Common Injuries/Emergencies and their Management

Strains and Sprains

Strain may be defined as a stretch, tear or rip to a tendon or muscle by over use
or stress. It is an injury to a muscle or tendon in which the muscle fibers tear as
a result of overstretching.

Sprain may be defined as an injury to a ligament resulting from overstress

which causes some degree of damage to the ligament fibers and their
attachment. It occurs when joint is forced beyond the range of motion.

RICE is the principle you should follow for the initial treatment of any sprains
and strains. However, serious sprains and suspected fractures/breaks should
always be seen by doctor.

R- Rest

I- Ice

C-Compression

E - Elevation

(i)Rest

The injured area should be in complete rest for 24-48 hours following the injury
- as immobilized as possible. This will protect the area from further injury and
slow down the bleeding in the injury site.

(ii)Ice
Ice should be applied immediately, keeping a thin towel a plastic bag between
the ice and the skin to avoid burns he cold will reduce any internal bleeding and
control summation. It will also bring down the swelling and minimize the pain.
If ice or ice packs are not available, frozen vegetables and cold water can also
be used. Don't leave the ice on for too long 20 minutes at a time is enough-and
keep checking to make sure the ice is not causing a burn. Ice should be applied
during the next 24-48 hours at regular intervals - for example every 2 hours, for
10-20 minutes at a time. It can so be alternated with heat in the following days,
for up to a week, gradually reducing the time for cold applications while
increasing the time for applying heat.
(iii) Compression
A bandage or taping/strapping should be applied as soon after the injury as
possible - either with or after the first application of ice. Compression will
physically restrict movement in the injured area and constrict it, bringing down
swelling. The compression shouldn't be so tight that it restricts blood flow into
the limb and it should allow for some swelling, so it's important to check the
tightness of the bandage regularly. Compression can be applied for several days
after the injury first occurs, with good results in controlling inflammation and
aiding recovery.
(iv) Elevation
By elevating the injury site above the heart level gravity comes in to assist in
reducing blood flow to the injured area and helps reduce swelling. Elevation is
an important part of immediate treatment of an acute injury, but it should also
be continued in the following days to maximize its benefits.
Contusion
A contusion, or bruise, is caused by an object striking the body with enough
force to crush the tissues beneath the skin. The greater the force of the blow
greater the tissue damage. If the blow is over a bony area, the bone also may be
contused.
A contusion causes varying amounts of swelling and disability, directly related
to the force of the blow and location. A contusion damages tissue cells and
capillaries resulting in blood and waste products leaking into the area around the
cells. These blood and waste products gradual travel to the skin, producing the
characteristic "black and blue mark" of a contusion
Symptoms:
i) Discoloration under the skin, starting from redness gradually turning to blue
or black
ii) Swelling and pain on the contused part
iii) Stiffness over the area
Treatment:
Treatment for contusions is the same as for other injuries and can be
remembered by the acronym RICE: rest ice, compression, and elevation. The
victim should be removed from activity, and the injured area cooled,
compressed, and elevated as soon as possible to minimize damage to uninjured
tissue.
Cuts and Wounds
A cut or laceration is an injury that results in a break or opening in the skin. It
may be near the surface or deep, smooth or jagged. It may injure deep tissues,
such as tendons, muscles, aments, nerves, blood vessels, or bone.
Minor cuts and scrapes usually don't require a trip to the emergency room. Yet
proper care is essential to avoid infection or other complications.
Treatment
1. Examine the patient for any fractures/dislocation and treat them
2. Stop the bleeding by applying pressure
3. Clean the wound with clear water. To clean the area around the wound,
use soap and a washcloth.
4. Apply an antibiotic to help keep the surface moist.
5. Cover the wound with bandages to help keep the wound clean and keep
harmful bacteria out
6. Change the dressing at least daily or whenever it becomes wet or dirty.
7. Get stitches for deep wounds. A wound that is more than 1/4-inch (6
millimeters) deep or is gaping or jagged edged and has fat or muscle
protruding usually requires stitches.
8. Watch for signs of infection. See your doctor if the wound isn't healing or
you notice any redness, increasing pain, drainage, warmth or swelling.
Fracture
A fracture is a complete or incomplete break in a bone resulting from the
application of excessive force. Here can be different types of fractures
depending upon the complexity of breakage of the bone.
Signs and Symptoms:
(i)Pain at or near the seat of fracture,
(ii) Tenderness of discomfort on gentle pressure over the affected area
(iii) Swelling about the seat of fracture. Swelling frequently render it difficult to
perceive other signs of fracture and care must be taken therefore not to treat the
condition as a less serious injury.
(iv) Loss or power; the injured part cannot be moved normally
(v) Deformity of the limb, the limb may assume an unnatural position and be
mis-shaped.
(vi) The contracting muscles may cause the broken ends of the bone to override,
thereby producing shortening of the limp.
(vii) Irregularity of the bone. If the fracture is near the skin the irregularity of
the bone may be felt.
(viii)Crepitus (bony grating) may be heard or felt.
(ix)Unnatural movement at the seat of the fracture.
The last two signs should never be sought deliberately, but they may be noted
during examination.
Any or all of these signs and symptoms may not be present: those which are
may vary in degree.
Treatment:
(i)Keep the patient quiet and do not move the injured part until the extent of the
injury has been determined.
(ii)Immobilize or splint the damaged extremity before moving the patient.
(iii)Always move the patient to a hospital in a lying-down position
(iv)Never sit the patient up or bend or move the injured part any more than its
absolutely necessary
Dislocations:
Joint dislocation or luxation occurs when bones in a joint become displaced or
misaligned. It is often caused by a sudden impact to the joint. The ligaments
always become damaged as a result of a dislocation. Fractures may also occur
frequently with dislocations. Shoulder, knee, elbow
 Symptoms of a Joint Dislocation:
 Swelling
 Intense Pain
 Immobility of the affected joint
 Deformity in the dislocated area
 Warmth, bruising, or redness in the injured area
Treatment
Specific treatment for a dislocation will depend various factors like age, overall
health, the extent of the injury the type of injury, etc. However, initial treatment
of a dislocation includes R.1.CE (rest. ice, compression, and observed in
elevation) the following guidelines may be treatment of dislocation
 Don't delay medical care. Get medical help immediately.
  Don't move the joint until you receive help. splint the affected joint into
its fixed position
 Don't try to move a dislocated joint or force it back to place. This can
damage the joint and its surrounding muscles, ligaments, nerves or blood
vessels.
 Put ice on the injured joint. This can help reduce swelling by controlling
internal bleeding and the buildup of in and around the injured joint.
Burns
A burn is a type of injury to flash caused by heat electricity, chemicals, light,
radiation or friction. Most burns only affect the skin (epidermal tissue and
dermis). Rare deeper tissues, such as muscle, bone, and blood vessels ca also be
injured. Burns may be treated with first aid, in an out of-hospital setting, or may
require more specialized treatment such as those available at specialized burn
centers.
Classification of Burns
(i) First-degree burns: These involve only the superficial layers of the skin and
evidence themselves by mere reddening. Most sunburn is first degree.
(ii)Second-degree burns: These burns involve not only the superficial layers but
also the deeper layers of the skin. They are characterized by blisters and by the
discharge of serum. Severe sunburns may fall into this category.
(iii) Third-degree burns: These burns involve all of the layers of the skin and
usually have caused complete skin destruction.
(iv) Fourth-degree burns: These burns not only destroy all layers of the skin but
involve the tissues beneath the skin, such as the subcutaneous tissues, muscles,
tendons, blood vessels, bones, etc.
First-aid Treatment for burns
For minor burns, including first-degree burns and second-degree burns limited
to an area no larger than 3 inches 17.6 centimeters) in diameter, take the
following action:
 Reassure the casualty and give him/her support
 Cool the burn. Hold the burned area under cool (not cold) running water
for 10 or 15 minutes or until the pain subsides. If this is impractical,
immerse the burn in cool water or cool it with cold compresses. Cooling
the burn reduces swelling by conducting heat away from the skin.
 Don't put ice on the burn or apply cold water.
 Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or
other material that may get lint in the wound. Wrap the gauze loosely to
 avoid putting pressure on burned skin. Bandaging keeps air off the burn
reduces pain and protects blistered skin.
 Talk to your doctor if you have concerns.
Minor burns usually heal without further treatment. They may heal with
pigment changes, meaning the healed area may be a different color from the
surrounding skin. Watch for signs of infection, such as increased pain, redness,
fever swelling or oozing. If infection develops, seek medical help
Caution
 Don’t use ice. Putting ice directly on a burn can cause burn victim's body
to become too cold and cause further damage to the wound.
 Don't apply butter or ointments to the burn. This could cause infection.
 Don't break blisters. Broken blisters are more vulnerable to infection

For major burns, call emergency medical help immediately. Until an emergency
unit arrives, follow these steps:
1) Don't remove burned clothing. However, do make sure the victim is no
longer in contact with smoldering materials or exposed to smoke or heat.
2) Don't immerse large severe burns in cold water. Doing 50 could cause a drop
in body temperature (hypothermia) and deterioration of blood pressure and
circulation (shock).
3) Check for signs of circulation (breathing, coughing or movement) If there is
no breathing or other sign of begin CPR.
4) Elevate the burned body part or parts, Raise above heart level, when possible.
5) Cover the area of the burn. Use a cool, moist, sterile bandage, clean, moist
cloth, or moist towels.
Drowning:
According to the World Health Organization, drowning a declined as "the
process of experiencing respiratory impairment from submersion/immersion in
liquid." Drowning outcomes should be classified as resulting in death,
morbidity sustaining an injury), and no morbidity. Most drawings occur within
a short distance of safety and can be prevented.
Treatment
In rescuing a person drowning, never attempt unless you have had lifesaving
training. The following guidelines are necessary for treating a person who has
drowned:
(i) Quickly remove any obstruction such as mud from the casualty's mouth and
begin artificial ventilation immediately
(ii) Put the victim in prone lying position with the backup and face down, on
one side and press the back to bring out the water from the lungs and stomach
(iii) When the casualty can be placed on a firm surface, check breathing, pulse
and continue resuscitation if necessary.
(iv) Keep the victim warm, if possible, remove wet clothes and dry him off,
cover with spare clothes or towel.
(v) Provide hot tea or coffee as soon as he is able to swallow
(vi) Do not allow him to sit up.
(vii) Remove false teeth if present
(viii) Pull tongue forward
(ix) Ensure medical attention for the casualty, even if he seems to recover
rapidly.
Electric Shock
The human body is a good conductor of electricity, and contact with a live
power source can cause significant burns or may interfere with the heart's
electrical system.
Treatment
(i) The victim usually gets stuck to the source of the electricity, and it is
important that you first separate him from the electrical source.
(ii) Turn off the power supply switch or best simply turn of the main power
supply or pull out the fuse.
(iii) Do not touch the victim with your bare hands, or the electric current will
pass through you as well.
(iv) Throw a blanket over the victim and try to separate him from the source.
You could also use dry, nonconductive material such as a wooden broom handle
or a chair ta separate the victim from the live current. Make se you are not
standing on anything that is wet.
(v)Once the victim has been separated, check to see if he is breathing. If
breathing has stopped or seems slow, administer CPR immediately.
(vi) Let his head be slightly lower than the rest of the body, and raise his legs.
(vii) Cover the victim with a blanket.
(viii) Move the victim as little as possible. He may have suffered injuries to his
spine and neck.
(ix) If the victim has a burn, remove the clothing from the burned area (unless
it's stuck to the skin) and rinse it in cool, running water. Cover the burn with a
dressing.
(x) Don't apply ice or any other ointment or cotton dressing to the burn.
(xi) Call for emergency medical attention as soon as possible.
Bleeding from Nose (Epistaxis)
The nose is a part of the body rich in blood vessels (vascular) and is situated in
a vulnerable position as it protrudes on the face. As a result, trauma to the face
can cause nasal injury and bleeding. Bleeding from nose can also be due to
rupture of tiny blood vessels inside the nostrils, or as a result of sneezing,
picking or blowing the nose.
Treatment
i) Make patient sit down with head erect of bend slightly forward so that the
blood does not trickle down the throat
ii)Loosen clothing at neck.
iii) Pinch the soft part of the nose firmly for five minutes to compress the blood
vessels.
iv) Ask the patient to breathe through his mouth.
v) Apply a cold compress to the nose and seat the patient near and open window
to let plenty of fresh air,
vi) Patient should be instructed not to blow his nose for some hours.
Shock
Shock is a condition of profound depression of the functions following injuries,
hemorrhage, and severe pain emotional upset.
Symptoms of Shock:
(i) Pale, cold, clammy skin
(ii) Shallow, irregular breathing
(iii) Weak rapid pulse
(iv) General weakness
(v) Reduced consciousness or unconscious
(vi) Dilation of the pupils
(vii) Nausea and vomiting
First aid treatment:
i) Lay the patient flat with head one side and legs elevated about 9 inches,
unless there are fracture in which case wait till the fracture is immobilized.
ii)Stop any bleeding
iii)Loosen clothing at neck and waist;
iv) Keep the patient warm
v)Handle as gently as possible and avoid any unnecessary movement.
vi) See that there is plenty of air surrounding the patient.
vii) Give drinks or sweetened hot tea or coffee, if there is no chest or abdominal
injury or unconscious.
vi) Be cheerful and support his moral.
vii)Get a doctor or send to the hospital as early as possible.
Fainting:
Fainting (syncope) is a sudden loss of consciousness from a lack of blood flow
to the brain.
The first aid treatment can be:
i) If the patient has not lost consciousness sit him down. And lower his head
between the knees, or lay him down with the head lower than the feet
ii) Check to see if airways is clear and breathing/pulse is normal
iii) If not provide CPR
iv) Loosen clothing at neck and waist
v) Allow plenty of fresh air
vi) Keep body warm
vi) Pour face with cold water
vii)When consciousness returns gradually is the and give sips of water, tea or
coffee
Chocking:
Choking occurs when a foreign object becomes in the throat or windpipe,
blocking the flow of air in adults piece of food often is the culprit. Young
children often swallow small objects. Because choking cuts off oxygen to the
brain, administer first aid as quickly as possible.
The universal sign for choking is hands clutched to the throat. If the person
doesn't give the signal, look for then indications:
i) Inability to talk
ii) Difficulty breathing or noisy breathing
iii) Inability to cough forcefully
iv) Skin, lips and nails turning blue or dusky
v) Loss of consciousness
First aid treatment:
If the person is conscious:
(i) First, deliver five back blows between the person's shoulder blades with the
heel of your hand,
(ii) Next, perform five abdominal thrusts (Heimlich maneuver). Stand behind
the person. Wrap your arms around the waist. Make a fist with one hand and
place your fist with thumb side in, just above the navel but below the person's
rib cage in the front. Grasp the fist with the other hand. Keeping your arms off
the person's rib cage, give four or five quick inward and upward thrusts. Repeat
this several times (four to five times) the object is coughed out or the person
becomes unconscious.
(iii) Alternate between five back blows and five abdominal thrusts until the
blockage is dislodged.
If victim is in an unconscious:
(i)Gently lay him or her flat, in a suffocation free environment.
(ii) If the blockage is visible than try to remove it with the help of hand or
fingers.
(iii) Use your arms to encircle the victim's abdomen or chest area from back and
give light compressions. This is called an upward thrust.
(iv) Repeat upward thrusts until the object are forced out or victim feels better
whichever is first.
(v)Use mouth to mouth respiration technique or artificial respiration mask for
emergency oxygen.
(vi) Sprinkle some water droplets to make the victim conscious.
(vii) Ensure that the person is breathing properly and there is no blockage in the
airways.
Special wounds:
A) Dog bites:
(i) All dog bites should be thoroughly washed with running water, but the
wound should never be rubbed or scrubbed, as this will push the virus deeper
inside.
(ii) Apply an antibiotic ointment and cover with a non-stick bandage.
(iii)In addition to basic first aid and cleaning the wound, your child may need
antibiotics, a tetanus shot, and/or rabies vaccination after a dog bite.
(iv) You should seek immediate medical attention for multiple or serious bites,
especially in younger children and bites that involve the child's head and neck.
B) Snake bites:
i) Hang the bitten limb down and immediately apply a triangular bandage, neck
tie or handkerchief on the hard side of the bite, just tight enough to congest the
veins and to prevent the flow of poison to general circulation
ii) Rest the patient
iii) Gently wash and scrub the wound thoroughly without scrubbing
iv) As far as possible, do not let the victim walk.
v) Transfer to a hospital or sent for a doctor and seek medical attention for anti-
venom injection immediately