kept warm but should not be moved into the position
ordinarily used for the treatment of shock.
If you must transport the victim to another place,
do it with the utmost care. Use a rigid stretcher, a
padded door, or a wide board. Keep the victim supine.
In some cases, the victim will be more comfortable if
the legs are straight, while in other cases the victim will
be more comfortable with the knees bent and the legs
drawn up. When you have placed the victim in the
most comfortable position, immobilization should be
accomplished. Fractures of the hip are best treated
with traction splints. Adequate immobilization can
also be obtained by placing pillows or folded blankets
between the legs as shown in figure 4-44 and using
cravats, roller bandages, or straps to hold the legs
together, or through the use of MAST garments.
Fasten the victim securely to the stretcher or
improvised support, and evacuate very carefully.
MANAGEMENT OF JOINT
AND MUSCLE INJURIES
LEARNING OBJECTIVE: Select the
appropriate stabilization and treatment
procedure for the management of joint and
Injuries to joints and muscles often occur together,
and it is sometimes difficult to tell whether the primary
injury is to a joint or to the muscles, tendons, blood
vessels, or nerves near the joint.
Sometimes it is
difficult to distinguish joint or muscle injuries from
fractures. In case of doubt, always treat any injury to a
bone, joint, or muscle as though it were a fracture.
In general, joint and muscle injuries may be
classified under four headings: (1) dislocations, (2)
sprains, (3) strains, and (4) contusions (bruises).
When a bone is forcibly displaced from its joint,
the injury is known as a dislocation. In some cases, the
bone slips back quickly into its normal position, but at
other times it becomes locked in the new position and
remains dislocated until it is put back into place.
Dislocations are usually caused by falls or blows but
occasionally by violent muscular exertion. The most
frequently dislocated joints are those of the shoulder,
hip, fingers, and jaw.
A dislocation is likely to bruise or tear the muscles,
ligaments, blood vessels, tendons, and nerves near a
joint. Rapid swelling and discoloration, loss of ability
to use the joint, severe pain and muscle spasms,
possible numbness and loss of pulse below the joint,
and shock are characteristic symptoms of dislocations.
The fact that the injured part is usually stiff and
immobile, with marked deformation at the joint, will
help you distinguish a dislocation from a fracture. In a
fracture, there is deformity between joints rather than
at joints, and there is generally a wobbly motion of the
broken bone at the point of fracture.
As a general rule, you should not attempt to reduce
a dislocationthat is, put a dislocated bone back into
placeunless you know that a medical officer cannot
be reached within 8 hours. Unskilled attempts at
reduction may cause great damage to nerves and blood
vessels or actually fracture the bone. Therefore, except
in great emergencies, you should leave this treatment
to specially trained medical personnel and concentrate
your efforts on making the victim as comfortable as
possible under the circumstances.
The following emergency measures will be
1. Loosen the clothing around the injured part.
2. Place the victim in the most comfortable
3. Support the injured part by means of a sling,
pillows, bandages, splints, or any other device
that will make the victim comfortable.
4. Treat the victim for shock.
5. Get medical help as soon as possible.
You should NEVER attempt to reduce the more
serious dislocations, such as those of the hip.
However, if it is probable that the victim cannot be
treated by a medical officer within a reasonable time,
you should make a careful effort to reduce certain
Figure 4-44.Immobilizing a fractured pelvis.