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Chapter IV - Grade 3 emergencies, sprains, dislocations and fractures

Sprain

Represents a traumatic injury of a joint caused by the sudden execution of a movement beyond the physiological limits without being followed by a permanent displacement of the bones or ligaments.

The most frequently encountered are those at the level of the ankle, knee, wrist and the fingers.

Types of sprains:

• mild sprain, occurs when the fibers of the ligaments overstretch or tear slightly;
• moderate sprain, occurs when the fibers of the ligaments tear but without leading to a complete rupture;
• severe sprain, occurs when one or more ligaments tear completely and the area is painful, swollen and colored blue-black.

Recognition signs:

• a sound like a crack;
• pain;
• tenderness of the affected area;
• swelling;
• the colour will change (black-bluish).

First aid measures in case of a sprain:

• the affected area will be immobilized;
• compresses with cold water or ice will be applied;
• painkillers will be administered;
• use of the injured limb will be avoided;
• the injured person will be transported to the hospital.

Dislocation (sprain)

Represents a displacement of the bone ends of a joint from the usual position accompanied by the loss of normal movements.

The most frequently encountered are those at the level of the shoulder, ankle, hip and the elbow.

Depending on the position acquired by the injured distal segment, the dislocations can be:

• dorsal dislocations;
• volar dislocations;
• lateral dislocations.

Recognition signs:

• deformation of the joint;
• immobility of the affected joint;
• pain and color change of the skin around the traumatized area.

First aid in case of a dislocation:

• the affected area must be immobilized with a splint or with a sling and it is recommended to avoid using the injured limb;
• transporting the victim to the hospital, it is important that the treatment be performed by a correctly trained person because incorrect repositioning of the joint can produce additional injury of it and of the adjacent structures.

Fracture

Represents the rupture of a bone or of a cartilage of a body limb.

Most frequently these appear at the level of the limbs and the most predisposed to the production of fractures are elderly persons, due to the lower elasticity of the bones.

The fractures can be:

• closed (the skin remains intact);
• open (there is an open wound up to the level of the broken bone).

Recognition signs:

• spontaneous pain;
• deformation of the region;
• bruise;
• lack of transmission of movements.

First aid in case of a fracture:

• the victim will be positioned depending on the fractured area;
• cleaning, disinfecting and dressing;
• temporary immobilization of the affected region, this is done with the help of splints;
• pain relief by administering some painkillers;
• the injured person will be transported to the hospital.

Transport of the injured

An important factor is the transport of the victim due to the complications that may appear following the maneuvers performed to load the victim into the Ambulance or, in its absence, in any other means of transport.

During mobilization the victim must be handled carefully and the lifting and placing on the stretcher must be performed with the help of several persons who will position themselves at the head and at the feet of the one who must be lifted.

This maneuver must be done by lifting and not by pulling or pushing, so that the head, neck and trunk are kept in the same plane.

The position of the victim must remain during transport identical to the one in which the first aid was provided at the accident site.

The position of the stretcher must always be the horizontal one and the victim must be positioned with the head towards the direction of travel.

Once started, the cardio-respiratory resuscitation maneuvers will be continued also during transport.

Depending on the injuries and on the condition that the victim presents, the positioning will be:

• in case of dislocations, sprains or fractures the correct position will be that of rest (inactivity);
• in case of large hemorrhages, the victim will be positioned on the back with the lower limbs raised at 30-40 degrees compared to the position of the trunk;
• in case of a cardio-respiratory arrest the position of the victim will be the one on the back;
• in case of fractures of the forearm, jaw or mandible, the position of the victim will be sitting;
• in case of a rib fracture and the victim is conscious, this one will be positioned half-sitting with the back supported, and if this one is unconscious will be positioned on the side on the sick side;
• in case of a skull fracture, the victim will be positioned horizontal, on one side;
• in case of a vertebral column fracture, the victim being conscious will be positioned on the back and if the victim is unconscious will be placed on one side.