover with a clean non adherent cloth or clingfilm. Do not wrap any limbs circumferentially as burns tend to swell and the circulation could be compromised.
If you come across someone who’s clothing has caught fire, grab something to wrap them in, drop them to the ground and roll until the flames are out.
Do not try to peel the clothing off them as their skin will peel off too and more damage will occur.
The most painful burns are often the most superficial as all the nerve endings are intact. They will be red, perhaps cover a big area and may have small blisters. Intermediate burns are when large blisters form, the skin surface looks a little waxy and fluid is weeping.
Deep or full thickness burns look blackened and pink where the skin has gone and need emergency treatment in a specialist burns unit.
If you are in any doubt about the severity of a burn then please seek medical help.
Sprains, Strains & Fractures:
A sprain happens at a joint when you turn your ankle or bend a finger back. It is damage to ligaments that connect bone together at the joint. Ligaments are tough fibrous collagen material that have very little elastic property as they need to be strong and stable. Ligaments can be over stretched, partially torn or completely ruptured. They can mimic a fracture and so should really be treated as such until an x-ray is done. You may have swelling, bruising, loss of mobility, inability to weight bear and a great deal of pain. It is useful not to equate the pain or tissue damage seen with the severity of the injury as they do not often tie up. I have seen massively swollen, purple ankles that have only just partially torn the ligaments, and fractures that look no worse than a small lump with some mild pain. If in doubt, go to A&E.
The mnemonic PRICE applies to sprains in the first 36 or so hours after injury.
Protect from further injury, Rest, Ice pack for 10 mins on and 20 mins off, Compression with a tubi-grip bandage and Elevate the limb to control swelling. Avoid heat to the area in the first 36-48 hours. Good rehab after an ankle sprain is important to avoid further sprains.
A strain is an injury to muscle or tendons and usually occurs as a result of sudden unexpected movement, fall or explosive exercise such as sprinting or throwing.
The muscle can swell, bruise, and produce pain and heat and there may be some torn fibres which ball up and feel a little odd. Sometimes the muscle ruptures completely and there will be weakness, loss of movement and intense pain. These injuries need orthopaedic assessment in A&E for possible surgical intervention.
Again, the treatment should include protection of the area, rest, ice pack therapy and elevation.
People often confuse fractures and breaks and try to distinguish between the two. They are the same thing. A fracture is any disruption in the bone surface and can be a complete break of the bone into two or more pieces, or a tiny splinter or crack. One requires surgery and splinting and the other usually just a period of immobilisation in plaster or a special boot. Fractures are either open or closed. The bone has either pierced the skin or not. The complication with the open fracture is of course infection into the wound and bone itself. Both types can bleed a lot and a person is at risk of going into shock with fractures of the long arm and leg bones and of the pelvis.
If you suspect a major bone fracture, make the patient comfortable, call for help and prevent them from moving around or putting weight on the injured area.
Wounds & Bleeding:
Adults have about 4-5 litres of blood in their bodies and children about 70-80 ml per kilo of body weight.
Hypovolemic shock occurs when blood loss reaches about 1/5 of the total blood volume. This can happen quickly if the bleed is arterial (greater pressure) and less so if the wound has only affected capillaries.
The patient in shock may be pale, sweaty, dizzy, nauseous and anxious. Their pulse may be fast and weak and they may be yawning or pass out. Get help fast.
Wound management is primarily about preventing too much blood loss, but consideration should be given to infection, risk of further damage and other injuries present such as head or organ damage.
Cover wounds with absorbent, non adherent dressings, apply pressure and elevate the affected part if it is a limb. If the wound has something sticking out of it, do not pull out the foreign body but apply pressure around it or use indirect pressure at the nearest pulse point closest to the body such as the elbow or thigh. Please do not use a tourniquet (tight band round arm or leg) unless you are unable to stop blood flow by direct pressure on the wound. If you do decide to use one, it must be at least 4cm wide to avoid nerve and tissue damage, and at least 5cm above the wound. Do not tie a tourniquet around a joint or around the neck (you'd be surprised....)
Always note the time that the tourniquet was applied or write it on the patients limb if you can. Arrange removal to hospital ASAP.
Get the person to sit down and raise their legs to assist blood flow back to the heart and brain and prepare to manage their airway if they are sick or pass out.
Make sure you keep up to date with your tetanus vaccination, which needs to be boosted every few years.
Please do get in touch if you have any questions regarding anything in this article.
For osteopathy in High Wycombe and beyond call Lucy from OsteoFusion on 07833 321604 or visit www.osteofusion.co.uk
Thanks for reading.