CHAPTER EIGHT

FRACTURE
 FRACTURE

A fracture is any break in the

continuity of a bone. Fractures can
cause total disability or in some
cases death by serving vital organs
and/or arteries.
 CAUSES OF FRACTURE

•Direct force: fractures occurs at the site of

serve force is applied. e.g; Bullet injury, fall on
projecting stone, wheel passing over the bone.
•Indirect force : Fracture occurs away from the
site of application of force. e.g. Collarbone –
due to fall on an out stretched hand.
 TYPES OF FRACTURE
• Open fracture these are fractures that have punctured
the skin. The bone end may have returned and not visible,
but this is still an open fracture
• Closed fracture these are fractures where the
surrounding skin remains intact.
• Complicated fractures these are fractures that have
caused damage to internal structures, such as punctured
lung, or a fractures that involves significant bleeding.
TYPES OF FRACTURE
 SIGNS AND SYMPTOMS
• A casualty experiencing a fracture may experience one or
more of the following signs and symptoms:
• Pain at the injury site
• Bleeding (internal or external)
• Open wounds with or without exposed bone ends
• Deformity
• Shortening or rotation of the limb
• Inability to move or stand
 SIGNS AND SYMPTOMS
• The casualty reports hearing the bone break
• Tenderness
• Swelling or irregularity
• Shock life signs and symptoms
• Crepitus (the sound of bones grinding)
• Discolouration
• Shortening of the limb
 TREATMENT
The steps for the management of fractures are:
• Carry out primary assessment, Danger Response Send for Help,
Airway Breathing CPR (cardiopulmonary Resuscitation ) + control
Major Bleeding Defibrillation (DRSABCD)
• Seek medical attention (make sure EMS are en route)
• Control nay external bleeding using direct pressure and elevation if
possible
• For a closed fracture, ice packs maybe used to assist with pain relief
and swelling.
 IMMOBILIZING USING SPLINTS
Improvised splints:
• It can be made of card board, rolled newspaper, or magazines, umbrellas,
rolled blankets, pillows, etc. Ideal splints:
• It should be wide & and long to cover joints on both sides of the fracture,
well padded, and applied over clothing.
• STRAIN: Injury involving tendons
• SPRAIN: Injuries involving ligaments
• Dislocation: happens when a bone is moved out of its original position
Note: Never try to put the Dislocated Joint Back Into Place
 IMMOBILIZING USING SPLINTS
SPLINTING:

Figure 1: Elbow Bent Figure 2: Humerus & Elbow Straight

 IMMOBILIZING USING SPLINTS
SPLINTING:

Figure 3: Knee Straight & tibia Figure 4: Hip, femur, knee, tibia fibula
fibula (5 bandaging method) (7 bandaging method)
 IMMOBILIZING USING SPLINTS
SPLINTING:

• Figure 5: Knee bent Figure 6: Ankle Figure 7: Fingers

 GENERAL RULES FOR SPLINTING
1. Feel for a pulse in all extremities
2. See if feet and toes can move
3. See if hands and fingers can move
4. Touch the toes to assess for sensation
5. Touch the finger for sensation
6. If the patient is unresponsive, see if he/she respond to painful stimuli
7. Manual stabilization means holding the patient’s head firmly and
steadily in a neutral, in-line position
8. If allowed, apply a rigid cervical immobilization device to the patient.
CHAPTER NINE
BURNS
 BURNS
Burns can be one of the most traumatic injuries to deal
with. The victims can be in severe pain, there can be
the smell of burnt flesh and depending on the degree
of the burn, and charred clothing can be attached to
the victim’s flesh. The first step in dealing with burns is
to determine the level of the burn. It should be realized
that First and second degree burns can be caused by
prolonged exposure to intense sunlight.
 CLASSIFICATIONS
• First degree- skin is reddened
• Second degree – skin is blistered
• Third degree – skin is cook or
charred, the burn may extend into
the underlying tissue. In severe
cases skin or appendages may
be burned off
 TREATMENT
Large burn of any degree
1. If a doctor is available within 30 minutes or less
• Treat victim for shock
• Get victim to advanced medical treatment, attempt no treatment
2. If advanced medical aid is not readily (like in an
outdoor/camping/backpacking setting):
• - Remove clothing from burned area. Cut around clothing/cloth that
stick to burned area
• - Apply antiseptic cream to burned area
 TREATMENT
• Cover burned area with a sterile dressing
• Bandage snugly (not too tight, however )
• Treat for shock
• If the victim is conscious, allow them to drink all the water
they desire. Commercially sports drinks are even better than
water if available
• Get the victim as soon as possible to advanced medical
support
 TREATMENT
Do not!
• Touch the burned area with your fingers
• Breath on the burns
• Break on drain blister

Change any dressing that have been applied. Only advanced

medical support should change or removed any dressing
applied as first aid.
 MANAGEMENT
• COOL: use tepid, flowering water for at least 20
minutes. Chemical burns for up to an hour
• CLEAR: Remove anything that may keep burning (that
isn’t sticking). Removed jewelry. Remove clothing that
is contaminated by chemicals.
• COVER: Preferable with a non-adherent dressing.
Cling- the film is ideal (if available).
CHAPTER TEN
BITES AND STINGS
 BITES AND STINGS
People are bitten and stung everyday by insects,
spiders, snakes, animals and marine life. Most of the
time, these bites and stings do not cause serious
problems. However, in race circumstances, certain bites
and stings can cause serious illness or even death in
people who are sensitive to the venom. Bites from
humans and other animals, such as dogs, cats, bats,
raccoons, and rats, can cause severe bruises and
infection and tears or lecerations of tissues.
 GENERAL INSECT STINGS
Bed bug bites
Description: Bedbug are flat bodied,
oval, reddish brown, and about ¼ in size.
Although not painful at first, bedbug
bites usually becomes red, swollen, and
itchy. Reaction to bites range from mild
to severe
• Treatment: Apply paste of baking soda
and cold cream or use a commercially
available sting aid for topical relief of
bed bug bites.
•
 GENERAL INSECT STINGS
Bee & Wasp stings
Description: A very sore area that is red and
swollen. Usually there is a stinger protruding
from the skin.
• Treatment:
1. Scrape the stinger away with the edge of a
credit card, knife blade, or thumbnail. Do not
try to squeeze the stinger out, as this will
cause more bee/wasp venom into the skin.
2. After removing the stringer wash the area
with soap and water.
3. Apply a cool wash cloth or ice pack.
 GENERAL INSECT STINGS
4. Some people have symptoms of
severe allergic reactions are:
• Shortness of breath
• Thickening of the tongue
• Sweating
• An anaphylactic shock
• Seek medical help immediately if
you have an allergic reaction
 GENERAL INSECT STINGS
Chiggers
• Description: it is generally visible only
with magnification. Chiggers are different
from mites in that they feed only in the
larval stage. The chigger larvae get onto
the skin and move around until they meet
some obstacle, for example the waistband
of underwear, the elastic band of socks,
etc. They then attach to the skin and
begin feeding. The area around where
they are feeding usually turns red with an
itching sensation.
 GENERAL INSECT STINGS
• Treatment:
1. Wash the affective area with soap and
water
2. Apply a local topical hydrocortisone
cream; antihistamine, or local anesthetic
cream should be applied to reduce the
itching. Calamine can also be used
3. The wound must not be scratched
• Preventive: spray your feet and ankles
with a quality insect repellent. Dimenthyl
phthalate or flowers of sulphur can also
be used in the socks around the ankles.
 GENERAL INSECT STINGS
FIRE ANT STING
Description: After being stung by the
fire ant, tiny painful red bumps appear.
After an hour or so, they usually change
into blisters.
• Treatment:
1. Apply ice pack at ten minutes
intervals for a period up to ½ hour
2. When through with ice pack
treatments, apply bite smoothing lotion
such as calamine.
 GENERAL INSECT STINGS
• Some people have symptoms of
serve allergic reactions which are:
• Shortness of breath
• Thickening of the tongue
• Sweating
• An anaphylactic shock
• Seek medical help immediately if
you have an allergic reaction
 GENERAL INSECT STINGS
FLEE BITE
• Description: usually flea bites are
suspected when tiny itchy red
bumps appear below the knee.
• Treatment:
1. Reduce itching by applying an ice
pack
2. After removing ice pack and drying
skin, applying soothing lotion such as
calamine
 GENERAL INSECT STINGS
MOSQUITO BITES
• Description: Mosquito have a long
proboscis (snout) for sucking blood.
They are most active in shady, low
lights, damp or marshy areas

• Treatment: use sting aid for topical

relief of mosquito bites
 GENERAL INSECT STINGS
SCORPION STING
• Description: scorpions are usually
found in the old wooden houses,
grasses, log etc.

• Treatment:
1. Cold packs
2. Get victim to advanced medical
support as soon possible
 GENERAL INSECT STINGS
SPIDER BITES
• General signals of spider bites and
scorpion stings may include
1. A mark indicating a possible bite or
sting
2. Severe pain in the sting or bite
3. A blister lesion or swelling at the
entry site
4. Nausea and vomiting
 GENERAL INSECT STINGS
5. Stiff or painful joints
6. Chills or fever
7. Trouble breathing or swallowing or
signs of anaphylaxis
8. Sweating or salivating profusely
9. Muscles aches or severe abdominal
or back pain, dizziness, or fainting,
chest pain, elevated heart rate,
infection at the site of the bite.
 GENERAL INSECT STINGS
TREATMENT
• Apply an antibiotic ointment, if the person has no
known allergies or sensitivities to the medication,
to prevent infection
• Bandage the wound
• Apply an ice or cold pack to the site to reduce pain
and swelling
• Encourage the person to seek medical attention
• Children and older adults may need antivenom to
block the effects of the spider’s venom.
• If you transport the person to a medical facility,
keep the bitten area elevated and as still as
possible
 GENERAL INSECT STINGS
TICKS
• Description : Ticks is oval with small head, the
body is not divided into definite segments. Gray or
brown. Measures from ¼ inch – to ¾ inch when
mature. It can burrow into the skin.
• Prevention
• 1. Examine body and clothes after any exposure to
tick infested areas , and always remove ticks
immediately
• 2. Have a partner inspect your back side
• 3. Before entering tick infested area, cover neck ,
legs, back of neck, and arms with an insecticide
containing Deet 17
 GENERAL INSECT STINGS
Treatment
• 1. Grasp the tick with forceps as close to the skin surface
as possible and pull slowly and firmly. Do not twist or
crush the tick
• 2. After tick removal , swab the area with iodine
solution,
• 3. If you cannot remove the tick, or if its mouth parts
remain embedded , get medical care .
• If rash or flu-like symptoms appear (see list below ), get
medical help immediately Chills and fever
• Pains in bones, muscles and joints.
• Back and head aches l Coughing, vomiting and weakness
• Rash appears in 2 to 4 days
 GENERAL INSECT STINGS
SNAKE BITES
• Poisonous snakes DO NOT always inject venom
when they bite or strike a person. However, all
snakes may carry tetanus (lockjaw’s); any one
bitten by a snake , whether poisonous or non
poisonous , should immediately seeks medical
attention:
• Poison is injected from the venom sacs through
grooved or hollow fangs. Depending on the
species, these fangs are either long or short
Signals of a possibly venomous snakebite includes:
• Fang marks
• Local pain and bleeding
• Bruising/swelling/redness
 GENERAL INSECT STINGS
• Blistering
• Infection Generalized Nausea /
vomiting / abdominal pain /
weakness / drowsiness
• Visual disturbance
• Signs of shocks
• Swelling of whole body
• Pain whole body Treatment
 GENERAL INSECT STINGS
• Wash the wound
Apply an elastic (pressure
immobilization) bandage to slow the
spread of venom through the lymphatics
system by following these steps:
Check for feeling warmth and color of
the limb and note changes in skin color
and temperature
• Place the end of the bandage against
the skin and use overlapping turns
 GENERAL INSECT STINGS
• The wrap should cover a long body such as an
arms or a calf , beginning at the point farthest
from the heart. For a joint , such as the knee or
ankle , use figure- eight turns to support the joint
• Check above and below the injury for feeling ,
warmth and color , especially fingers and toes ,
after you have applied an elastics roller bandage.
By checking before and after bandaging , you
may be able to tell if any tingling or numbness is
from the elastic bandage or the injury.
• Check the snugness of the bandaging ------a
finger should easily , but not loosely , pass under
the bandage
 GENERAL INSECT STINGS
• Keep the injured area still and lower
than the heart. The person should
walk only if absolutely necessary
• Do not apply ice
• Do not cut the wound
• Do not apply suction……
• Do not apply a tourniquent
• Do not use electric shock, such as
from a car battery
 GENERAL INSECT STINGS
• Animal bites
• The bite of a domestic or wild animal can cause infection and
soft tissue injury. The most serious possible result is rabies.
Rabies is transmitted through saliva of diseased animals such as
skunks, bats, raccoons, cats, dogs, cattles, and foxes.

• Signal of an animal bite include

• A bite mark,
• Bleeding
 GENERAL INSECT STINGS
• Treatment First aid
(1)Cleanse the wound thoroughly with soap
(2)Flush it well with water
(3)Cover it with a sterile dressing
(4)Immobilize the injured arm or leg , if appropriate
(5)Transport the casualty immediately to a Medical
Treatment Facilities (MTF)
CHAPTER ELEVEN
BITES AND STINGS
 POISON
A poison is any substance that causes injury, illness or death if it enters the body.

TYPES OF POISON:
• A person can be poisoned by swallowing poison, breathing it absorbing it through the skin and by
having it injected into the body

• Swallowed
• Poisons Poisons that can be swallowed include foods, such as certain mushrooms, wild berries,
shellfish etc: an overdose of drugs; medications such as a high quantity of aspirin; household
items, such as cleaning products and pesticides
• Inhaled Poisons
• A person can be poisoned by breating in (inhaling) toxic fumes.
 POISON
Examples of poisons that can be inhaled include:
• Gases, such as:
• Carbon monoxide from an engine or car exhaust
• Carbon dioxide from wells and sewers.
• Do not apply suction……
• Do not apply a tourniquent
• Do not use electric shock, such as from a car battery
• Chlorine, found in many swimming pools.
• Nerve gas.
• Fumes from:
• Household products, such as glues and paints.
 POISON
Treatment
• Beware of Danger!
• Consider no action due to nature of poisoning. Stay back at safe
arrival point
• Call for assistance (make sure EMS have been notified)
• Carry out primary assessment, DRS ABCD (consider compression only
CPR if risk of cross contamination)
• If unresponsive and breathing is adequate, place the casualty in a
stable side position
 POISON
• Try to find out what has been taken, how much and when.
• Keep any containers of chemicals or medication found to show to the
ambulance paramedics
• Carry out secondary assessment
• Do not induce vomiting, unless instructed from EMS.
• Water or milk should only be give to casualties that have swallowed
corrosive substances (always follow instructions from EMS).
• Rest and reassure
CHAPTER TWELVE
DROWNING
 DROWNING
Call 911 If:
• Someone is drowning.
• A child is having problems breathing or has stopped breathing as a
result of being immersed or submerged in liquid. (Remember,
children can drown in as little as 1 inch of water.)
• A child has had a near-drowning episode
1. Get Help
• Notify a lifeguard, if one is close. If not, ask someone to call 911.
• If you are alone, follow the steps below.
 DROWNING
2. Move the Person
• Take the person out of the water.
3. Check for Breathing
• Place your ear next to the person's mouth and nose.
Do you feel air on your cheek?
• Look to see if the person's chest is moving.
 DROWNING

4. If the Person is Not Breathing,

Check Pulse
•Check the person's pulse for 10
seconds.
5. If There Is No Pulse, Start CPR
 FOR ADULTS
• Carefully place the person on their back.
• Place the heel of one hand on the center of the chest at the
nipple line. You can also push with one hand on top of the other.
• Press down at least 2 inches. Make sure not to press on ribs.
• Do chest compressions only, at the rate of 100-120 per minute or
more. Let the chest rise completely between pushes.
• Check to see if the person has started breathing.
• For a child, CPR starts with rescue breathing:
 FOR A CHILD
Repeat the breath a second time.
Then begin chest compressions:
• For a child, place the heel of one hand on the center
of the chest at the nipple line. For an infant, place two
fingers on the breastbone.
• Press down at least 2 inches for a child, about 1 and
1/2 inches for an infant. Make sure not to press on the
ribs or the end of the breastbone.
 FOR A CHILD

•Do 30 chest compressions, at the rate of 100

per minute. Let the chest rise completely
between pushes.
•Check to see if the child has started
breathing.
•If you’re alone, take a break to call 911 after
2 minutes of CPR.
6. Repeat if Person Is Still Not Breathing
• If you've been trained in CPR, you can now add two rescue breaths to
the adult CPR cycle. Open the airway by tilting the head back and
lifting the chin.
• Pinch the nose of the victim closed. Take a normal breath, cover the
victim's mouth with yours to create an airtight seal, and then give 2
one-second breaths as you watch for the chest to rise.
• Give two breaths followed by 30 chest compressions.
• Continue the cycle of 30 compressions and two breaths until the
person starts breathing or emergency help arrives.