1. Chapter 3 Injury Emergencies

2. Bleeding Control
Avoid contact with blood by putting on disposable exam gloves.
To control bleeding:
Place a gauze dressing over the wound. If not available, use your gloved hand.
Apply direct pressure.
If the dressing becomes blood-soaked, add more dressings onto the first one and press harder and wider over the wound.

4. Tourniquets
If direct pressure fails to control bleeding on an arm or a leg, apply a manufactured tourniquet 2 to 3 inches (5 to 7 cm) above the wound.
Tighten the tourniquet until the bleeding stops, then secure it in place.
Manufactured tourniquets appear to be better than those that are improvised.
Note: If time permits, an optional skills demonstration on Applying a Manufactured Tourniquet is included within the teaching package.

5. Tourniquets
If a manufactured tourniquet is not available, apply an improvised tourniquet.
Wrap a band of soft material twice around the arm or leg and about 2 to 3 inches (5 to 7 cm) above wound.
DO NOT use narrow materials, elastic materials, or bungee-type devices.
Tie a half or overhand knot on the arm or leg and place a short, rigid object over it. Then, tie a square knot over the rigid object.
Twist the rigid object until the bleeding stops.
Tie or tape the rigid object in place to keep the tourniquet from unwinding.
Note: If time permits, an optional skills demonstration on Applying an Improvised Tourniquet is included within the teaching package.

7. Hemostatic Dressings Apply a hemostatic dressing if:
Direct pressure is not effective in controlling bleeding.
A tourniquet is not available, is ineffective, or cannot be applied.
Apply a hemostatic dressing in combination with direct pressure followed by a pressure bandage (eg, roller bandage).
Courtesy of Z-Medica.

8. Bleeding Control: Scenario
A knife slipped and sliced into the forearm of a 35-year-old male butcher at a supermarket butcher shop. He is holding a blood-soaked cloth over the injury, and you see blood on the floor and a display case. He said the blood was shooting out of his arm.

9. Bleeding Control: Agree or Disagree?
Most cases of bleeding require more than direct pressure to stop it.
While trying to stop bleeding, remove and replace blood- soaked dressings.
If a bleeding arm wound is not controlled through direct pressure, apply pressure to the brachial artery.
If direct pressure fails to control an arm or leg’s severe bleeding, apply a tourniquet.
If direct pressure fails, raise the arm or leg.
Once bleeding has been stopped, pressure bandages can maintain control if needed.

10. Shallow Wounds: What to Do
Gently wash inside and around the wound with running water, with or without soap.
Flush with pressurized water.
Pat the area dry.
If bleeding restarts, apply direct pressure.
Apply a thin layer of antibiotic ointment over the wound .
Cover the wound with a sterile or clean dressing and bandage.
© Scott Camazine/Alamy

11. Severe Wounds: What to Do
For a wound with a high risk of infection, clean as best you can.
Cover with a sterile or clean dressing held in place by a bandage.
Care for shock; keep the person from getting chilled or overheated.

12. Wound Care: Scenario
You find a coworker in the storage room with a blood-soaked cloth covering his hand. He said that glass from a broken bottle caused the wound. You take a quick look and see a jagged, gaping, open wound.

13. Wound Care: Agree or Disagree?
Gently wash a shallow wound with soap and warm running water.
Soak a wound in water to clean it.
After cleaning a shallow wound, cover it with antibiotic ointment before putting on a dressing.
Apply alcohol or hydrogen peroxide to a wound.
Seek medical care for wounds more than 1 inch long or one in which the edges do not fall together.
Wounds with a high risk for infection should receive medical care for proper cleaning.

14. Nosebleeds: What to Do If nose was hit, suspect a broken nose.
Have the person sit leaning slightly forward.  
Pinch the nostrils shut for 10 minutes.  
© American Academy of Orthopaedic Surgeons.

15. Nosebleeds: What to Do If bleeding has not stopped after 10 minutes:
Have the person gently blow his or her nose to get rid of ineffective blood clots.
Pinch the nostrils together again for 10 minutes.  
Try other methods, such as applying an ice pack or spraying decongestant spray in nostrils.  
If bleeding reoccurs, seek medical care.

16. Nosebleeds: Scenario
Sean played a practical joke on one of his coworkers, startling him. In reaction, the coworker jumped up, hitting his nose against Sean’s elbow, causing a nosebleed. You pinch his nostrils shut, but his nose continues to bleed.

17. Nosebleeds: Agree or Disagree?
Position the person in a sitting posture.
Keep the head tilted slightly backward.
Pinch the nostrils shut for 10 minutes.
All nosebleeds require medical care.

18. Tooth Injuries: What to Do
Attempt to reimplant the tooth:
DO NOT touch the root of the tooth.
If the tooth is dirty, rinse it in a bowl of water.
Replace the tooth into its socket.
If unable to reimplant, store the tooth in one of the following until a dentist is available:
Hank’s Balanced Salt Solution
Egg white
Coconut water
Whole milk
© Amercian Academy of Orthopaedic Surgeons.

19. Tooth Injuries: What to Do
If none of the previously mentioned solutions are available, have the person spit saliva in a small container into which the tooth can be placed.
Seek a dentist as soon as possible.

20. Tooth Injuries: Scenario
Your friend was struck in the mouth by a pipe that was loosely suspended from a cable. He has spit out two of his front teeth, which are lying on the ground.

21. Tooth Injuries: Agree or Disagree?
Place a knocked-out tooth in mouthwash or rubbing alcohol until you reach a dentist.
Before attempting to reinsert a knocked-out tooth, scrub the tooth.
Only a dentist should attempt to reinsert a knocked-out tooth.
Never put an aspirin on an aching tooth or gums.
Have the person spit saliva into a small container and place the knocked-out tooth in it until you reach a dentist.

22. Eye Injuries: What to Do
Blow to the eye
Apply an ice pack around the eye for 15 minutes. DO NOT place the pack on the eye.
Have the person keep the eyes closed.
Seek medical care.
© American Academy of Orthopaedic Surgeons.

23. Eye Injuries: What to Do
Loose object in the eye
Have the person blink the eye several times.
Pull the upper eyelid out and over the lower lid.
Gently irrigate with clean, warm water.
Lift the eyelid up and over a cotton swab. If object is seen, remove it with the corner of a wet gauze pad.
If successful, medical care is usually not needed.

24. Eye Injuries: What to Do
Object stuck in the eye
DO NOT remove the object.
For a long object, place padding around the object to stabilize, and place a paper cup over the object.
For a short object, place a donut-shaped pad around the eye, and wrap a bandage around the head to hold it in place.
Cover both eyes.
Keep the person flat on his or her back.
Call as soon as possible.

25. Eye Injuries: What to Do
Chemical in the eye
Hold the eye wide open; flush with warm water for at least 15 minutes.
The eyes may need to be loosely bandaged.
Contact the poison control center.
If not available, seek medical care as soon as possible or call

26. Eye Injuries: What to Do
Cut on the eyeball
DO NOT apply pressure to the injured eye.
Cover both eyes with gauze pads, and lightly wrap a bandage around the head.
Call or drive the injured person to a medical facility as soon as possible.
© American Academy of Orthopaedic Surgeons.

27. Eye Injuries: What to Do
Burns caused by light
Cover both eyes with moist, cool cloths.
Give pain medication if needed.
Seek medical advice.

28. Eye Injuries: Scenario
You are having a part of your house remodeled. One of the construction workers working on the project unintentionally pulls the trigger of a nail gun he is using. A nail becomes impaled (embedded) in the eye of another worker.

29. Eye Injuries: Agree or Disagree?
Tears will sufficiently flush out chemicals in the eye.
To rinse a chemical out of the eye, pour water into the eye for about 5 minutes.
To rinse a chemical out of the eye, hold the eye open and flood the eye with water for 20 minutes.
Use tweezers to remove small objects in the eye.
For a cut to the eyeball, cover both eyes with dressings and immediately obtain medical care.
For a long object stuck in the eye, protect it from being bumped and stabilize against movement.

30. Impaled (Embedded) Object: What to Do
Sliver
Remove with tweezers.
Wash the area with soap and water.
Apply antibiotic ointment.
Apply an adhesive bandage.

31. Impaled (Embedded) Object: What to Do
Large object
DO NOT remove or move the object.
Stabilize the object with bulky dressings or padding placed around the base of the object.
If bleeding, apply direct pressure around the base of the object.
If necessary, reduce the length or weight of the object by cutting or breaking it.
Call
© American Academy of Orthopaedic Surgeons.

32. Impaled (Embedded) Object: Scenario
Your husband is helping to remodel a part of your house. While working on setting up some wall framing, he fires an air-powered nail gun. The nail penetrates into his left index and middle fingers.

33. Impaled (Embedded) Object: Agree or Disagree?
Remove an embedded object to prevent infection.
Prevent an embedded object from moving by placing bulky padding around the base of the object.
Use tweezers to remove a sliver in the skin.
For a long, embedded object in an eye, use a paper cup or similar item over the eye for protection.
Allow a person with an embedded object in the eye to see by leaving the uninjured eye uncovered.

34. Amputations: What to Do
Call
Control the bleeding.
© E.M. Singletary, M.D. Used with permission.

35. Amputations: What to Do
Care for the amputated part:
Wrap the part in a moistened sterile gauze or clean cloth.
Put the wrapped part in a waterproof container.
Keep the part cool by placing the wrapped part in a container of ice.
DO NOT bury the part in ice or allow it to directly touch the ice. DO NOT submerge it in water.
If the amputated part was not found, ask others to search for it and, if located, to take it to the medical facility where the person is going.

36. Avulsions: What to Do
Gently move the skin back to its normal position.
Cover with a sterile or clean dressing and apply pressure.
If bleeding continues, apply a tourniquet or a hemostatic dressing, if available.
© American Academy of Orthopaedic Surgeons.

37. Amputations and Avulsions: Scenario
Your neighbor is mowing tall, wet grass when it begins to back up at his mower’s discharge opening. He reaches into the discharge chute to try to brush away a clump of grass, and his fingers are struck by the mower’s blade. Two fingers are cut off. You find him sitting on the lawn, firmly holding what remains of his fingers.

38. Amputations and Avulsions: Agree or Disagree?
Recover any amputated part, regardless of size, and take it with the person to the nearest hospital.
Cut off a partially attached body part because it will not survive.
Wrap an amputated part in a moistened, sterile gauze dressing, enclose it in a waterproof container, and keep it cool.
Keep an amputated part buried in ice or cold water.
Be prepared to apply a tourniquet if the bleeding does not stop by applying direct pressure.

39. Head Injuries: What to Do
If you suspect a skull fracture:
Apply a sterile or clean dressing over the wound and hold it in place with gentle pressure.
Control bleeding by pressing on the edges of the wound.
Call
© Jones & Bartlett Learning. Courtesy of MIEMSS.

40. Head Injuries: Scenario
At work, you are called to help a carpenter who fell from a ladder. A bystander says that, though responsive now, he was motionless for a couple of minutes. He complains about a severe headache and dizziness. There is swelling on the back of his head. You see no blood on him or in the surrounding area.

41. Head Injuries: Agree or Disagree?
To control bleeding with a suspected skull fracture, press around the edges and not directly on the wound.
Do not remove an impaled object from a skull.
A person whose head is injured may also have a spine injury.
Move any skin flap back to its normal position.
A person with a suspected concussion does not require medical care—only rest.

42. Spinal Injuries: What to Do
Call Wait for trained rescuers with proper equipment.
DO NOT attempt to move the person.
Apply spinal stabilization.
Cover the injured person to prevent heat loss.
© American Academy of Orthopaedic Surgeons.

43. Spinal Injuries: Scenario
At a construction site, a worker has fallen from a 15-foot ladder. He is complaining about back pain and cannot wiggle his toes, nor can he feel you pinching his toes on either foot.

44. Spinal Injuries: Agree or Disagree?
Consider a spinal injury whenever an older person falls.
Consider a spinal injury whenever the person is involved in a high-speed vehicle collision.
Being able to wiggle fingers and toes could indicate a spinal injury.
Trouble breathing is a reliable sign of a spinal injury.
Stabilize a person with a suspected spinal injury with your hands until EMS arrives.

45. Chest Injuries: What to Do
For all chest injuries, look for:
DOTS: Deformity, Open wound, Tenderness, Swelling
Abnormal breathing rate and/or sounds
Guarding
© American Academy of Orthopaedic Surgeons.
© American Academy of Orthopaedic Surgeons.

46. Chest Injuries: What to Do
Rib fracture
Help the person find a comfortable position.
Stabilize the chest by:
Having the person hold a pillow or other similarly soft material against the area, or
Placing arm on the injured side in a sling and binder.
DO NOT apply tight bandages around the chest.  
Give pain medication.  
Have the person cough and take deep breaths a few times every hour to prevent pneumonia.  
Call

47. Chest Injuries: What to Do
Flail chest
Stabilize the chest by:
Placing a pillow or similarly soft material against area or arm on the injured side in a sling and binder, and
Placing the person on his or her injured side with a blanket or similarly soft material underneath the person.
DO NOT apply tight bandages around the chest.  
Call

48. Chest Injuries: What to Do
Penetrating object
Stabilize the object in place with bulky dressings or clothes.
DO NOT try to remove the object.  
Call
© American Academy of Orthopaedic Surgeons.

49. Chest Injuries: What to Do
Open chest wound
Leave the wound exposed to air without a dressing or any airtight material.
DO NOT allow a blood-soaked dressing to become a barrier or obstruction if a dressing and direct pressure are used to stop bleeding.
Call

50. Chest Injuries: Scenario
A worker was struck by a piece of reinforcing bar at a building under construction. The bar penetrated the worker’s chest. You are called over to help, and you see that the iron rod has been removed. Air is passing in and out of the man’s chest with each breath he takes.

51. Chest Injuries: Agree or Disagree?
Stabilize a broken rib by taping a person’s chest as tight as possible.
Stabilize an impaled object in the chest with bulky padding to prevent it from moving.
Do not apply an airtight material to seal off an open chest wound.
Have the person with a chest injury sit up.
Stabilize a broken rib by holding a pillow or blanket over the injured area.

52. Abdominal Injuries: What to Do
Penetrating object
DO NOT remove a penetrating object.  
Stabilize the object against movement.  
Call

53. Abdominal Injuries: What to Do
Protruding organs
DO NOT try to push protruding organs back into the abdomen.
DO NOT touch organs.
Cover them with a moist, clean dressing.
Call

54. Abdominal Injuries: What to Do
Hard blow to abdomen
Roll the person onto one side and expect vomiting.
Monitor for signs of possible internal injuries.
Call

55. Abdominal Injuries: Scenario
A repairman falls while carrying replacement glass for a broken window. The new glass breaks into several jagged pieces. You find him lying on his back with a blood-soaked shirt. You see a lacerated abdomen with several loops of bowel protruding through the wound. The man says that a piece of glass caused the wound.

56. Abdominal Injuries: Agree or Disagree?
Gently push protruding organs back into the abdominal wound.
Keep the dressing covering protruding intestines dry.
Remove a penetrating object from the abdomen.
Stabilize an impaled object in place using bulky dressings or cloths.
For a blow to the abdomen when internal injuries are suspected, place the person on his or her side with the legs pulled up toward the abdomen.

57. Bone Injuries: What to Do
If EMS will arrive soon, hold the injured part.
If EMS is delayed or if you are transporting the person a long distance, use the RICE procedure and stabilize the part with a splint.
DO NOT try to straighten an injured extremity.
Call for a blue or extremely pale extremity.
© E.M. Singletary, M.D. Used with permission.
Note: If time permits, the following optional skills demonstrations are included within the teaching package:
RICE Procedure for an Ankle Injury
Applying a Rigid Splint on a Forearm
Applying a Soft Splint on a Forearm
Applying an Arm Sling
Applying a Cravat Bandage on an Arm or Leg
Applying a Cravat Bandage to the Palm of the Hand
Making a Cravat Bandage from a Triangular Bandage

58. Bone Injuries: Scenario
While cleaning leaves out of a rain gutter, your neighbor falls off the roof of her house and lands into a section of bushes. She complains about pain in her left lower leg. You look at the leg and feel it. It is beginning to swell and when compared with the uninjured leg, the injured one has a slight bend in it. The house is about 20 miles from the nearest hospital.

59. Bone Injuries: Agree or Disagree?
Check for DOTS to locate a possible broken bone.
If EMS is delayed, use the RICE procedure on a suspected broken bone.
If you are transporting a person with a suspected broken bone to a medical facility, apply a splint to stabilize the part.
If a bone is sticking out through the skin, try to push the bone ends back beneath the skin surface.
Try to straighten a crooked or bent broken bone.

60. Joint Injuries: What to Do
Dislocation
Call
Hold the part when transporting a short distance or until EMS arrives.
If EMS is delayed or if you are transporting a long distance:
Use the RICE procedure.
Use a splint to stabilize the part.
DO NOT try to reduce or reset a dislocation.

61. Joint Injuries: What to Do
Sprain
Most sprains do not require medical care.
If recuperation seems long, consult a physician.
Use the RICE procedure.
© American Academy of Orthopaedic Surgeons

62. Joint Injuries: Scenario
During a city league basketball game, a player turns his ankle. He hobbles with difficulty and pain off the court. By the time he takes off his shoe, swelling has started to form on the ankle’s outer side.

63. Joint Injuries: Agree or Disagree?
Use the RICE procedure to treat sprains and dislocations.
When using an ice pack, place it directly on the skin.
Apply an elastic bandage to help control swelling in a joint.
Seek medical care for dislocated joints.
Try to reset or reduce dislocations.

64. Muscle Injuries: What to Do
Cramp
Try one or more of these methods to relax the muscle:
Gently stretch the affected muscle.
Press on the muscle.
Apply an ice pack to the muscle.
Drink lightly salted cool water or a commercial sports drink.
DO NOT give salt tablets.
Bruises and strains
Use the RICE procedure.

65. Muscle Injuries: Scenario
While sprinting toward the finish line, a high school runner suddenly stops and with pain showing on her face. She hobbles her way off the track. Her coach asks what happened, and she complains about pain in her upper leg and believes that she has “pulled” a muscle.

66. Muscle Injuries: Agree or Disagree?
Give a sports drink to help treat a muscle cramp.
Use the RICE procedures for muscle bruises.
For muscle injuries, apply an ice pack for 5 minutes.
The rest part of the RICE procedure refers to getting 7 to 9 hours of sleep.
A thin cloth should be placed between an ice pack and a person’s skin.

67. Thermal Burns: What to Do
Stop the burning by removing the person from the heat source.
Remove clothing and jewelry from the burn area.
DO NOT try to remove stuck clothing.
Seek medical care for the following:
Burns on face, neck, hands, feet, or genitals
Breathing difficulty
Blistering or broken skin
Large area of skin or tissue burned
All third- and large second-degree burns

68. First-Degree Burns: What to Do
Immerse the burned area in cool or cold water for at least 10 minutes.
Give ibuprofen.
Have the person drink as much water as possible without becoming nauseous.
Keep the burned arm or leg raised.
After burn has been cooled, apply aloe vera gel.
© Suzanne Tucker/ShutterStock.

69. Second-Degree Burns: What to Do
Small second-degree burns
Follow Steps 1 through 4 for first-degree burns, with the following additions:
After burn has been cooled, apply a thin layer of antibacterial ointment.
Cover the burn with a loose, dry, nonstick, sterile or clean dressing.
Large second-degree burns
Follow Steps 1 through 4 for first-degree burns, with the following additions:
Apply cold, but monitor, as it may cause hypothermia.
Call

70. Third-Degree Burns: What to Do
Cover the burn with a dry, nonstick, sterile or clean dressing.
Call
© American Academy of Orthopaedic Surgeons

71. Thermal Burns: Scenario
Your roommate is boiling water in the kitchen. She reaches across the stove for a cup and the sleeve of her blouse touches the gas flame and ignites, sending fire racing up her arm. Her screams bring you racing into the kitchen. After putting the fire out, you check her and find that she has burns on about 5% of her arm.

72. Thermal Burns: Agree or Disagree?
Apply butter or petroleum jelly on a burn.
Apply ice or ice water on a burn.
Run cold water over first- and small second-degree burns.
Cover first-degree burns with a sterile dressing.
Break blisters from a burn to shorten the healing time.

73. Electrical Burns: What to Do
If the person is still in contact with electricity:
Call to have the electricity turned off.
DO NOT touch or move power lines or the person.
DO NOT try to move electrical wires or devices with a wooden pole or handle.
Keep people away from the area.

74. Electrical Burns: What to Do
If the person is not in contact with electricity and danger to rescuer has passed:
Check breathing, and if absent, begin CPR.
Call immediately.
Cover burn wounds with sterile dressings.
© Chuck Stewart, MD.

75. Electrical Burns: Scenario
You call an electrician to your home to resolve some electrical issues that have been occurring. You leave him as he begins to work on a live electrical circuit-breaker box. When you come back to check on him, you find him on floor not moving.

76. Electrical Burns: Agree or Disagree?
If an electrocuted person is in contact with an outdoor electrical wire, try to move the wire or the person with a wooden object.
For an electrocuted person inside a building, turn off the electricity at the fuse box, circuit-breaker, or outside switch box, or unplug the appliance.
After an unresponsive, electrocuted person has been rescued, check for breathing.
Care for both entrance and exit wounds.
All electrocuted people need medical care.

77. Chemical Burns: What to Do
Once the area is safe:
Brush a dry or powder chemical off the skin with a gloved hand or piece of cloth before flushing with water.
Flush the burn with large amounts of cool running water for at least 20 minutes or until EMS arrives.
Call immediately for all chemical burns.
DO NOT try to neutralize the chemical.
© American Academy of Orthopaedic Surgeons.

78. Chemical Burns: What to Do
Once the area is safe (cont’d):
For a chemical in an eye:
Tip the head so the affected eye is below the nose.
Wash the eye with warm water from nose out to the side of the face for at least 20 minutes.

79. Chemical Burns: Scenario
You are helping a coworker replace a battery when it explodes, showering his arms with battery acid.

80. Chemical Burns: Agree or Disagree?
When washing chemicals off the body, flush continuously with water for at least five minutes.
When washing chemicals off the body, use high pressure water.
Try to neutralize a chemical so it does not cause more damage.
Brush dry powder chemicals from the skin before flushing.
Taking off clothing covering the affected area can be done while flushing the body with water.

81. Blisters: What to Do
Hot spot and a blister that is closed and not very painful
Depending upon availability and the blister’s location, apply one of the following:
Blister bandage (Blist-O-Ban)
Surgical tape (Micropore paper tape)
Elastic tape (Elastikon)
Trim and round the edges of the tape to prevent it from peeling off.
© Maximillian Weinzierl/Alamy.

82. Blisters: What to Do Blister that is closed and very painful
Clean the blister and a needle with an alcohol pad.
Make several small holes at the base of the blister with the needle. Gently press the fluid out.
Apply paper tape.
Cover paper tape with elastic (Elastikon) or adhesive tape.
Trim and round the edges of the tape.
Watch for signs of an infection.

83. Blisters: What to Do Blister that is very painful and open or torn
Use scissors to carefully trim off the dead skin.
Place a blister pad (Spenco 2nd Skin) over the raw skin.
Cover the blister pad with paper tape.
Cover paper tape with elastic (Elastikon) or adhesive tape. Trim and round the edges of the tape.
Watch for signs of an infection.

84. Blisters: Agree or Disagree?
Apply paper tape to relieve a hot spot.
For an open or torn blister, apply a blister pad once the blister roof has been removed.
Drain the fluid out of a very painful, closed blister.
Apply an adhesive strip (Band-Aid) over a blister.
Regardless of cause (ie, friction, burn, frostbite, poison ivy), treat all blisters the same.