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| Thursday, September 28, 2006 |
| SPORT & COMMON INJURY |
SPORT & COMMON INJURY
Nausea and Vomiting
Nausea is an uneasiness of the stomach, which may or may not lead to vomiting.
These are symptoms of diseases rather than diseases themselves.
Cause
v Viral and bacterial infections like colds and flu’s ,
v Food poisoning ,Over eating and indigestion,
v Certain smells and odors,
v Intense pain, High fever, Emotional stress (like fear or excitement), Motion sickness , seasickness, and dizziness, Exposure to toxins (poisons, chemicals) ,
v Blocked intestine (rather uncommon, and usually found in early infancy), Appendicitis,
v Head injuries, like, concussions, migraines, brain injury etc
Sign & Symptoms
v If it occurs right after a meal : indigestion, an ulcer, or a mental disorder (such as bulimia)
v One to eight hours after a meal : indicate food poisoning. Diseases like salmonella may take several days before any nausea is felt.
Treatment
v In many cases both nausea and vomiting can be controlled to some degree.
v If feeling nauseous
v Try and control or stop the feelings.
v Drink clear or cold drinks
v Eat light simple foods, like saltine crackers, which don’t have a strong taste or odor. Avoid sweet, greasy, and fried foods. Do not mix hot and cold foods.
v Drink beverages slowly and take small sips
v Do not brush your teeth right after eating
If you already feel nauseous and want to avoid the unpleasantness of vomiting
v Drink small amounts of sweet clear cool liquids, like ginger ale, fruit juice. (Avoid citrus as they are too acidic), Sweet liquids are good for calming the stomach.
v Eating cool sweet things like Popsicles but not too many as the condition may worsen.
If you do get sick
v In most cases vomiting is harmless, but sometimes it can indicate or even cause problems
v lookout for signs of dehydration, especially with children.
- Dry lips or mouth - Increased thirst
- Decreased urination - Sunken eyes
v Rapid breathing or pulse
v Consult doctor if:
v Vomiting goes on for longer than one day (or if they are very young and it continues for a few hours)
v There is blood in the vomit.
v If the vomiting is occurring because of a known injury, like head trauma
v The person acts confused, lazy or lethargic, and is less alert than usual.
v They have a fever of over 102 Fahrenheit
v Vomiting, diarrhea, severe abdominal pain are present
Fainting
When there isn’t enough blood flowing to the brain. The unconscious spell is usually brief
Cause
- Emotional and/or physical shock - Dehydration
- Pain - Overexertion
- Heart diseases - Sudden changes in body position
- Insufficient fluid and food intake.
First Aid Treatment
v If a person feels faint/weak/lightheaded/dizzy/nauseous),
v Have them lie down on their back with their feet elevated above the level of their heart (about 8-12 inches), or have them sit with their head placed down between their knees.
v Loosen any tight clothing and jewelry especially around their head and neck.
v Check airway and breathing whether normal or not.
v If breathing stops then the situation becomes more serious and you should try to get medical help as soon as possible.
v Do not try to give the person anything to eat or drink
Caution
v If victim vomit, turn the person onto their side.
v If suspect a head, neck, or spinal injury get medical help as soon as possible and do not move the person unless absolutely necessary.
v If the person does not regain consciousness within 2 minutes call 911 or get other emergency medical help.
v If the person is older (over 40) contacting a doctor or calling 911 may be in order to make sure it was not a heart related problem.
Heat Exhaustion
Heat exhaustion is similar to, and often follows, dehydration.
It is a form of volume shock, i.e, the lack of fluid causes the blood vessels, especially in your arms and legs, to constrict. However this is a non-life threatening illness.
Exhaustion is a greater loss of electrolytes whereas
Dehydration is a greater loss in fluids.
Cause
exposure to hot weather / or drop in body fluid levels .
Symptoms
- Sweating - Increased pulse and respiration
- Pale and clammy skin - Fatigue
- Nausea and vomiting - Slightly lowered or elevated temperature
- Exhaustion - Lightheadedness and dizziness
- Possible heat cramps - Feeling thirsty
Treatment:
v Give sports drink or oral dehydrations solution (ORS). Drink fluid slowly, as the body will absorb it better.
v Take a good long rest before continuing activities; if symptoms seem severe, seek a medical professional.
v If the person is suffering from heat cramps a slightly salty drink (sports drink or ORS) and stretching the muscle should ease them.
v If it return discontinue the activity you are doing for the rest of the day.
v If heat exhaustion is not properly treated, it may become Heat Stroke, which is deadly.
v If the person’s temperature goes above 103° then treat them for heat stroke!
Dehydration
Cause
v Exposure to hot weather / or drop in body fluid levels.
Symptoms :
Early or mild dehydration: Moderate to severe dehydration:
Extreme thirst Fainting
Flushed face Convulsions
Dry, warm skin Low blood pressure
Weakness Less sweating
Headache Severe arm, leg, stomach, and back cramps
Dry mouth with thick saliva Bloated stomach
Decreased coordination Sunken ‘dry’ eyes
Fatigue Lack of skin elasticity
Smaller appetite Very few tears (when crying)
Impaired judgement Dizziness that worsens as you stand and move
Small amounts of dark yellow urine
Treatment :
v Give the victim more liquids than usual, but in small doses, (Water, sports drinks, and oral dehydration solutions (ORS)
v The drinks should be sipped slowly. Chilling the liquids can help, as it can prevent internal body temps from becoming to high and progressing to heat stroke.
v Rest victim in the shade and should not resume activities until urination becomes normal (pale yellow and clear), and the other symptoms of dehydration disappear.
v In cases of severe dehydration, get the person to an emergency room, as untreated dehydration can lead to death.
v If a person who is severely dehydrated can drink, they should still be given the ORS and water.
Blisters
Blister happen when the skin outer layer separate from the inner layer dan body fluid gather in or between the skin due to repeated rubbing and friction. Blisters will also form more easily on skin that is warm and moist.
First Aid Treatment
v Clean the surrounding blister with antiseptic liquid or medicated soap.
v Press the blister slowly with pad or tissue paper to help body absorbed back the fluid.
v Bandage with plaster with padding big enough to cover the whole blister area .
v If the blister is too big, avoid from puncture or break the skin.
v If the blister tear, clean the area with antiseptic cream/solution. Donot remove the loose skin
v Use plaster or bandage to cover the affected.
Caution
v Avoid products containing Neomycin, which is known to cause allergic reactions
v Infected blisters : Pus draining from the blister , red or warm skin around the blister or Red streaks leading away from the blister.
v Treatment : Go to a doctor to receive the proper treatment.
Nosebleeds
Drying out of the capillary membranes that cause nosebleeds.
First Aid Treatment
v In most cases the common nosebleed is fairly easy to stop, and no medical help is needed
Stopping the common nosebleed:
v Using a clean cloth, tissue or sterile gauze, pinch the nose together at the nostrils and firmly apply pressure towards the face.
v Holds like this for at least 8 minutes, or until the nose stops bleeding.
v Have the person lean forward slightly or sit up straight.
v Do not let the person lean back, or blood may flow into the windpipe.
v Keep the head above the heart, or in other words, don’t let the person lie down. If they must lie down try to keep their head elevated at a 45 degree angle.
v Apply crushed ice in a bag or cloth to nose and cheeks. Make sure the ice is in a bag or cloth because direct application may cause frostbite to skin.
To prevent the nose from bleeding again :
v Rest with your head elevated at a 30- 45 degree angle, or keep your head higher than your heart
v Avoid medications, which will thin the blood (such as aspirin).
v Try not to sneeze. If must sneeze, open your mouth to allow the air another way to escape to avoid upsetting the nose.
v No straining, heavy lifting/pulling/pushing.
v Try to keep to a “cool diet” for 24 hours. Avoid hot liquids.
Minor Burns
First-degree burn The least serious burns are those in which only the outer layer of skin (epidermis) is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't been burned through. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint.
Second-degree burn When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is termed a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.
If the second-degree burn is no larger than 2 to 3 inches in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, get medical help immediately.
Treatment For minor burns,
including second-degree burns limited to an area no larger than 2 to 3 inches in diameter, take the following action:
Cool the burn. Hold the burned area under cold running water for at least 5 minutes, or until the pain subsides. If this is impractical, immerse the burn in cold 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.
Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin.
Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.
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. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.
Caution:
Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
Don't break blisters. Broken blisters are vulnerable to infection.
Sunburn
Signs and symptoms of sunburn usually appear within a few hours of exposure, bringing pain, redness, swelling and occasional blistering. Because exposure often affects a large area of your skin, sunburn can cause headache, fever and fatigue.
Treatment for sunburn:
Take a cool bath or shower.
Apply an aloe vera lotion several times a day.
Leave blisters intact to speed healing and avoid infection.
If needed, take an over-the-counter pain reliever such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Don't give children or teenagers aspirin. It may cause Reye's syndrome, a rare, but potentially fatal, disease.
If your sunburn begins to blister or if you experience immediate complications, such as rash, itching or fever, see doctor.
Eye emergencies
Eye emergencies include cuts, scratches, objects in the eye, burns, chemical exposure, and blunt injuries to the eye.
Since the eye is easily damaged, any of these conditions can lead to vision loss if left untreated.
Occasionally, serious damage to the eye itself occurs from the pressure of the swollen tissue. Bleeding inside the eye can reduce vision, cause glaucoma, or damage the cornea.
Causes:
Head injury
Foreign object in the eye
Chemical injury
Blow to the eye (direct trauma)
Eyelid and eye cuts
Corneal abrasion
Symptoms:
Eye pain
Loss of vision
Decreased vision
Double vision
Redness -- bloodshot appearance
Sensitivity to light
Bleeding
Bruising
Cuts or wounds
Headache
Itchy eyes
Pupils of unequal size
Stinging and burning
Sensation of something in the eye
Treatment
Take prompt action and follow the steps below :
i. SMALL OBJECT ON THE EYE OR EYELID
The eye will often clear itself of tiny objects, like eyelashes and sand, through blinking and tearing. If not, take these steps:
Tell the person not to rub the eye. Wash your hands before examining it.
Examine the eye in a well-lighted area. To find the object, have the person look up and down, then side to side.
If you can't find the object, grasp the lower eyelid and gently pull down on it to look under the lower eyelid. To look under the upper lid, you can place a cotton-tipped swab on the outside of the upper lid and gently flip the lid over the cotton swab.
If the object is on an eyelid, try to gently flush it out with water. If that does not work, try touching a second cotton-tipped swab to the object to remove it.
If the object is on the eye, try gently rinsing the eye with water. It may help to use an eye dropper positioned above the outer corner of the eye. DO NOT touch the eye itself with the cotton swab.
A scratchy feeling or other minor discomfort may continue after removing eyelashes and other tiny objects. This will go away within a day or two. If the person continues to have discomfort or blurred vision, get medical help.
ii. OBJECT STUCK OR EMBEDDED IN EYE
Leave the object in place. DO NOT try to remove the object. DO NOT touch it or apply any pressure to it.
Calm and reassure the person.
Wash your hands.
Bandage both eyes. If the object is large, place a paper cup or cone over the injured eye and tape it in place. Cover the uninjured eye with gauze or a clean cloth. If the object is small, cover both eyes with a clean cloth or sterile dressing. Even if only one eye is affected, covering both eyes will help prevent eye movement.
Get medical help immediately.
iii. CHEMICALS IN THE EYE
Flush with cool tap water immediately.
Turn the person's head so the injured eye is down and to the side. Holding the eyelid open, allow running water from the faucet to flush the eye for 15 minutes.
If both eyes are affected, or if the chemicals are also on other parts of the body, have the victim take a shower.
If the person is wearing contact lenses and the lenses did not flush out from the running water, have the person try to remove the contacts AFTER the flushing procedure.
Cover both eyes (even if only one eye is affected) with a clean dressing, and avoid any rubbing of the eyes. Even if only one eye is affected, covering both eyes will help prevent eye movement.
After following the above instructions, seek medical help immediately.
iv. EYE CUTS, SCRATCHES, OR BLOWS
If the eyeball has been injured, get medical help immediately.
Gently apply cold compresses to reduce swelling and help stop any bleeding. DO NOT apply pressure to control bleeding.
If blood is pooling in the eye, cover both of the person's eyes with a clean cloth or sterile dressing, and get medical help.
v. EYELID CUTS
Carefully wash the eye. Apply a thick layer of bacitracin or mupirocin ointment on the eyelid. Place a patch over the eye. Seek medical help immediately.
If the cut is bleeding, apply gentle pressure with a clean, dry cloth until the bleeding subsides.
Rinse with water, cover with a clean dressing, and place a cold compress on the dressing to reduce pain and swelling.
Do Not:
DO NOT press or rub an injured eye.
DO NOT remove contact lenses unless rapid swelling is occurring, there is a chemical injury and the contacts did not come out with the water flush, or you cannot get prompt medical help.
DO NOT attempt to remove a foreign body that appears to be embedded in any part of the eye. Get medical help immediately.
DO NOT use cotton swabs, tweezers, or anything else on the eye itself. Cotton swabs should only be used on the eyelid.
DO NOT attempt to remove an embedded object.
Call immediately for emergency medical assistance if:
There appears to be any visible scratch, cut, or penetration of your eyeball.
Any chemical gets into your eye.
The eye is painful and red.
Nausea accompanies the eye pain.
You have any trouble seeing (such as blurry vision).
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posted at 10:37 AM   |
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| Tuesday, September 26, 2006 |
| FRACTURES & DISLOCATIONS. |
FRACTURES & DISLOCATIONS.
Fractures & Dislocations.
There are different kinds of broken bones.
Simple or closed fractures:
v The broken bone is not visible through the skin nor is there a skin wound near the fracture site. An example of this is a greenstick fracture. It is called this because the x-ray shows a barely visible fracture and it resembles the pattern of a very young splintered twig.
Compound or open fracture:
v A bone may separate partially or completely from the other half and a skin wound is also present. The bone can protrude through the skin or the skin has been cut due to the injury.
Bones can break in more than one place.
Bones in children are more pliable and may resist breakage more than bones in adults.
Broken bones need treatment right away.
They may cause future deformities and limited movement if not properly cared for. They are also very painful.
Type of Fractures & Dislocations
1. Hip fracture:
v Hip fractures are most common in elderly women and usually are caused by simple falls. Hip fractures also occur in motor vehicle accidents and other sudden deceleration incidents.
v Blood loss can be moderate to severe. The affected extremity may appear to be shorter than the other extremity. Discoloration and swelling may be present over the fracture site.
v A hip fracture is a serious injury that must be evaluated by an orthopedist.
2. Humerus fracture:
v The humerus is the longest and strongest bone in the upper extremity, and substantial force is required to fracture it; blood loss can be heavy. Neurovascular compromise may develop. This is a serious injury that requires evaluation by an orthopedist.
3. Wrist fracture:
v Wrist fractures often occur when persons fall on their outstretched hands or when they throw up their hands to protect themselves against hitting the interior of the vehicle in a motor vehicle accident.
4. Ankle fracture:
v The bones of the lower legs often are fractured in sports accidents, motor vehicle accidents, and falls.
v If the injury was caused by rapid vertical deceleration (a fall), suspect spinal and heel injuries as well, because the energy would have been directed up the body on impact.
v Obvious deformity may be present, or the only indication of trauma may be swelling and pain.
5. Dislocations:
v Any dislocation of a joint can be serious.
v Disruption of the blood supply and nerves in the area can result in loss of the limb or permanent disability. Even if the dislocated joint slips back into place, the patient still must be evaluated by an orthopedist.
v Hip dislocation.
A hip dislocation is a serious orthopedic emergency.
The blood supply to the head or top of the hip may be impaired, causing necrosis and necessitating replacement with an artificial joint in the future. Pressure on the sciatic nerve can result in permanent disability.
Hip dislocation often occurs in motor vehicle accidents when a person's knees strike the dashboard, and the energy then is directed back to the hips. Pain is often severe, and the leg may rest in an abnormal position.
6. Knee dislocation.
v When the bones forming the knee are dislocated or fractured, serious injury to the popliteal artery may occur. Therefore, arteriograms are obtained in the hospital whenever a patient has a dislocated knee.
v Serious knee injuries may necessitate amputation of the leg; consequently, knee dislocation is an orthopedic emergency.
7. Impalement:
v Penetrating trauma may result in foreign bodies or objects impaling bones, muscles, or tendons. Disability or loss of the extremity may occur.
8. Lacerations:
v Although simple lacerations often heal with only simple suturing, lacerations that penetrate the tendons and ligaments in the hands and feet can result in permanent disability if not thoroughly irrigated and repaired.
9. Traumatic Amputations:
v Often sustained in industrial and recreation accidents, traumatic amputations are serious emergencies. Depending on the circumstances, the amputated parts can sometimes be replanted, so the parts should always accompany the patient to the hospital.
v Blood loss may be significant, and some disability and disfigurement are to be expected.
10. Sprain:
v Tearing of a ligament that connects one bone to the other commonly is due to twisting forces and results in a sprain. Although sprains are not usually serious, the patient should be evaluated by a physician.
11. Strain:
v Overstretching or overexerting a muscle, as in sports activities, can cause a strain of that muscle, which is associated with pain. The strain is generally in the area of the tendon, where the muscle attaches to the bone.
TREATMENTS
v Don’t put ice directly on the injured area without cover
v Don’t elevate the injured part if there’re any symptoms of internal bleeding
v If the site of injury is bleeding then treat the wounds and cuts accordingly, but do not try to reset/reshape the bone or joint.
v Also look for signs of shock.
v If the joint or bone needs to be repositioned, do not give the person anything to eat or drink as it will put off medical treatment.
v If there is bleeding do not give aspirin because aspirin is a mild blood thinner and will delay clotting.
Strain Sign & Symptoms
Sudden pain on the injured area
Can cause cramp or immobility
Swollen on the affected area.
Sprain Sign &; Symptoms
Pain on the injured joint
Pain increased when joint were move
Swollen and bruise
Inability to move and bear weight
Any discoloration ( bluish, reddish)
Dislocate happen when the bone and joint are overstressed, contact sports, rheumatoid arthritis, sudden jerking of arm or hand of a small child..
Sign & Symptoms
The injured area look abnormal
Injured body part cannot be moved or painful when moved
Swollen and bruise
A misshapen appearance
Inability to move and bear weight
1. First Aid Treatment for Strain, Sprain and Dislocation
if possible make a splint to help immobilize the affected area.
Do not try to reposition the bone/joint while making the splint.
Apply the RICE method
v Rest : Avoid movement of the injured area and avoid participation in activities that can to re-injure until after the wound had had plenty of time to heal.
v Ice :Use ice to minimize swelling. If no ice is available, a bag of frozen veggies is a good substitute.
v Compression : an elastic or fabric bandage may help decrease swelling and ease the pain. Make sure the bandage is not wrapped to tightly.
v Elevation : If possible raise the injured limb up above the heart. Support the elevated limb in a sling or under a pillow or folded blanket.
v Get help if needed
Muscle Cramps
Discomforts on the body muscle.
Sign &; Symptoms:
v A sharp sudden painful spasm, or tightening of a muscle, (especially common in the legs).
v Muscle hardness
v Twitching of the muscle
v Persistent cramping pains in lower abdominal muscles
v Muscle contracts with great intensity and stays contracted, refusing to stretch out again.
Causes
v Imbalances in certain minerals, body fluids, hormones, and chemicals
v Malfunctions in the nervous system
v Excessive physical activity and hormonal imbalances causes heavy sweating.
First Aid Treatment
v Try to stretch the muscle and massage out the cramp using medicated ointment.
v Muscle cramps can also be caused by a lack of potassium and vitamin E, so eating something like bananas or pineapple can help to replenish the minerals you’ve lost.
Caution
v If suffer from frequent or severe cramps, see doctor especially if severe cramps in chest, shoulders, or arms which, can be symptoms of a heart attack; call immediately for medical help.
v Muscle cramp lasts more than an hour.
v Cramp is in your chest or arms.
2. Fracture Treatment: Immobilization
Defination
Immobilization refers to the process of immobilizing or fixating the position of a joint, bone, extremity, or torso with a splint, cast, or brace.
Purposes of Immobilizing Fractures
To prevent the sharp edges of the bone from moving and cutting tissue, muscle, blood vessels, and nerves. This reduces pain and helps prevent or control shock.
In a closed fracture immobilization keeps bone fragments from causing an open wound and prevents contamination and possible infection.
Purpose
To support and protect broken bones, dislocated joints, and injured soft tissue, such as tendons and ligaments. It can help reduce pain, swelling, and muscle spasms and to prevent an injured area from moving while it heals.
Method of Immobilization
§ Slings.
o A sling is a bandage or a piece of cloth, a belt and so forth suspended from the neck to support an upper extremity. It may be improvised by using the tail of a coat or shirt, and pieces torn from such items as clothing and blankets. The casualty's hand should be higher than his elbow, and the sling should be applied so that the supporting pressure is on the uninjured side.
§ Bandages.
o Bandages may be improvised from belts, rifle slings, bandoliers, kerchiefs, or strips torn from clothing or blankets. Narrow materials such as wire or cord should not be used to secure a splint in place.
§ Splints.
o Improvised from items such as boards, poles, sticks, tree limbs, rolled magazines, rolled newspapers, or cardboard.
o If nothing is available for a splint, the chest wall can be used to immobilize a fractured arm and the uninjured leg can be used to immobilize (to some extent) the fractured leg.
§ Padding.
o Padding may be improvised from such items as a jacket, blanket, poncho, shelter half, or leafy vegetation.
Basic Splinting Principle : immobilize the joints above and below any fracture.
>>figure
Fractures & Dislocations.
>>figure
Procedures for Splinting Suspected Fractures
v Gather whatever splinting materials are available such as splints, like wooden boards, branches, or poles. Other splinting materials include padding, improvised cravats, and/or bandages. Ensure that splints are long enough to immobilize the joint above and below the suspected fracture.
v If possible, use at least four ties (two above and two below the fracture) to secure the splints. The ties should be nonslip knots and should be tied away from the body on the splint.
Evaluate the victim.
v Be prepared to perform any necessary lifesaving measures that include clearing the airway, rescue breathing, preventing shock, and/or bleeding control.
WARNING
v Unless there is immediate life-threatening danger, such as a fire or an explosion, DO NOT move the casualty with a suspected back or neck injury. Improper movement may cause permanent paralysis or death.
v In a chemical environment, DO NOT remove any protective clothing. Apply the dressing/splint over the clothing.
Locate the Site of the Suspected Fracture.
v Ask the casualty for the location of the injury. Does he have any pain? Where is it tender? Can he move the extremity? Look for an unnatural position of the extremity. Look for a bone sticking out (protruding).
Prepare the Casualty for Splinting the Suspected Fracture .
v Reassure the casualty.
v Loosen any tight or binding clothing.
v Remove all the jewelry from the casualty and place it in the casualty's pocket. Tell the casualty you are doing this because if the jewelry is not removed at this time and swelling occurs later, further bodily injury can occur.
NOTE: Boots/shoes should not be removed from the casualty unless they are needed to stabilize a neck injury, or there is actual bleeding from the foot.
Gather Splinting Materials
v If standard splinting materials (splints, padding, cravats, and so forth) are not available, gather improvised materials like wooden boards, tree branches, poles, rolled newspapers or magazines.
v Splints should be long enough to reach beyond the joints above and below the suspected fracture site.
v Improvised padding, such as a jacket blanket, poncho, shelter half, or leafy vegetation may be used.
v A cravat can be improvised from a piece of cloth, a large bandage, a shirt, or a towel or parts of the casualty's body may be used. For example, the chest wall may be used to immobilize an arm; and the uninjured leg may be used to immobilize the injured leg.
v If splinting material is not available and suspected fracture CANNOT be splinted, then swathes, or a combination of swathes and slings can be used to immobilize an extremity.
Pad the Splints
v Pad the splints where they touch any bony part of the body, such as the elbow, wrist, knee, ankle, crotch, or armpit. Padding prevents excessive pressure to the area.
Check the Circulation Below the Site of the Injury
v Note any pale, white, or bluish-gray color of the skin which may indicate impaired circulation.
v Circulation can also be checked by depressing the toe/fingernail beds and observing how quickly the color returns. A slower return of pink color to the injured side when compared with the uninjured side indicates a problem with circulation. Depressing the toe/fingernail beds is a method to use to check the circulation in a dark-skinned casualty.
v Check the temperature of the injured extremity. Use your hand to compare the temperature of the injured side with the uninjured side of the body. The body area below the injury may be colder to the touch indicating poor circulation.
v Question the casualty about the presence of numbness, tightness, cold, or tingling sensations.
Casualties with fractures to the extremities may show impaired circulation, such as numbness, tingling, cold and/or pale to blue skin. These casualties should be evacuated by medical personnel and treated as soon as possible. Prompt medical treatment may prevent possible loss of the limb.
WARNING
If it is an open fracture (skin is broken; bone(s) may be sticking out),
DO NOT ATTEMPT TO PUSH BONE(S) BACK UNDER THE SKIN.
Apply the Splint in Place
i. Splint the fracture(s) in the position found. DO NOT attempt to reposition or straighten the injury:-
v If it is an open fracture, stop the bleeding and protect the wound. Cover all wounds with field dressings before applying a splint.
v If bones are protruding (sticking out), DO NOT attempt to push them back under the skin. Apply dressings to protect the area.
ii. Place one splint on each side of the arm or leg. Make sure that the splints reach, if possible, beyond the joints above and below the fracture.
iii. Tie the splints. Secure each splint in place above and below the fracture site with improvised (or actual) cravats. Improvised cravats, such as strips of cloth, belts, or whatever else you have, may be used. With minimal motion to the injured areas, place and tie the splints with the bandages.
v Push cravats through and under the natural body curvatures (spaces), and then gently position improvised cravats and tie in place.
v Use nonslip knots. Tie all knots on the splint away from the casualty (Figure 4-2). DO NOT tie cravats directly over suspected fracture/dislocation site.
Check the Splint for Tightness
v Check to be sure that bandages are tight enough to securely hold splinting materials in place, but not so tight that circulation is impaired.
v Recheck the circulation after application of the splint. Check the skin color and temperature. This is to ensure that the bandages holding the splint in place have not been tied too tightly. A finger tip check can be made by inserting the tip of the finger between the wrapped tails and the skin.
v Make any adjustment without allowing the splint to become ineffective.
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| posted at 2:42 PM |
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| Thursday, August 17, 2006 |
| Wound, Bleeding and Shock (under construction) |
WOUND , BLEEDING & SHOCK
2. Type of Wound
2.1. Close Wound
Injury to tissue under the skin cause by bumping, contusion or falling down OR the breaking of a blood vessel under the skin due to a blow to the skin like bruise.
2.2. Open Wound
Any break or opening in the skin or an organ caused by violence or surgical incision.
2.1. Close Wound & Treatment
Bruise/Contusion
Definition
Bruise due to blunt blow on the body that cause injury to tissue under the skin like bumping, contusion or falling down.
Sign and symptoms
- Pain on the injured area
- Injury to tissue and capillary that leaking the blood flow. The blood and the human excretion( sweat & fluid) will pool around the injured tissue causing bluish skin discoloration.
- Serious injury called ‘Hematoma” happen when there’re higher amount of blood and fluid. Hematoma can cause severe blood lost and shock.
Type of Bruise
- hematoma : Bruise becomes firm and seems to become larger due to large amount of blood wall is off the wound, rather than clean it up. It may need to be drained by doctor.
- heterotopic ossification: When the body deposits calcium in the area of the injury that cause it becomes tender and firm and requires x-rays and a trip to the doctor.
- Petechiae: Little (3-3 millimeters) red dots; are tiny little accumulations of blood. Often there are few of them and they usually indicate some sort of serious health problem.
- Bruising around the belly button could be a result of bleeding in the abdomen
- Bruising behind the ear can indicate a skull fracture
- Bruises that are raised, firm, and occur without any injury may be signs of a “autoimmune” disease, in which the body attacks it’s own blood vessels.
First Aid Treatment
Apply the RICE method
- Rest : Rest the injured body part
- Ice : Put wrap-up ice on the injured part
- Compress : Bandage the injured area over a thick cotton layer
- Elevate : Raise the injured part
Get help if needed
Caution
- Dont put ice directly on the injured area without cover
- Don’t elevate the injured part if there is any symptom of internal bleeding.
2.2. Open Wound & Treatment
Classification of Open Wounds
i. Incision:
o These cuts result of some sharp object such as broken glass, knives and sharp edges.
o The amount of bleeding varies on the depth and extension of the cut.
o Some of these wounds require stitches.
ii. Laceration:
o These are jagged irregularly shaped cuts or tears in the skin. Most lacerations are serious and require stitches, because of heavy bleeding.
o Chances of infection depend on the size, cause, and depth of the laceration. Severe laceration should be treated by a doctor.
iii. Punctures:
o Puncture wounds are caused by an object piercing the skin.
o These wounds range from minor to severe and should often be looked at by a doctor.
o Because the wound penetrates the skin (and in some cases, several layers of skin) they are often difficult to clean and infections are common.
o If bone puncture is suspected, visit doctor as soon as possible.
iv. Abrasion
o Abrasion happen when layer of skin loose due to continuous friction on the skin.
o The skin outer layer loose and exist several drop of bloods or body fluid on the injured area.
Treatment
Abrasion Treatment:
- Clean the skin with water and soap to rid of any foreign object embedded on the wound (Don’t scrub)
- Put antiseptic cream /solution.
- Cover the whole area using padding or plaster .
If the abrasion is only on the skin first layer, leave the wound open without padding after applying antiseptic cream/solution for faster healing.
Cuts and Scrapes Treatment
- Clean out the wound. Make sure you wash your hands before cleaning a wound to avoid transferring more dirt to the cut.
- Wipe away from the wound when removing dirt and other particles that may be in the wound.
- Washing the wound use soap and water, but do not scrub because that may do more damage.
- Apply direct pressure with a clean dry cloth or sterile gauze bandage, while elevating limb (if possible) above the heart. This will slow bleeding and help a clot to form.
- If bleeding is spurting out of wound or bleeding continues heavily after pressure has been applied for 5-10 minutes stitches may be needed, so go to the hospital and have the wound checked out by doctor as soon as possible.
- If the bleeding slows, cover the wound with a clean bandage.
- Apply a thin layer of antibacterial ointment to the wound first, to protect against infection.
- If the wounds are on the hands or feet avoid using these ointments after the first day. Make sure the wound is kept clean and dry while it heals.
- Caution:
o Apply only a thin layer of ointment to ensure the best protection.
o Always apply the ointment with a clean swab or gauze. Applying ointment from the tube may contaminate the tube and put future wounds at risk.
o Make sure to wash the wound before applying fresh ointment.
o When applying fresh bandages make sure your hands are clean and the bandage remains sterile. It is advised that the bandage is opened over the wound and that the pad remains untouched except by the wound.
Severe bleeding injuries
- Lay the person down. If possible, position the person's head slightly lower than the trunk, or elevate the legs. This position reduces the chances of fainting by increasing blood flow to the brain. If possible, elevate the site of bleeding.
- Remove any obvious debris or dirt from the wound using sterile tools.
- Do not remove any objects pierced into the victim.
- Do not probe the wound or attempt to clean it at this point. Your principal concern is to stop the loss of blood.
o Apply pressure directly on the wound with a sterile bandage, clean cloth or even a piece of clothing. (Avoid direct contact with wound)
o Maintain pressure until the bleeding stops for 10 minutes or more.
o When bleeding stop:
- bind the wound tightly with adhesive tape or a bandage. If none is available, use a piece of clean clothing.
- If the bleeding continues and seeps through the gauze or other material you are holding on the wound, do not remove it. Instead, add more absorbent material on top of it.
o If the bleeding does not stop with direct pressure:
- apply pressure to the major artery that delivers blood to the area of the wound.
- In the case of a wound on the hand or lower arm, for example, squeeze the main artery in the upper arm against the bone. Keep your fingers flat; with the other hand, continue to exert pressure on the wound itself.
- Immobilize the injured body part once the bleeding has been stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible or, if they cannot be moved for help.
SHOCK
Shock happens when the heart and blood vessels are unable to pump enough oxygen-rich blood to the vital organs of the body.
Although every illness involves shock to some degree, it can be a life-threatening problem.
The best way to protect people from the serious damages that shock can have on the system is to recognize the symptoms before the person gets into serious trouble.
In most cases, only a few of the symptoms will be present, and many do not appear for some time.
1. Common Symptoms
- Pale, cold, clammy and moist skin
- Vacant or dull eyes, dilated pupils
- Anxiety, restlessness, and fainting
- Weak, rapid, or absent pulse
- Nausea and vomiting
- Shallow, rapid, and irregular
breathing
- Excessive thirst
- Person may seem confused
- Look tired and fatigue
2. Classification of shock:
i. Hypovolemic Shock:
• Brought on by a decrease in the amount of blood vessels or other fluids in the body.
• Cause by excessive bleeding from internal and external injuries, fluid loss due to diarrhea, burns, dehydration, and severe vomiting.
ii. Neurogenic Shock:
• The blood vessels become abnormally enlarged and the pooling of the blood disallows an adequate blood flow to be maintained.
• Fainting is an example of this sort of shock, as the blood temporarily pools as the person stands. When the person falls the blood rushes back to the head and the problem is solved.
iii. Psychogenic Shock:
• This shock is more common, and is known as a “shock like condition”. It is produced by excessive fear, joy, anger, or grief. “Shell shock” is a psychological adjustment reaction to stressful wartime experiences.
• Treatment for shell shock is limited to emotional support and help from a medical facility.
iv. Anaphylactic Shock:
This form of shock is brought on by an allergic reaction from a food, bee sting or other insect bite, and inhalants.
3. General Treatment
- Call local emergency help provider for help
- Lay the victim face up, on a blanket or coat if possible, and raise the feet above the head unless they are fractured.
- Check the injured person's airway, breathing and circulation. Open and maintain the airway, and perform rescue breathing or CPR if necessary
If the person is bleeding from the mouth or vomiting, tilt their head to the side to avoid fluids going into the lungs and airways. If you are unsure of injuries keep the person laying flat.
- Loosen tight clothing, braces, belts, jewelry etc to avoid constriction of the waist, neck and chest.
- Keep the victims comfortable and warm enough to be able to maintain their own body heat. If possible, remove wet clothing and place blankets beneath the victim. NEVER use artificial sources of heat eg electric blanket.
If they are bleeding severely do not apply heat to the wounded area, as it will prevent the blood from clotting as easily.
- Check for other injuries, such as bleeding and burns and treat the other injuries according to first aid procedures.
If possible try to splint sprains or broken bones. If you are unsure of how to do this, leave them as they are to avoid further damage.
- If they claim they are thirsty moisten their lips with water but DO NOT give them anything to drink, as it may induce vomiting.
- Try to keep the victim calm, excitement and excessive handling will worsen their condition try to assure them help is on the way.
These treatment if apply before shock has completely developed you may prevent its occurrence and if it had developed you may stop it from becoming fatal.
If shock is left unattended to the victim will die, it is extremely important that first aid be performed as soon as possible.
Give fluids only if the following conditions are met:
The injured person can hold the cup and drink by himself;
surgery is not likely within six hours;
there is no abdominal injury;
evacuation is more than six hours away; and
there are no downward changes in the person's level of consciousness.
FIRST AID KIT
Remember the Three Mechanisms of Injury:
• Trauma – due to high impact e.g. car accident
• Medical – illness e.g high blood pressure, diabetic
• Environmental- e.g tsunami
The Complete KIT
The First aid kit must be well organized, weather proof, accessible in an emergency, and user friendly. The simplest way to organize is:
- to separate bandages, dressings, meds, etc. with ziplocks, or some sort of waterproof dividers.
- Writing what's in the bag can help when the adrenaline is pumping, or some people even color code what is what.
- Having gloves, pocket mask, and other protection readily available is very important.
Not only is the first aid kit itself important, it is how easily you can assemble all your resources.
Suggested Personal First Aid Kit List
1 - roll 1" cloth tape
4 - 4" x 4", or 3" x 3" general gauze pads
2 - non-adherent gauze pads
1 - 8" x 7" combine (bulk) dressing
8 - band-aid bandages
2 - 3" or 4" stretch roller gauze
3 - 3" or 4" occlusive dressings
2 - triangular bandages
1 - 4" ace wrap
1 - Sam Splint or wire splint
4pr - vinyl exam gloves
1 - CPR pocket mask w/ 1 way valve or shield
1 - Airways, nasal and/or airway
1 - blister kit (personal preference)
5 - povodine iodine packets
1 - trauma scissors
1 - splinter tweezers
1 - thermometer
1 - med kit (personal preference)
1 - blanket pin
2 - safety pins
1 - 12 to 60cc syringe
1 - 20-30' duct tape
-Medication
Carrying Device
One that works best in environment in which you travel.
o Dry Bag/Box, fanny pack, compartmentalized pouch, ziplock bags, etc.
Personal Protection
Must be easily accessible. Gloves can be placed in various places e.g in your pack, a lifejacket in a film canister, etc.
- Vinyl or Latex Gloves - 2 to 4 pairs per person*
- CPR Mask - or at the very least, a CPR Shield
- Airways - dependent on level of training
Wound Care
Bandages - narrow piece of cloth tie around wound or dressing :3" and/or 4" roller gauze that stretches and possibly self-adhering
Dressings – material used 2 cover and protect wound: carry multiple sizes of sterile gauze bandages or a 4" x 4". Different dressings may help make wound care much more manageable.
General Purpose Gauze Pads - uses for wound care, from padding to absorbency.
Combine and Trauma Dressing - used where high absorbency and/or padding are necessary. Larger sizes in these are usually recommended e.g Surgipad.
Occlusive Dressings - dressing to keep a wound dry in a wet environment. Care must be taken to remove these dressings during rest periods to help promote healing in a prolonged context. Examples include Bioclusive and Tegaderm.
Bandage Strips - a bandage with an attached dressing, better known as Band-Aids. It is important to change these regularly, so bring enough.
Tape – To secure bandages or closing wounds. 1" cloth tape is usually all that is needed in a basic first aid kit.
Duct, packaging and other tapes make great securing tools for bandages, splints, clothing, etc. Be careful to watch for constriction and other circulation problems. 20-30 ft.
Wound Cleansing
The risk of infection is greater when the wound is close, so prior wound cleansing is vital.
Clean water for washing off residue
Povidine Iodine (PI) used in a solution with water, to adequately irrigate the wound and surrounding area. Some people are allergic to iodine, so check their medical history first.
Soaps, as well as medical "scrubs" that can be used for cleansing around wounds.
Splinting
The most improvised skill there is. Lifejackets, packs, paddles, ski poles, etc. all make great splints.
- Use the injured’s person equipment first!
- Remember to watch for constriction, comfort, and compatibility.
Hardware
Tool that can expedite and assist during treatment:
Tweezers – to pull out splinter or hold cotton for wound cleaning
Pins - to secure materials such as using a sleeve as a improvised sling, or securing a tarp as a shelter.
Plastic bags - make great irrigators, improvised glove, or occlusive layer. Big trash bags are perfect for vapor barriers when wrapping up a patient, emergency shelter, and to put trash in.
Thermometer - A digital indoor/outdoor thermometer with a probe is a good resource to tell temp. variations of a patient who is either immobilized during or waiting for evac, although not as accurate as a medical version.
Trauma shears - for removing clothing, cutting improvised splints to size etc
Heat/Cold Packs - again usually carried in major med kits, these will help in short term context. Water bottles with warm water, cooled wet towels, filled ziplocks, can be improvised heat/cold packs.
Mirror/signal device - a compass with a mirror show a spruce speck in the eye, or help locate tick or leech. It can also be used to signal aircraft or other groups.
Whistle - can be use as signals.
Flashlight/headlamp - Select a light appropriate to your activity
Lighter/ waterproof matches- if traveling in wet, cold environments it is also good to carry a fire catalyst, such as fire ribbon, or fire gel.
Medications
Adequate training, written policies and procedures and medical control should all be considered.
- Topical antibiotic cream - such as Neosporin, has been proven to promote healing in shallow wounds and help maintain a good barrier.
- Analgesic, Antipyretic and Anti-inflammatory – pain killer such as Tylenol, Ibuprofen, and aspirin. It is personal preference to what has worked best for you.
- Antihistamine – for allergies: such as Benadryl and Sudafed for
- Antacid – for stomach discomfort/ burning feeling due to e.g overeating : Mylanta, Gelusil, Pepto Bismol, Maalox
- Antidiarrheal - Pepto, Keopectate, Immodium, Lomotil
- Anticonsptipation - Metmucil, glycerine suppositories
- Antifungal/yeast - Tinactin, Mystatin
- Dental Problems - pain relief from clove oil, Orabase
- Special Needs and Medications - such as prescription antibiotics, asthma inhalers, altitude meds, epineherine, etc
- Glucose - liquid glucose in a single use tube
- Oral Electrolyte Replacement Solution - such as Gookinaid, Gatorade, etc.
- Tincture of Benzoin - helps keep bandages attached
- Activated Charcoal – poisoning emergencies
BANDAGE, TRIANGULAR BANDAGE & CRAVAT
1. DEFINITION
Standard bandages are made of gauze or muslin and are used over a sterile dressing to secure the dressing in place, to close off its edge from dirt and germs, and to create pressure on the wound and control bleeding.
A bandage can also support an injured part or secure a splint. The most common types of bandages are the roller and triangular bandages.
2. General Application
- Applied evenly, firmly, but not too tightly. Excessive pressure may cause interference with the circulation and may lead to disastrous consequences e.g gangrene.
- It is safer to apply a large number of turns of a bandage, rather than to depend upon a few turns applied too firmly to secure a compress.
- In applying a wet bandage, or one that may become wet, you must allow for shrinkage.
- The turns of a bandage should completely cover the skin, as any uncovered areas of skin may become pinched between the turns, with resulting discomfort.
- The terminal end of the completed bandage is turned under and secured to the final turns by either a safety pin or adhesive tape. When these are not available, the end of the bandage may be split lengthwise for several inches, and the two resulting tails may be secured around the part by tying
Bandaging any extremity (arms or legs)
- leave the fingers or toes exposed so the circulation of these parts may be readily observed. (capillary refill)
- Include the whole member (arm or leg, excepting the fingers or toes) so that uniform pressure may be maintained throughout.
- It is also desirable in bandaging a limb that the part is placed in the position it will occupy when the dressing is finally completed, as variations in the flexion and extension of the part will cause changes in the pressure of certain parts of the bandage.
- The initial turns of a bandage on an extremity (including spica bandages of the hip and shoulder) should be applied securely, and, when possible, around the part of the limb that has the smallest circumference
- In bandaging the arm or hand the initial turns are usually applied around the wrist.
- in bandaging the leg or foot, the initial turns are applied immediately above the ankle.
- The final turns of a completed bandage are usually secured in the same manner as the initial turns, by employing two or more overlying circular turns.
- As both edges of the final circular turns are exposed, they should be folded under to present a neat, cuff like appearance.
3. Bandage Technique
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ROLLER BANDAGE FOR HAND AND WRIST
- Figure-eight bandage is ideal.
- Anchor the dressing, whether it is on the hand or wrist, with several turns of a 2- or 3-inch bandage.
- If on the hand, anchor the dressing with several turns and continue the bandage diagonally upward and around the wrist and back over the palm.
- Make as many turns as necessary to secure the compress properly
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ROLLER BANDAGE FOR ARM AND LEG
- Use the spiral reverse bandage to cover wounds of the forearms and lower extremities
- Make two or three circular turns around the lower and smaller part of the limb to anchor the bandage and start upward, going around making the reverse laps on each turning, overlapping about one-third to one-half the width of the previous turn.
- Continue as long as each turn lies flat.
- Continue the spiral and secure the end when completed
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ROLLER BANDAGE FOR ANKLE AND FOOT
- Use figure-eight bandage for dressings of the ankle, as well as for supporting a sprain.
- While keeping the foot at a right angle, start a 3-inch bandage around the instep for several turns to anchor it.
- Carry the bandage upward over the instep and around behind the ankle, forward, and again across the instep and down under the arch, thus completing one figures eight.
- Continue the figure-eight turns, overlapping one-third to one-half the width of the bandage and with an occasional turn around the ankle, until the compress is secured or until adequate support is obtained
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ROLLER BANDAGE FOR HEEL.
- Place the free end of the bandage on the outer part of the ankle and bring the bandage under the foot and up.
- Then carry the bandage over the instep, around the heel, and back over the instep to the starting point.
- Overlap the lower border of the first loop around the heel and repeat the turn, overlapping the upper border of the loop around the heel.
- Continue this procedure until the desired number of turns is obtained, and secure with several turns around the lower leg
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TRIANGULAR BANDAGE
The longest side of the triangular bandage is called the base; the corner directly opposite the middle of the base is called the point; and the other two corners are called ends
The triangular bandage is useful because it can be folded in a variety of ways to fit almost any part of the body. Padding may be added to areas that may become uncomfortable.
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TRIANGULAR BANDAGE FOR HEAD
- This bandage is used to retain compresses on the forehead or scalp.
- Folds back the base about 2 inches to make a hem.
- Place the middle of the base on the forehead, just above the eyebrows, with the hem on the outside.
- Let the point fall over the head and down over the back of the head.
- Bring the ends of the triangle around the back of the head above the ears, cross them over the point, carry them around the forehead, and tie in a SQUARE KNOT.
- Hold the compress firmly with one hand, and, with the other, gently pull down the point until the compress is snug; then bring the point up and tuck it over and in the bandage where it crosses the back part of the head.
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TRIANGULAR BANDAGE FOR SHOULDER
- Cut or tear the point, perpendicular to the base, about 10 inches.
- Tie the two points loosely around the patient’s neck, allowing the base to drape down over the compress on the injured side.
- Fold the base to the desired width, grasp the end, and fold or roll the sides toward the shoulder to store the excess bandage.
- Wrap the ends snugly around the upper arm, and tie on the outside surface of the arm.
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TRIANGULAR BANDAGE FOR CHEST
- Cut or tear the point, perpendicular to the base, about 10 inches.
- Tie the two points loosely around the patient’s neck, allowing the bandage to drape down over the chest.
- Fold the bandage to the desired width, carry the ends around to the back, and secure by tying.
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TRIANGULAR BANDAGE FOR HIP OR BUTTOCK
- Cut or tear the point, perpendicular to the base, about 10 inches.
- Tie the two points around the thigh on the injured side.
- Lift the base up to the waistline, fold to the desired width, grasp the ends, fold or roll the sides to store the excess bandage, carry the ends around the waist, and tie on the opposite side of the body.
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TRIANGULAR BANDAGE FOR FOOT OR HAND
This bandage is used to retain large compresses and dressings on the foot or the hand.
- For the foot: After the compresses are applied, place the foot in the center of a triangular bandage and carry the point over the ends of the toes and over the upper side of the foot to the ankle. Fold in excess bandage at the side of the foot, cross the ends, and tie in a square knot in front.
- For the hand: After the dressings are applied, place the base of the triangle well up in the pal mar surface of the wrist. Carry the point over the ends of the fingers and back of the hand well up on the wrist. Fold the excess bandage at the side of the hand, cross the ends around the wrist, and tie a square knot in front
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CRAVAT BANDAGE
A triangular bandage can be folded into a strip for easy application during an emergency.
- When folded as shown, the bandage is called a cravat. To make a cravat bandage, bring the point of the triangular bandage to the middle of the base and continue to fold until a 2-inch width is obtained.
- The cravat may be tied, or it may be secured with safety pins (if the pins are available).
- When necessary, a cravat can be improvised from common items such as T-shirts, bed linens, trouser legs, scarves, or any other item of pliable and durable material that can be folded, torn, or cut to the desired size.
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Cravat Bandage for Temple, Cheek, or Ear
After a compress is applied to the wound, place the center of the cravat over it and hold one end over the top of the head.
- Carry the other end under the jaw and up the opposite side, over the top of the head, and cross the two ends at right angles over the temple on the injured side.
- Continue one end around over the forehead and the other around the back of the head to meet over the temple on the uninjured side.
- Tie the ends in a square knot. (This bandage is also called a Modified Barton.)
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Cravat Bandage for Eye
- After applying a compress to the affected eye, place the center of the cravat over the compress and on a slant so that the lower end is inclined downward.
- Bring the lower end around under the ear on the opposite side.
- Cross the ends in back of the head, bring them forward, and tie them over the compress.
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Cravat Bandage for Elbow or Knee
- After applying the compress, and if the injury or pain is not too severe, bend the
- elbow or knee to a right-angle position before applying the bandage.
- Put on middle of a rather wide cravat over the point of the elbow or knee, and carry the upper end around the upper part of the elbow or knee, bringing it back to the hollow, and the lower end entirely around the lower part, bringing it back to the hollow.
- See that the bandage is smooth and fits snugly; then tie in a square knot outside of the hollow.
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Cravat Bandage for Arm or Leg
- The width of the cravat you use will depend upon the extent and area of the injury.
- For a small area, place a compress over the wound, and center the cravat bandage over the compress.
- Bring the ends around in back, cross them, and tie over the compress.
- For a small extremity, it may be necessary to make several turns around to use all the bandage for tying.
- If the wound covers a larger area, hold one end of the bandage above the compress and wind the other end spirally downward across the compress until it is secure, then upward and around again, and tie a knot where both ends meet.
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Cravat Bandage for Axilla (Armpit)
- This cravat is used to hold a compress in the axilla.
- It is similar to the bandage used to control bleeding from the axilla.
- Place the center of the bandage in the axilla over the compress and carry the ends up over the top of the shoulder and cross them.
- Continue across the back and chest to the opposite axilla, and tie them.
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Spiral Bandage Technique
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| posted at 2:23 PM |
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| Thursday, August 10, 2006 |
| THE MUSCULAR SYSTEM |
5. THE MUSCULAR SYSTEM
5.1 Overview
The muscular system is the biological system of humans that allows them to move. It is the body's network of tissues that controls movement both of the body and within it. Walking, running, jumping is possible only because of the contraction (shortening) and relaxation of muscles. These major movements, however, are not the only ones directed by muscular activity. Muscles make it possible to stand, sit, speak, and blink. Beside that it allows blood rush through blood vessels, air fill the lungs, and food move through the digestive system. In short, muscles are the machines of the body, allowing it to work.
Muscle tissue is composed of a series of fibers, similar to neurons in shape, that operate in a coordinated manner under the supervision of the nervous system to:
i) support movement in the body, and
ii) assist in maintaining body temperature through shivering to create heat.
There is three forms of muscles in the human body:
-Smooth muscle, involuntary, uninucleated, non-striated found on the walls of internal organs
-Cardiac muscle, involuntary, uninucleated, striated (*with intercalated disc) found only in the heart
-Skeletal muscle, voluntary, multinucleated, striated which help strengthen the body and connect to bones.
Muscles are labeled as either voluntary or involuntary.
-Voluntary muscles are muscles that you can move whenever you want to.
-Involuntary muscles contract and relax automatically inside your body. We can not control our involuntary muscles.
-Muscles can only pull. They never push.
5.2 The muscular muscle cell
-Each muscle is made of hundreds to thousands of individual muscle cells, unusually shaped i.e elongated like a cylinder or a long rod.
-Because of their shape, muscle cells are normally referred to as muscle fibers.
-Whereas most cells have a single nucleus (the part of the cell that controls its activities), muscle fibers have as many as 100 or more nuclei. The nuclei are located on the surface of the fiber, just under its thin membrane.
-Another difference between muscle fibers and other body cells is their size. They can extend the entire length of a muscle. For example, a muscle fiber in a thigh muscle could measure 0.0004 inch (0.001 centimeter) in diameter and 12 to 16 inches (30 to 40 centimeters) in length.
5.3 Tendons
-Tendons attach muscles to bone
-It is layers of connective tissue that bundle the various parts of a muscle usually converge or come together at the end of the muscle to form a tough, white, cord-like tissue.
-Tendons are much stronger than muscle tissue because it contains fibers of the tough protein collagen.
-The collagen fibers are arranged in a tendon in a wavy way so that it can stretch and provide additional length at the muscle-bone junction. As muscles are used, the tendons are able to withstand the constant pulling and tugging.
-Muscles are always attached at both of their ends. The end that is attached to a bone that moves when the muscle contracts is called the insertion. The other end, attached to a bone that does not move when the muscle contracts, is called the origin.
-It is important to note that not all muscles are attached to bones at both ends. The ends of some muscles are attached to other muscles; some are attached to the skin.
5.4 The muscular major muscle
-Skeletal muscles support the skull, backbone, and rib cage are called axial skeletal muscles that include the muscles of the head and neck and those of the trunk.
-Roughly 60 percent of all skeletal muscles in the body are axial muscles.
-The skeletal muscles of the limbs (arms and legs) are called distal or appendicular skeletal muscles. These include the muscles of the shoulders and arms and those of the hip and legs.
-Muscle names are descriptive according to their;
*Location in the body like the frontalis muscle overlies the frontal bone of the skull.
*Relative size like maximus (largest), minimus (smallest), and longus (long). *Shape like the deltoid muscle has the shape of the Greek letter delta, which is triangular-shaped. *Actions like flexor (to flex or bend in), extensor (to extend or straighten out), adductor (to draw toward a line that runs down the middle of the body), and abductor (to draw away from a line that runs down the middle of the body)
5.6 THE MUSCULAR SYSTEM FUNCTIONS
-Muscles have three important functions: to produce movement, maintain posture, and generate heat.
-Almost all movements by the human body result from muscle contraction.
-Muscles lend support to the body and help it maintain posture against the force of gravity. Even when the body is at rest (or asleep), muscle fibers are contracting to maintain muscle tone.
-Any activity by muscles generates heat as a byproduct, which is vital in maintaining normal body temperature.
The link between nerve cells and muscle fibers
 Muscle fibers must be stimulated by nerve impulses sent through motor neurons or nerves.These impulses originate in the brain, then run down the spine to contract or shorten muscle.From there, they branch out to all parts of the body.
A single motor neuron may stimulate a few muscle fibers or hundreds of them. A motor neuron along with all the fibers it stimulates is called a motor unit. When a motor neuron reaches a muscle fiber, it does not touch the fiber, but fits into a hollow on the surface of the muscle fiber. This region where the end of the motor neuron and the membrane of the muscle fiber come close together is called the neuromuscular junction.
When a nerve impulse reaches the end of the motor neuron at the neuromuscular junction, acetylcholine (a neurotransmitter chemical) is released. Acetylcholine then travels across the small gap between the motor neuron and the muscle fiber and attaches to receptors on the membrane of the muscle fiber. This triggers an electrical charge that quickly travels from one end of the muscle fiber to the other, causing it to contract.
Muscle fiber energy
In order to contract, muscles need energy. That energy comes from adenosine triphosphate (ATP), a high-energy molecule found in every cell in the body. ATP is the only energy source that muscles can use to power their activity.
In the human body, the liver stores glucose by converting it to glycogen. When the body needs energy, the liver is stimulated to change glycogen back into glucose and secrete it into the bloodstream for use by the cells.
In the cells, glucose combines with oxygen to yield or produce carbon dioxide, water, heat, and ATP. This process of energy production that uses oxygen in the reaction is called aerobic ("with air") metabolism.
-Carbon dioxide, water, and heat are all waste products of this chemical reaction.
-Carbon dioxide moves from the cells into the blood to be carried to the lungs, where it is exhaled.
-The water becomes a necessary part of a cell's internal fluid.
-The heat contributes to normal body temperature. If too much heat is generated, such as during vigorous physical activities, the excess heat is carried away and removed from the body through the process of sweating.
WHY DOES THAT HAPPEN?
Q: Why do I shiver when I become cold?
A: When the
temperature of the body drops below normal, the brain signals the muscles to
contract rapidly—what we perceive as shivering. The heat generated by these
rapid muscle contractions helps to raise or at least stabilize body temperature.
When lactic acid builds up in muscle fibers, it increases the acidity in the
fibers. Key enzymes in the fibers are then deactivated, and the fibers can no
longer function properly. As a result, muscles are not as effective, contracting
less and less. This condition is known as muscle fatigue.
In a state of
fatigue, muscle contractions may be painful. Finally, muscles may simply stop
working.
Movement and muscle arrangement
-Muscles cannot push; they can only pull. In order to create movement, muscles must act in pairs.
-Muscles are arranged on the skeleton in such a way that the flexing or contracting of one muscle or group of muscles is usually balanced by the lengthening or relaxation of another muscle or group of muscles. Thus, when a muscle performs an action, another can undo or reverse that action.
-For example, when the biceps (muscle on the front of the upper arm) contracts, the forearm moves in at the elbow toward the biceps; at the same time, the triceps (muscle on the rear of the upper arms) lengthens. When the forearm is moved out in a straight-arm position, the opposite occurs: the triceps contracts and the biceps lengthens.
-A muscle whose contraction is responsible for producing a particular movement is called a prime mover (or an agonist).
-A muscle that opposes or reverses the movement of a prime mover is called an antagonist. Generally, antagonistic muscles are located on the opposite side of a limb or portion of the body from prime mover or agonist muscles.
-Most muscles do not act by themselves to produce a particular movement. Muscles that help prime movers by producing the same movement or by reducing unnecessary movement are called synergists. When the biceps flexes the elbow, smaller muscles in the upper arm also come into play. If the elbow is flexed with the palm of the hand up, the biceps is the prime mover. However, if the elbow is flexed with the palm down or the thumb up (palm in), the other muscles become the prime movers. These particular synergistic muscles allow for greater mobility or movement of the hand when the elbow is flexed.
-Although prime movers are mainly responsible for producing certain body movements, the actions of antagonists and synergists are equally important. Without the combined efforts of all three types of muscles, body movements would not be smooth, coordinated, and precise.
Muscle tone
-Even when the body is at rest, certain muscle fibers in all muscles are contracting. This activity is directed by the brain and cannot be controlled consciously.
-This state of continuous partial muscle contractions is known as muscle tone are not strong enough to produce movement, but do tense and firm the muscles. In doing so, they keep the muscles firm, healthy, and ready for action.
-Muscles with moderate muscle tone are firm and solid, whereas ones with little muscle tone are limp and soft.
-Muscle tone is the result of different motor units throughout a muscle being stimulated by the nervous system in an orderly way. First one group of motor units is stimulated, then another. Alternate fibers contract so the muscle as a whole does not become fatigued.
-Muscle tone is important because it helps human beings maintain an upright posture. Without muscle tone, an individual would not be able to sit up straight in a chair or hold his or her head up. Muscle tone is also important because it generates heat to help maintain body temperature. Normal muscle tone accounts for about 25 percent of the heat in a body at rest.
5.7 Muscle Disorder
-Spasm: Sudden, involuntary muscle contraction.
-Strain: Slight tear in a muscle; also called a pulled muscle.
-Botulism (BOCH-a-liz-em): Form of food poisoning in which a bacterial toxin prevents the release of acetylcholine at neuromuscular junctions, resulting in paralysis.
-Muscular dystrophy (MUS-kyu-lar DIS-tro-fee): One of several inherited muscular diseases in which a person's muscles gradually and irreversibly deteriorate, causing weakness and eventually complete disability.
-Myasthenia gravis (my-ass-THEH-nee-ah GRA-vis): Autoimmune disease in which antibodies attack acetylcholine, blocking the transmission of nerve impulses to muscle fibers.
-Tetanus (TET-n-es): Bacterial disease in which a bacterial toxin causes the repetitive stimulation of muscle fibers, resulting in convulsive muscle spasms and rigidity.
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| posted at 11:28 AM |
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| THE SKELETAL SYSTEM |
4. THE SKELETAL SYSTEM
The Skeletal System serves many important functions; it provides the shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals.
4.1. Functions
i. Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached.
ii. Vital organs are protected by the skeletal system. The brain is protected by the surrounding skull as the heart and lungs are encased by the sternum and rib cage.
iii. Bodily movement is carried out by the interaction of the muscular and skeletal systems. For this reason, they are often grouped together as the musculo-skeletal system. Muscles are connected to bones by tendons. Bones are connected to each other by ligaments. Where bones meet one another is typically called a joint. Muscles which cause movement of a joint are connected to two different bones and contract to pull them together. An example would be the contraction of the biceps and a relaxation of the triceps. This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm.
iv. Blood cells are produced by the marrow located in some bones. An average of 2.6 million red blood cells are produced each second by the bone marrow to replace those worn out and destroyed by the liver.
v. Bones serve as a storage area for minerals such as calcium and phosphorus. When an excess is present in the blood, buildup will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply.
4.2 Types of Bone
The bones of the body fall into four general categories: long bones, short bones, flat bones, and irregular bones.
Long bones are longer than they are wide and work as levers. The bones of the upper and lower extremities (ex. humerus, tibia, femur, ulna, metacarpals, etc.) are of this type.
Short bones are short, cube-shaped, and found in the wrists and ankles.
Flat bones have broad surfaces for protection of organs and attachment of muscles (ex. ribs, cranial bones, bones of shoulder girdle).
Irregular bones are all others that do not fall into the previous categories. They have varied shapes, sizes, and surfaces features and include the bones of the vertebrae and a few in the skull.
4.3 Bone Composition
Bones are composed of tissue that may take one of two forms.
Compact, or dense bone, and spongy, or cancellous, bone. Most bones contain both types.
Compact bone is dense, hard, and forms the protective exterior portion of all bones.
Spongy bone is inside the compact bone and is very porous (full of tiny holes). Spongy bone occurs in most bones. The bone tissue is composed of several types of bone cells embedded in a web of inorganic salts (mostly calcium and phosphorus) to give the bone strength, and collagenous fibers and ground substance to give the bone flexibility
4. 4. Divisions of the Skeleton
 The human skeleton is divided into two distinct parts:
The axial skeleton consists of bones that form the axis of the body and support and protect the organs of the head, neck, and trunk.
o The Skull
o The Sternum
o The Ribs
o The Vertebral Column
The appendicular skeleton is composed of bones that anchor the appendages to the axial skeleton.
o The Upper Extremities
o The Lower Extremities
o The Shoulder Girdle
o The Pelvic Girdle--(the sacrum and coccyx are considered part of the vertebral column)
o Tendons and ligaments are strong bands of fibrous connective tissue that attach muscles to bones, and bones to bones, respectively.
 Overview of Axial Skeleton
 The Skull
Cranial bones are flat, rounded, and fused to protect the brain.
oFacial bones provide a framework for the facial muscles, form eye sockets, and form jaws for the teeth.
oThe hinged mandible (jaw bone) moves freely during mastication (chewing) and speech.
The Vertebral
~The vertebral column has three groups of vertebrae and two sets of fused bones;
o vertebrae include seven cervical (neck) vertebrae,
o twelve thoracic (upper back) vertebrae
o and five lumbar (lower back) vertebrae.
~Five fused vertebrae form the sacrum and from three to five fused small vertebrae form the coccyx (tail bone).
~The vertebrae form a column of bone that protects the spinal cord. The thoracic vertebrae have facets (indentations) upon their surfaces that articulate (meet) with the ribs.
The Ribs
~The twelve pairs of ribs are long, flattened, and curved bones that form a protective cage for the heart, lungs, and other internal organs.
~The vertebrosternal (true) ribs are the first seven ribs; they are "true" because they attach directly to the sternum (breast bone).
~Ribs eight through twelve are the false ribs because they indirectly attach to the sternum or they lack a sternal attachment.
~Ribs eight through ten are the vertebrochondral ribs because they attach indirectly to the sternum by cartilage.
~Ribs eleven and twelve are called floating (vertebral) ribs because they do not attach to the sternum. Instead, their floating position allows them to bend sideways while providing protection for the kidneys.
Overview of Appendicular skeleton
The Pectoral Girdle Bones
~include two scapulae (shoulder blades) and two clavicles (collar bones).
oThe scapula is in the upper back and articulates with two bones: the humerus and the clavicle. Because the scapula is part of the shoulder joint, the scapula must be mobile to allow the upper extremities freedom of movement.
oThe clavicle articulates with the sternum and the scapula, giving support to the pectoral girdle and adding stability to the shoulder joint.
The Bones Of The Upper Extremities
oConsist of the humerus, ulna, radius, carpals (wrist bones), metacarpals (hand bones), and phalanges (finger bones).
oThe humerus in the arm articulates with the scapula at the shoulder joint and with the ulna and radius at the elbow.
oThe radius and ulna in the forearm articulate with the carpals at the wrist. The ulna articulates with the humerus and forms the elbow.
oThe carpals are small, flat, irregularly shaped wrist bones. They articulate with the metacarpals in the hand. The metacarpals articulate with the phalanges.
The Bones Of The Lower Extremities
~The Pelvic
o In the pelvic girdle are two hip bones. Each coxa (hip bone) forms from fused bones. The two coxae, sacrum, and coccyx form the pelvis, a bowl-shaped cavity that supports and protects many abdominal organs.
o The pelvic girdle articulates with the femur (thigh bone) at the acetabulum (hip joint) and with the sacrum at the sacroiliac joint. Also, the coxae articulate with each other at the pubic symphysis, a joint with limited movement.
~The femur
 o is the longest and heaviest bone in the body and helps in weight-bearing while standing.
o At the knee, the femur articulates with the tibia (shin bone). Suspended within muscle tendons at the front of the knee joint is the patella (kneecap). The patella is an example of a sesamoid bone (small bone) that is within a tendon.
~The Fibula
o Attaching to the lateral (outer side) of the tibia is the fibula (leg bone).
o The fibula provides points of attachment for muscles of the foot and leg and increases the lateral stability of the ankle.
o The fibula is not a weight-bearing bone like the tibia.
~The Foot
o In the foot are specialized bones designed for weight-bearing. Among these are the tarsals (ankle bones), metatarsals (foot bones), and phalanges (toe bones).
o These foot bones form a system of arches that allow the foot to support much weight.
4.5 Bone marrow
Within the long bones are two types of bone marrow: red marrow and yellow marrow. The yellow marrow has fatty connective tissue and fills the marrow cavity. During starvation, the body uses the fat in yellow marrow for energy.
 The red marrow of some bones is an important site for blood cell production.
Here all erythrocytes (red blood cells), platelets, and most leukocytes (white blood cells) form in adults. From the red marrow, erythrocytes, platelets, and leukocytes migrate to the blood to do their special tasks.
Red blood cells carry oxygen and nutrients to the body tissues. Platelets help in blood clotting. White blood cells help fight disease and infection.
4.6 Joints
~Bones of the skeleton articulate at joints.
~A joint, or articulation, is the place where two bones come together. There are three types of joints classified by the amount of movement they allow: immovable, slightly movable, and freely movable.
~Immovable joints are synarthroses. In this type of joint, the bones are in very close contact and are separated only by a thin layer of fibrous connective tissue. An example of a synarthrosis is the suture in the skull between skull bones.
 ~Slightly movable joints are called amphiarthroses. This type of joint is characterized by bones that are connected by hyaline cartilage (fibro cartilage). The ribs that connect to the sternum are an example of an amphiarthrosis joint.
~Most of the joints in the adult human body are freely movable joints. This type of joint is called a diarthrosis joint. There are six types of diarthroses joints. These are:
o Ball-and-Socket: The ball-shaped end of one bone fits into a cup shaped socket on the other bone allowing the widest range of motion including rotation. Examples include the shoulder and hip.
o Condyloid: Oval shaped condyle fits into elliptical cavity of another allowing angular motion but not rotation. This occurs between the metacarpals (bones in the palm of the hand) and phalanges (fingers) and between the metatarsals (foot bones excluding heel) and phalanges (toes).
o Saddle: This type of joint occurs when the touching surfaces of two bones have both concave and convex regions with the shapes of the two bones complementing one other and allowing a wide range of movement. The only saddle joint in the body is in the thumb.
o Pivot: Rounded or conical surfaces of one bone fit into a ring of one or tendon allowing rotation. An example is the joint between the axis and atlas in the neck.
o Hinge: A convex projection on one bone fits into a concave depression in another permitting only flexion and extension as in the elbow and knee joints.
o Gliding: Flat or slightly flat surfaces move against each other allowing sliding or twisting without any circular movement. This happens in the carpals in the wrist and the tarsals in the ankle.
4.7 Bone Cells
There are five main types of bone cells in bone tissue.
oOsteogenic cells respond to traumas, such as fractures, by giving rise to bone-forming cells and bone-destroying cells.
oOsteoblasts (bone-forming cells) synthesize and secrete unmineralized ground substance and are found in areas of high metabolism within the bone. Osteocytes are mature bone cells made from osteoblasts that have made bone tissue around themselves.
oThese cells maintain healthy bone tissue by secreting enzymes and controlling the bone mineral content; they also control the calcium release from the bone tissue to the blood. oOsteoclasts are large cells that break down bone tissue.
They are very important to bone growth, healing, and remodeling. The last type of cells are bone-lining cells. These are made from osteoblasts along the surface of most bones in an adult.
Bone-lining cells are thought to regulate the movement of calcium and phosphate into and out of the bone.
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| posted at 10:38 AM |
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