Five principles of first aid for fractures
Fractures are usually divided into two categories: closed and open. A closed fracture means that the skin and soft tissue are relatively intact and the fracture end is not yet connected to the outside world; an open fracture means that there is a wound at the fracture site and the fracture end is connected to the outside world. Fractures can occur in all parts of the body, but the most common are fractures of the extremities. Once you suspect a fracture, you should minimize the activity of the affected area and try to use a hard bed when transferring. Here are the 5 principles of first aid after fracture.
I. Life-saving
The first principle of first aid at the scene of serious trauma is to save life. If the heartbeat and respiration of the injured person have stopped or are on the verge of stopping, chest cardiac compression and artificial respiration should be carried out immediately; unconscious patients should keep their airways open and remove foreign bodies from their oropharynx in time; patients with consciousness impairment can needle their acupuncture points such as Renzhong and Baihui; open fracture injuries can have a lot of bleeding at the wound, and generally dressings can be used to stop bleeding with pressure. If a tourniquet is used to stop bleeding in severe bleeding, be sure to record the time when the tourniquet is started and should be relaxed once every 30 minutes (30 to 60 seconds each time) to prevent ischemic necrosis of the limb. In case of the above life-threatening fracture patients, they should be quickly transported to the hospital for treatment.
Second, wound treatment
The treatment of open wounds should not only stop bleeding in a timely and appropriate manner, but also immediately dress the wound with sterile gauze or clean cloth to prevent the wound from continuing to be contaminated. The foreign body on the wound surface should be removed, and the exposed fracture end should not be pushed into the wound to avoid contamination of deep tissue. If possible, it is best to use potassium permanganate and other disinfectant solutions to rinse the wound before dressing and fixing.
III. Simple fixation
Timely and correct fixation of the broken limb in first aid can reduce the pain of the casualty and continue to damage the surrounding tissues, and also facilitate the handling and transfer of the casualty. But the fixation in first aid is temporary. Therefore, it should be simple and effective, and accurate fracture repositioning is not required; open fractures with exposed bone ends should not be repositioned, but fixed in situ. The length of the fixation should be such that the upper and lower joints of the fracture are fixed. If you can’t find a hard object to fix, you can also tie the injured limb directly to your body with a cloth belt. The upper limb of the fracture can be fixed to the chest wall so that the forearm hangs in front of the chest; the lower limb of the fracture can be fixed together with the healthy limb.
IV. Necessary pain relief
After severe trauma, strong pain stimulation can cause shock, so the necessary painkillers should be given. Such as oral painkillers, can also inject painkillers, such as morphine 10 mg or Dulcolax 50 mg. However, those who have brain and chest injury should not inject morphine, so as not to inhibit the respiratory center.
V. Safe transportation
After the above scene rescue, the casualty should be quickly and safely transferred to the hospital for treatment. During the transfer, attention should be paid to light and steady movements to prevent vibration and touching the injured limbs to reduce the pain of the casualty; pay attention to their warmth and appropriate activities.
Treatment details.
1, quickly use a splint to fix the affected area, the fixation should not be too tight; pad loose items between the board and the limb, and then tie it with straps, the board grows out of the upper and lower two joints of the fracture site, if there is no board available branches, rolling pins, umbrellas, newspaper rolls and other items instead.
2, open fractures with rupture bleeding, available clean sterilized gauze compression, compression can not stop the blood, available tourniquet ring tie the wound above (proximal end) to stop bleeding.
3. In thigh fractures, internal bleeding can reach 1000 ml (total human blood volume is about 4000 ml). Too tight a bandage fixation can also cause nerve paralysis, and close attention must be paid to the patient’s condition.
Experts point out that the treatment of fractures on the spot is more diverse, depending on the specific situation to take different treatment methods, such as a mild woundless fracture, not yet swollen, if possible, should first cold compress treatment, using ice water, ice or freezing agent dressing to prevent swelling of the fracture site, frozen mineral water and pure water can also be, but not recommended to use tap water, fixed and sent to the hospital for treatment.
If there is a wound, it is not advisable to apply cold compresses, use sterile gauze to stop bleeding, and in case of serious bleeding inconvenience or inability to stop bleeding by compression (generally refers to open thigh fractures or other parts of serious bleeding), apply a tourniquet or cloth, etc. to ring the part near the side of the heart and send it to the hospital immediately, and keep communicating with the injured person to pay attention to his condition and prevent him from losing too much blood causing coma, shock or even death. Compression can be used to stop the bleeding. The important thing to remember is that once the hemostasis is stopped with cloth straps or rope, the time of the straps must be recorded and should generally not exceed 1 hour to avoid ischemic necrosis of the limb due to excessive time. It is generally necessary to loosen the tourniquet for at least 5 minutes every 1 hour. If the bleeding is dark red and slow for venous blood, the bandage is done at the distal end of the wound. If the bleeding is bright red and rapid, it is arterial and should be bandaged at the proximal end of the wound. If the fracture end is exposed, do not try to put the fracture end back in place, but continue to keep it exposed so as not to bring bacteria into the deep part of the wound causing deep infection. If the fracture end or dislocated joint is repositioned, it should be noted and clearly explained to the physician at the time of transport to the hospital.
In addition, the orthopedic department of the upper limb can help the injured person to go to the hospital, while the spine, waist and lower limb fractures must be transported on a stretcher, and the condition of the injured person must be confirmed before moving the injured person. The injured person’s limbs should not be moved or moved to avoid secondary injuries.
Finally, experts especially emphasize that if the fracture is in the cervical spine, improper first aid operations can cause damage to the cervical spinal cord, resulting in paraplegia and, in severe cases, life-threatening respiratory depression. Improper handling of thoracolumbar spine fractures can also damage the spinal cord nerves of the thoracolumbar spine and lead to paralysis of the lower limbs. The correct approach should be to fix the injury in place and carry the injured person reasonably if a spinal fracture is suspected. Rapid local swelling of the fractured limb suggests that the fracture end may pierce the blood vessels and cause internal bleeding, so fix the fracture temporarily with some sticks and use local compression with towels to stop the bleeding; do not move the injured limb at will to avoid the fracture end piercing the local blood vessels and causing bleeding.
Treatment of closed fractures
Closed fractures have less soft tissue damage and faster fracture healing. A closed fracture is a break in the integrity and continuity of the bone. Closed fractures can be caused by trauma and skeletal disease, the latter such as osteomyelitis, bone destruction due to bone tumors, and fractures that occur with minor external forces, which become pathological fractures. Closed fractures can be caused by trauma and skeletal disease, the latter such as osteomyelitis, bone destruction due to bone tumors, and fractures that occur with minor external forces become pathological fractures, with traumatic fractures being the majority.
The first aid measures for closed fractures are as follows.
1, general treatment: all patients with suspected fractures should be treated as fractures. First resuscitate life. Closed bone When a closed fracture has the risk of penetrating the skin and damaging blood vessels and nerves, try to eliminate the significant displacement and then fix it with a splint.
2. Wound dressing: If the fracture end has been poked out of the wound and is contaminated but not compressing the vascular nerve, it should not be reset immediately to avoid bringing dirt deeper into the wound. If the fracture end has slipped back into the wound on its own while dressing the wound, it should be explained to the physician in charge and urged to pay attention to it.
3. Proper fixation: The most important item in the emergency treatment of fracture. The purpose of first aid fixation is threefold.
(1) To prevent the fracture end from moving during transport and injuring more soft tissues, blood vessels, nerves or internal organs.
(2) To stop pain after fixation of the fracture and to prevent shock.
(3) Easy to transport.
4. Rapid transport: principles of treating fractures: repositioning, fixation and functional exercise.