immobilized by strapping it to a flat, wooden
stick, such as a tongue depressor.
DISLOCATION OF THE SHOULDER.
Before reduction, place the victim in a supine posi-
tion. After putting the heel of your foot in the
victims armpit, grasp the wrist and apply steady
traction by pulling gently and increasing resistance
gradually. Pull the arm in the same line as it is
found. After several minutes of steady pull, flex
the victims elbow slightly. Grasp the arm below
the elbow, apply traction from the point of the
elbow, and gently rotate the arm into the exter-
nal or outward position. If three reduction at-
tempts fail, carry the forearm across the chest and
apply a sling and swathe. An alternate method
involves having the patient lie face down on an
examining table with the injured arm hanging over
the side. Apply prolonged, firm, gentle traction
at the wrist with gentle external rotation. A water
bucket with a padded handle placed in the crook
of the patients elbow may be substituted.
Gradually add sand or water to the bucket to in-
crease traction. Grasping the wrist and using the
elbow as a pivot point, gently rotate the arm into
the external position.
A SPRAIN is an injury to the ligaments and
soft tissues that support a joint. A sprain is caused
by the violent wrenching or twisting of the joint
beyond its normal limits of movement and usually
involves a momentary dislocation, with the bone
slipping back into place of its own accord.
Although any joint may be sprained, sprains of
the ankle, wrist, knee and finger are most
Symptoms of a sprain include pain or pressure
at the joint, pain upon movement, swelling and
tenderness, possible loss of movement, and dis-
coloration. Treat all sprains as fractures until
ruled out by x-rays.
Emergency care for a sprain includes applica-
tion of cold packs for the first 24 to 48 hours to
reduce swelling and to control internal hemor-
rhage; elevation and rest of the affected area;
application of a snug, smooth, figure-of-eight
bandage to control swelling and to provide im-
mobilization (basket weave adhesive bandages can
be used on the ankle); a follow-up examination
by a medical officer; and x-rays to rule out the
presence of a fracture. Note: Check bandaged
areas regularly for swelling that might cause cir-
culation impairment and loosen bandages if
necessary. After the swelling stops (24 to 48 hours)
moist heat can be applied for short periods (15
to 30 minutes) to promote healing and to reduce
swelling. Moist heat can be warm, wet com-
presses, warm whirlpool baths, etc. CAUTION:
Heat should not be applied until 24 hours after
the last cold pack.
An injury caused by the forcible overstretching
or tearing of a muscle or tendon is known as a
STRAIN. Strains may be caused by lifting ex-
cessively heavy loads, sudden or violent
movements, or any other action that pulls the
muscles beyond their normal limits.
The chief symptoms of a strain are pain,
lameness or stiffness (sometimes involving knot-
ting of the muscles), moderate swelling at the place
of injury, discoloration due to the escape of blood
from injured blood vessels into the tissues, possi-
ble loss of power, and a distinct gap felt at the site.
Keep the affected area elevated and at rest;
apply cold packs for the first 24 to 48 hours to
control hemorrhage and swelling; after the swell-
ing stops, apply mild heat to increase circulation
and aid in healing. As in sprains, heat should not
be applied until 24 hours after the last cold pack.
Muscle relaxants, adhesive straps, and complete
immobilization of the area may be indicated.
Evacuate the victim to a medical facility where
x-rays can be taken to rule out the presence of
CONTUSIONS, commonly called BRUISES,
are responsible for the discoloration that almost
always accompanies injuries to bones, joints, and
muscles. Contusions are caused by blows that
damage bones, muscles, tendons, blood vessels,
nerves, and other body tissues, although they do
not necessarily break the skin.
The symptoms of a contusion or bruise are
familiar to everyone. There is immediate pain
when the blow is received. Swelling occurs because
blood from the broken vessels oozes into the soft
tissues under the skin. At first the injured place
is reddened due to local skin irritation from the
blow; later the characteristic black and blue
marks appear; and finally, perhaps several days
later, the skin is yellowish or greenish. The bruised
area is usually very tender.
As a rule, slight bruises do not require treat-
ment. However, if the victim has severe bruises,