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Chapter 15 Extremity Injuries.

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Presentation on theme: "Chapter 15 Extremity Injuries."— Presentation transcript:

1 Chapter 15 Extremity Injuries

2 Extremity Injuries Injuries to the extremities are common because people are involved in active lifestyles that include sports and wilderness activities.

3 Extremity Injury Assessment (1 of 2)
Look for signs and symptoms of fractures and dislocations. Examine the extremities, using the mnemonic D-O-T-S. Compare one extremity with the other to determine size and shape differences. Use the “rule of thirds” for extremity injuries.

4 Extremity Injury Assessment (2 of 2)
Consider the cause of injury (COI) when evaluating the possibility of a fracture and its location. Use the mnemonic CSM as a reminder to check for Circulation, Sensation, and Movement of fingers or toes.

5 Types of Injuries Types of injuries to the extremities range from simple contusions to complex open fractures. Contusions Strains Sprains Tendinitis Dislocations Fractures

6 Care for Extremity Injuries
Use the RICE procedures. Apply a splint to stabilize fractures and dislocations.

7 RICE Procedure (1 of 2) R= Rest. Injuries heal faster if rested.
I= Ice. Ice should be applied to the inured area as soon as possible after the injury. C= Compression. Compressing the injured area squeezes fluid out of the injury site. E= Elevation. Gravity slows the return of blood to the heart from the lower parts of the body.

8 RICE Procedure (2 of 2) R = Rest I = Ice C = Compression E = Elevation

9 Shoulder Injuries Three bones come together at the shoulder: Scapula
Clavicle Humerus The shoulder is the most freely movable joint in the body.

10 Shoulder Dislocation A dislocation of the shoulder occurs when the bones of the shoulder comes apart. Shoulder dislocation is second in frequency only to finger dislocations.

11 Recognizing Shoulder Dislocation (1 of 2)
Victim holds the upper arm away from the body, supported by the uninjured arm Dislocated arm cannot be brought across the chest wall to touch the opposite shoulder Extreme pain in the shoulder area In a dislocation, the shoulder looks squared off, rather than rounded.

12 Recognizing Shoulder Dislocation (2 of 2)
Victim may describe a history of previous dislocations. Numbness or paralysis in the arm from pressure, pinching blood vessels or nerves

13 Care for a Shoulder Dislocation
Do not try to force, twist, or pull the shoulder back in place. Place a pillow between the upper arm and the chest. Apply an arm sling and swathe. Apply an ice pack for 20 minutes. Seek immediate medical care.

14 Clavicle Fracture Fractures of the clavicle are common and usually are the result of falling with the arm and hand outstretched. 80% of clavicle fractures occur in the middle third of the bone.

15 Recognizing a Clavicle Fracture (1 of 2)
Usually the fracture is easy to detect because the clavicle lies immediately under the skin. The victim: Fell on an outstretched arm Received a direct blow to the clavicle or shoulder

16 Recognizing a Clavicle Fracture (2 of 2)
AND if the victim has: Severe pain over the injured area Not moved the arm because of pain Swelling Visible deformity Tenderness “Dropped” or drooped shoulder Bruising

17 Care for a Clavicle Fracture
Treat for shock. Apply an arm sling and swathe. Apply ice to the area for 20 minutes, three to four times during the next 24 hours. Seek immediate medical care.

18 Contusions Direct blows cause contusions around the shoulder.
Often called shoulder pointers Contusions of this type may cause severe discomfort

19 Recognizing Contusions
Swelling Pain at the injury site Feeling of firmness when pressure is exerted on the shoulder Tenderness Discoloration under the skin

20 Care for Contusions Apply an ice pack to the area for 20 minutes, three to four times during the first 24 hours. Place the arm in a sling and swathe.

21 Tendinitis General cause of tendinitis in the shoulder is continuous overuse or unusual use. Examples include many of the throwing sports, such as baseball, and in swimming.

22 Recognizing Tendinitis
Constant pain or pain with motion of the shoulder Limited motion of the shoulder “Crackling” sound when the joint is moved Tenderness over the area

23 Care for Tendinitis Use an ice massage for 10 minutes before and after exercise. Use a sling and swath to rest the shoulder. Use pain medication such as ibuprofen. Seek medical advice if needed.

24 Humerus Fracture The shaft of the humerus can be felt throughout its entire length along the inner side of the upper arm.

25 Recognizing a Humerus Fracture (1 of 2)
The victim received: Direct blow to the area Twist or fall on the outstretched arm AND any one or combination of these occurred: Severe pain Swelling

26 Recognizing a Humerus Fracture (2 of 2)
Visible deformity Tender if touched May be unable to move the arm Will hold the arm against the chest for comfort

27 Care for a Humerus Fracture
Treat for shock. Apply an ice pack for 20 minutes. Stabilize the arm by applying one rigid splint on the part of the arm away from the body. Apply an arm sling and swathe. Seek immediate medical care.

28 Elbow Injuries All elbow fractures and dislocations should be considered serious and treated with extreme care. Inappropriate care can result in injury to the nearby nerves and blood vessels.

29 Recognizing Elbow Fractures and Dislocations
Immediate swelling Severe pain Possible visible deformity; compare it with the uninjured elbow. Restricted, painful motion Numbness or coldness of the hand and fingers below the elbow

30 Care for Elbow Fractures and Dislocations
Do not move the elbow. Treat for shock. Splint the elbow in the position found in order to prevent nerve and blood vessel damage. Apply an ice pack for 20 minutes. Seek immediate medical care.

31 Tennis Elbow Results from sharp, quick twists of the wrist (not just from playing tennis) An inflammation of the tendons on the outer side of the elbow Can be very painful whenever the wrist and elbow are used

32 Recognizing Tennis Elbow
Pain increases while using the arm Causes gradual grip weakness Injured elbow fatigues quicker than normal Very tender on outer protrusion of elbow

33 Care for Tennis Elbow Apply heat before an activity; the victim might wear a brace on the sore elbow. Apply ice for 20 minutes after completion of the activity. Seek medical advice for appropriate rehabilitation program.

34 Golfer’s Elbow The equivalent of the more common tennis elbow but with pain on the inside of the elbow It is tendinitis affecting the tendons attached to the bony protrusion, on the inside of the elbow.

35 Recognizing Golfer’s Elbow
Pain increases while using the arm. Causes gradual grip weakness The injured elbow fatigues quicker than normal.

36 Care for Golfer’s Elbow
Apply heat before an activity; the victim might wear a brace on the tender elbow. Apply an ice pack for 20 minutes after completion of the activity. Seek medical advice for appropriate rehabilitation program.

37 Radius and Ulna Fractures
The radius and ulna are the two large bones in the forearm. When only one bone is broken, the other acts as a splint and there may be little or no deformity. When both bones are broken, the arm usually appears deformed.

38 Recognizing Radius and Ulna Fractures (1 of 2)
The victim has pain in the forearm or wrist from: A direct blow Falling on an outstretched hand AND has: A visible deformity Severe pain radiating up and down from the injury site

39 Recognizing Radius and Ulna Fractures (2 of 2)
An inability to move the wrist or it is painful while moving the wrist. OR The wrist is painful on the thumb side and pain continues into next day

40 Care for Radius and Ulna Fracture
Treat for shock. Apply an ice pack to the area for 20 minutes. Apply two rigid splints on both sides of the arm from the tip of the elbow to the fingers. Place the arm in a sling and swathe with the hand in a thumb-up position. Seek medical care.

41 Wrist Fracture The wrist is usually broken when the victim falls with the arm and hand outstretched.

42 Recognizing a Wrist Fracture
Injury to the wrist associated with a snapping or popping sensation within the wrist Pain in the wrist that is aggravated by movement Tenderness Swelling Unable or unwilling to move the wrist Lump-like deformity on the back of the wrist

43 Care for a Wrist Fracture
Use the RICE procedures. Stabilize the wrist with a splint. Seek medical care.

44 Hand Injuries—Crushed Hand
The hand may be fractured by a direct blow or by a crushing injury. Recognizing a crushed hand: Pain Swelling Loss of motion Open wounds Broken bones

45 Care for a Crushed Hand Control the bleeding.
Apply an ice pack for 20 minutes. Seek medical care.

46 Finger Injuries The three bones that make up each finger are the most commonly broken bones in the body. The three joints can also be injured. A so-called finger sprain may be a complicated fracture or dislocation.

47 Finger Fracture Contrary to popular belief, broken bones — especially the fingers — can move when they are broken.

48 Recognizing Finger Fractures (1 of 2)
The finger or thumb has: A visible deformity Immediate pain and hurts with or without movement Numbness Swelling Pinpointed tenderness

49 Recognizing Finger Fractures (2 of 2)
Test for a finger fracture: If possible, straighten the fingers and place them on a hard surface. Tap the tip of the injured finger toward the hand. Pain lower down in the finger or into the hand can indicate a fracture.

50 Care for Finger Fractures
Do not try to realign the finger. Gently apply an ice pack. Splint the finger by one of two methods: Buddy taping the fractured finger to another for support Keeping the hand and fingers in the position of function with extra padding in the palm

51 Finger Dislocation Finger dislocations are common.
Same causes of fractured fingers can also cause a dislocated finger.

52 Recognizing Finger Dislocation
The finger or thumb has: A visible deformity Immediate pain Swelling Shortening of the finger May be unable to bend the finger in the injured area

53 Care for Finger Dislocation
Do not try to realign the dislocation. Apply an ice pack. Splint the finger by one of two methods: Buddy taping the fractured finger to another for support Keeping the hand and fingers in the position of function with extra padding in the palm Seek medical care.

54 Sprained Finger The upper joints of the fingers have a ligament on each side of the joint.

55 Recognizing a Sprained Finger
The finger or thumb has been: “Jammed” or compressed Stepped on Forced or twisted sideways AND the victim: Has pain and swelling Is unable to make a fist Has weakness while curling the finger or gripping

56 Care for a Sprained Finger
Apply an ice pack for 20 minutes. Reevaluate after the ice-pack application and seek medical care if pain and weakness exist. Tape fingers with buddy taping.

57 Nail Avulsion When a nail is partly or completely torn loose
Recognizing a nail avulsion: Nail may be completely detached or partially held in place by the skin

58 Care for a Nail Avulsion
Secure the damaged nail in place with an adhesive bandage. If part of all of the nail has been completely torn away, apply antibiotic ointment. Do not trim away the loose nail. Consult a physician for further advice.

59 Splinters Sharp splinters can be impaled into the skin or under a fingernail or toenail. Recognizing splinters: Small puncture wound Sliver may be seen or in other cases, not seen nor can it be felt

60 Care for Splinters If embedded in the skin, use tweezers to remove it.
In some cases, you may need to tease it out with sterile needle. Clean the wound with soap and water. If the splinter is impaled under a fingernail or toenail and breaks off flush, cut a V-shaped notch in the nail to gain access to the splinter.

61 Blood Under a Nail Blood collects under a nail when underlying tissues are bruised. Recognizing blood under a nail: Excruciating pain exists because of the blood pressure against the nail Pain does not disappear until the collection of blood is drained

62 Care for Blood Under a Nail
Apply an ice pack with the hand elevated. Relive the pressure using a knife or a red-hot metal paperclip or needle. Apply a dressing.

63 Ring Strangulation Can be a serious problem if it cuts of the blood supply long enough Recognizing ring strangulation: The ring has become tight on the finger after an injury or swelling.

64 Care for Ring Strangulation (1 of 2)
Try one of the following methods to remove a ring: Lubricate the finger with soap and water or some other slippery substance. Immerse the finger in cold water or apply an ice pack to reduce swelling. Liberally spray window cleaner onto the finger, then try to slide the ring off.

65 Care for Ring Strangulation (2 of 2)
Massage the finger from the tip toward the hand to move the swelling Lubricate the finger again and try removing the ring Cut the narrowest part of the ring with a ring saw, jeweler’s saw, or fine hacksaw blade, taking care to protect the exposed parts of the finger.

66 Hip-Joint Injuries Hip Dislocation Hip Fracture

67 Hip Dislocation A hip can be dislocated by a fall, a blow to the thigh, or direct force to the foot or knee. Often a hip is dislocated when the knee strikes the dashboard during a motor vehicle crash. It is difficult to differentiate a hip dislocation from a hip fracture.

68 Recognizing Hip Dislocation
Severe pain at the injury site Swelling at the injury site Hip is flexed and the knee bent and rotated inward toward the opposite hip Injury usually quite visible

69 Care for Hip Dislocation
Treat for shock. Stabilize the injury. Check for an ankle pulse. Seek medical care. This injury is best transported by EMS.

70 Hip Fracture Fracture of the upper end of the femur, not the pelvis
Elderly people, especially women, are susceptible to this type of injury because of brittle bones.

71 Recognizing a Hip Fracture
Severe pain in the groin area Inability to lift the injured leg Leg may appear shortened and be rotated with the toes pointing abnormally outward.

72 Care for a Hip Fracture Treat for shock.
Stabilize the injured leg against movement. Monitor the ankle pulse. Seek immediate medical care. This injury is best transported by EMS.

73 Thigh Injuries Femur fracture Muscle contusion Muscle strain

74 Femur Fractures Because the femur is the largest bone in the body, considerable force is required to break it. Femur fractures often include open wounds and external bleeding may be severe.

75 Recognizing a Femur Fracture
Severe pain at the injury site Deformity may occur Swelling comes from severe damage to blood vessels Victim may report having heard or felt a severe pop or snap at the time of injury.

76 Care for a Femur Fracture
Treat for shock. Cover a wound with a sterile dressing. Stabilize the injured leg against movement. Monitor the ankle pulse. Seek immediate medical care. This injury is best transported by EMS.

77 Muscle Contusion The muscle group on the front of the thigh is the quadriceps group and often gets bruised. Depending upon the force of impact and muscles involved, the contusion may be of varying degrees of severity.

78 Recognizing a Muscle Contusion
Victim received a direct hit producing: Swelling Pain and tenderness Tightness or firmness of site when pressed Visible bruise that may appear hours later

79 Care for a Muscle Contusion
Follow the RICE procedures. Stretch the muscle by bending the knee toward the victim’s chest.

80 Muscle Strain When a muscle is overstretched, it can result in a tear, called a strain. Different degrees of strains occur, but first aiders will be unable to determine their degree.

81 Recognizing a Muscle Strain
While running or jumping, the victim: Feels a pop or pulling sensation And later has: Tenderness Stiffness and pain during movement Swelling A visible bruise appearing days later

82 Care for a Muscle Strain
Follow the RICE procedures. Stretch the muscle but do not force stretching.

83 Knee Injuries Among the most serious joint injuries
Their severity is difficult to determine, thus medical care is necessary if the injury is from being hit or twisted and not from overuse.

84 Knee Fracture Generally occurs as a result of a fall or a direct blow
May occur at the end of the femur, at the end of the tibia, or in the knee cap

85 Recognizing a Knee Fracture
Determining if a fracture exists is difficult. Some fractured knees may look like a discoloration. Other signs include: Deformity Tenderness Swelling

86 Care for a Knee Fracture
If a pulse can be felt in the ankle with no deformity, splint the leg with the knee straight. If a pulse can be felt in the ankle with significant deformity, splint the knee in the position found. Seek medical care.

87 Knee Dislocation A knee dislocation is a serious injury.
Recognizing a knee dislocation: Excruciating pain Deformity Pulse may be absent in the ankle Do not confuse a knee dislocation with a patella dislocation

88 Care for a Knee Dislocation
Stabilize the knee in the position found. Seek medical care immediately.

89 Patella Dislocation A dislocated patella can be a very painful injury and must be treated immediately. Some people have repeated kneecap dislocations. A dislocated patella most commonly occurs in teenagers and young adults who are engaged in athletic activities.

90 Recognizing a Patella Dislocation
Possible swelling An inability to bend or straighten the knee Pain Deformity

91 Care for a Patella Dislocation
Follow the RICE procedures. Do not try to relocate a dislocated kneecap. Splint the knee in the position found. Seek medical care.

92 Knee Sprain Ligament injuries occur most often in sports.
The knee is very prone to ligament injury, ranging from mild sprains to complete tearing.

93 Recognizing a Knee Sprain
At the time of injury the victim has: Severe pain The feeling of a pop or snap A locking sensation The victim may not be able to walk without limping, or bend the knee Later, there may be swelling in the knee and bruising.

94 Care for a Knee Sprain Follow the RICE procedures. Seek medical care.

95 Knee Contusion Contusions of the knee are caused by a direct blow or by falling on the knee. Recognizing a knee contusion: Pain Swelling Tenderness Bruise marks Care for a knee contusion: Follow the RICE procedures.

96 Lower-Leg Injuries Tibia and fibula fractures
Tibia and fibula contusion Muscle cramps Shin splints Ankle and foot injuries Toe injuries

97 Tibia and Fibula Fractures
Tibia and fibula injuries can occur at any place between the knee joint and the ankle joint. Injuries to the blood vessels, caused by extreme deformity, are common with injuries of the tibia and fibula, and the pain is usually severe.

98 Recognizing Tibia and Fibula Fractures
Severe pain Swelling Visible deformity Tenderness when touched

99 Care for Tibia and Fibula Fractures
Stabilize the leg using a splint. Apply an ice pack. Seek medical care.

100 Recognizing Tibia and Fibula Contusion
Victim received a hit directly on the shin. Tender when touched Sharp pain Later has: Discoloration Difficulty moving ankle up and down Numbness or coldness in toes or foot

101 Care for a Tibia and Fibula Contusion
Expose the injury. Apply the RICE procedures. If numbness or tingling exists, seek medical care.

102 Muscle Cramp Muscle spasm or cramping usually occurs in the calf and sometimes in the thigh or hamstring. It is a temporary condition of little consequence.

103 Recognizing a Muscle Cramp
Happens during or after intense exercise sessions Painful, muscle contraction or spasm which disables the victim

104 Care for Muscle Cramps Try one or more of the following:
Have the victim gently stretch the affected muscle. Relax the muscle by applying pressure to it. Apply ice to the cramped muscle. Pinch the upper lip hard to reduce calf-muscle cramping. Have the victim drink lightly salted, cool water.

105 Shin Splints Describes pain in the front of the lower leg
Caused by repetitive stress in the leg such as running or walking

106 Recognizing Shin Splints
The shin aches during activity, but: Ache subsides significantly after activity stops Ache is a result of an increase in the workout routine Usually a chronic problem that gets worse

107 Care for Shin Splints Apply an ice pack before an activity.
Apply pressure with a 3-inch elastic bandage over the sorest point. Apply an ice pack for 20 minutes after the activity. Curtail activity until the shin is pain free. Pain medications that are anti-inflammatory drugs may be taken.

108 Ankle and Foot Injuries
The ankle and foot frequently are injured, mainly by twisting. In some cases, the damage requires surgical correction. Most ankle injuries are sprains; about 85% of sprains involve the outside ligaments.

109 Recognizing Foot and Ankle Injuries
Press along the bones to check for pain and tenderness. Ask the victim, “Have you tried standing on it?” If the victim hops on the good foot and the injured ankle cannot tolerate the jarring, suspect a fracture. Ankle sprains tend to swell on only one side of the foot; swelling on both sides usually accompanies fractures.

110 Care for Foot and Ankle Injuries
Controversy exists about whether to remove a shoe from an injured foot. Shoe may act as a splint and retard swelling; however, taking the shoe off allows for better examination and care. Use RICE procedures to reduce swelling.


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