5. Bone and Joint Injury

1. 5. Bone and Joint Injury • Fractures • Open (Compound) • Bone protrudes through the skin • Complicates fracture with an open wound • Closed • No open wounds • Follow guidelines for immobilization • Set and splint the fracture • Signs and symptoms of a fracture • Pain • Tenderness • Discoloration • Swelling deformity • Loss of function • Grating

2. 5. Bone and Joint Injury • Sprains • Accidental over stretching of a tendon or ligament causes sprains • Signs and symptoms: • Pain • Swelling • Tenderness • Discoloration (black and blue) • When treating sprains, think RICE: • R - Rest injured area • I - Ice for 24 hours, then heat after that • C - Compression • E - Elevation of the affected area

3. 6. Wounds • Wound = > Any physical injury causing a break in the skin • Examples: open wounds, skin diseases, frostbite, trench foot, burns • Any delay in treatment could cause infection, a serious threat • Do not touch a wound with dirty hands or objects • One exception is when it's necessary to control arterial bleeding • Promptly clean all wounds • Antibiotics, when available, should be taken for the control of infection. • Treating open wounds: • Dressing and Bandages • Cover wound with clean dressing after cleansing • A proper bandage will anchor the dressing to the wound and afford further protection • Bandages should be snug to prevent slippage, but not too tight • Lacerations (cuts) are best left open due to the probability of infection from the source that caused the laceration • Clean thoroughly, remove foreign material, apply dressing

4. 6. Wounds • Skin Diseases and Ailments • Boils • Apply warm compresses to bring the boil to a head • Open the boil using a sterile knife, wire, needle, or similar item • Fungal Infections • Keep skin clean and dry • Expose the infected area to as much sunlight as possible • Do not scratch the affected area • Rashes • First determine what is causing the rash • Rules to follow: • If it is moist, keep it dry • If it is dry, keep it moist • Do not scratch it • Treat rashes as open wounds => clean and dress them daily

5. 6. Wounds • Frostbite => Results from frozen tissues • Light frostbite involves only the skin that takes on a dull, whitish look • Deep frostbite extends to a depth below the skin • Feet, hands, and exposed facial areas are vulnerable to frostbite • Treating Frostbite: • Do not thaw the affected areas using an open flame • Gently rub affected areas in lukewarm water • Dry affected area and place it next to your skin to warm it at body temperature

6. 6. Wounds • Trench Foot • Results from many hours or days of exposure to wet or damp conditions at a temperature just above freezing • Nerves and muscles sustain the main damage, but gangrene can occur • In extreme cases, flesh dies and may result in amputating the foot or leg • Best prevention is to keep your feet dry. • Burns • Cause severe pain • Increase probability of shock and infection • Can lead to loss of considerable body fluids and salts • Treatment: • Covering burn with clean dressing of any type reduces pain and chance for infection • Maintenance of body fluids and salts is necessary • Only way to administer fluids in burn situations is by mouth

7. 7. Bites and Stings • Insect Bites • Mostly just an irritant • Can cause severe allergic reactions in some individuals • Can be carriers of diseases • In other countries, you may be exposed to serious, even fatal, diseases not encountered in the United States • Ticks => Rocky Mountain spotted fever, Lyme disease • Mosquitoes => Malaria, dengue, and many other diseases • Flies => Can spread disease from contact with infectious sources • Sleeping sickness, typhoid, cholera, and dysentery • Fleas => Plaque • Lice => Typhus, Relapsing fever

8. 7. Bites and Stings • Insect Bites (continued) • Treatment: • Immunizations can prevent most diseases from mosquitoes and flies • If antibiotics are available, obtain and use them • Common fly-borne diseases usually treatable with penicillin or erythromycin • Most tick-, flea-, louse-, and mite-borne diseases are treatable with tetracycline • Most antibiotics come in 250 milligram (mg) or 500 mg tablets • 2 tabs, 4 times a day, for 10 to 14 days will usually do the job

9. 7. Bites and Stings • Bee and Wasp Stings • If stung by a bee, immediately remove the stinger and venom sac, if attached, by scraping with a fingernail or a knife blade. • Wash sting site thoroughly with soap and water to lessen chance of infection

10. 7. Bites and Stings • Spider Bites • Black widow spider is identified by a red hourglass on its abdomen • Only the female bites, and it has a neurotoxic venom • Initial pain is not severe, but severe local pain rapidly develops • Pain gradually spreads over entire body, more intense in abdomen and legs • Some symptoms include: • Abdominal cramps and progressive nausea • Vomiting • Rash may occur • Weakness, tremors, sweating and salivation • Symptoms begin to regress after several hours; usually gone in a few days • Funnel web spider is a large brown or gray spider found in Australia • Symptoms and treatment are same as for black widow • Brown house or recluse spider is a small, light brown spider identified by a dark brown violin on its back

11. 7. Bites and Stings • Spider Bites (continued) • Brown house or recluse spider is a small, light brown spider identified by a dark brown violin on its back • There is no, or so little pain, that usually a victim is not aware of the bite • Within a few hours a painful red area with a blotch blue center appears • The outstanding characteristic of the brown recluse bite is an ulcer that does not heal but persists for weeks or months • Victim will experience fever, chills, joint pain, vomiting, and a generalized rash. This occurs in children or weak and tired persons • Tarantulas are large, hairy spiders found mainly in the tropics • Pain and bleeding are certain, and infection is likely • Treat tarantula bite as for any open wound => Try to prevent infection • If symptoms of poisoning appear, treat as you would a black widow

12. 7. Bites and Stings • Scorpion Stings • Scorpions are all poisonous, some more than others • Death is rare, occurring mainly in children and adults with high blood pressure or illnesses • Treat sting same as a black widow • Two different reactions, depending on the species • Severe local reactions only, with pain/swelling around sting area • Possible prickly sensation around mouth and a thick-tongue feeling • Severe systematic (whole body) reaction • Little or no visible local reaction around the sting area • Possible reactions: • Breathing difficulties • Thick-tongue feeling • Body spasms • Drooling • Gastric distention • Double vision, blindness, involuntary rapid movement of eyeballs

13. 7. Bites and Stings • Snakebites • Death from snakebites is rare • 50% of the snakebite victims have little or no poisoning • 25% develop serious systemic poisoning • Before treating a snakebite, determine if snake was poisonous • Bites from poisonous snake may have rows of teeth showing, but will have one or more distinctive puncture marks caused by the fangs • Symptoms of poisonous bite may include: • Pain at bite area • Swelling at bite area within a few minutes or up to 2 hours later • Spontaneous bleeding from the nose and anus • Blood in the urine • Symptoms of neurotoxic venoms usually appear 1.5 to 2 hours after bite: • Breathing difficulty • Paralysis • Weakness • Twitching • Numbness

14. 8. Vital Injuries • Head Injuries • Pose additional problems related to brain damage • Can also interfere with breathing and eating • Bleeding is more heavy flowing in the face and head area • Infections have more difficulty taking hold • Abdominal Wounds • Particularly serious in survival situations • Extremely high mortality rate • Renders victim totally unable to care for themselves • If intestines are not coming out through the wound, a secure bandage should be applied to keep this from occurring • If intestines are coming out: • Do not replace due to almost certain fatal peritonitis • Victim should lie on back and avoid any motions that increase intra-abdominal pressure which might cause more intestine to come out • “Nature” will eventually take care of the problem, either through death, or walling-off of damaged area

15. 8. Vital Injuries • Chest Injuries • Common, painful and disabling • Severe bruises of chest or rib fractures require that the chest be immobilized to prevent large painful movements of the chest wall • Apply bandage while the patient deeply exhales • Sucking Chest Wounds • Easily recognized by the sucking noise and appearance of foam or bubbles in the wound • Wound must be closed immediately before serious respiratory and circulatory complications occur • Eye Injuries • Serious in survival situation due to pain and interference with other survival functions • More serious eye injuries involving disruption of the contents of the orbit may require that the lids of the affected eye be taped closed or covered to prevent infection • Thorns and Splinters • Frequently encountered in survival situations • Reduce their danger by wearing gloves and proper footgear

16. 9. Environmental Injuries • Heatstroke • Breakdown of body’s heat regulatory system • Body temperature more than 105ºF • Signs and symptoms include: • Swollen, beet-red face • Reddened whites of eyes • Not sweating • Unnatural paleness or absence of color in the skin • Bluish color to lips and nail beds • Cool skin • Hypothermia • Body’s failure to maintain a temperature of 97ºF • Caused by exposure to cool or cold temperature over a short or long time • Treatment: • Gradually warm victim • Get victim into dry clothing • Replace lost fluid

17. 9. Environmental Injuries • Diarrhea • Common ailment • Can be caused by: • Change of water and food • Drinking contaminated water • Eating spoiled food • Becoming fatigued • Using dirty dishes • You can avoid most of these causes by practicing preventive medicine • Intestinal Parasites • Usually avoided with preventive measures => Example: Never go barefoot • Most effective prevention is to avoid uncooked meat and raw vegetables contaminated by raw sewage or human waste which was used as a fertilizer