inches above the level of the elbow. Support the forearm in this position by means of a wide sling (fig. 4-57). A wide roller bandage (or any wide strip of cloth) may be used to secure the victim’s arm to the body (see figure 4-53). A figure-of-eight bandage may also be used for a fractured clavicle. Treat the victim for shock and evacuate to a definitive care facility as soon as possible.
Fracture of the Rib
If the ribs are broken, make the victim comfortable and quiet so that the greatest danger— the possibility of further damage to the lungs, heart, or chest wall by the broken ends–is minimized.
The common finding in all victims with fractured ribs is pain localized at the site of the fracture. By asking the patient to point out the exact area of the pain, you can often determine the location of the injury. There may or may not be a rib deformity, chest wall contusion, or laceration of the area. Deep breathing, coughing, or movement is usually painful. The patient generally wishes to remain still and may often lean toward the injured side, with a hand over the fractured area to immobilize the chest and to ease the pain.
Figure 4-57.—Sling for immobilizing fractured clavicle.
Figure 4-58.—Swathe bandage of fractured rib victim.
Ordinarily, rib fractures are not bound, strapped, or taped if the victim is reasonably comfortable. However, they may be splinted by the use of external support. If the patient is considerably more comfortable with the chest immobilized, the best method is to use a swathe (fig. 4-58) in which the arm on the injured side is strapped to the chest to limit motion. Place the arm on the injured side against the chest, with the palm flat, thumb up, and the forearm raised to a 45° angle. Immobilize the chest, using wide strips of bandage to secure the arm to the chest.
Wide strips of adhesive plaster applied directly to the skin of the chest for immobilization should not be used since the adhesive tends to limit the ability of the chest to expand and this interferes with proper breathing. Treat the victim for shock and evacuate as soon as possible.
Fracture of the Nose
A fracture of the nose usually causes localized pain and swelling, a noticeable deformity of the nose, and extensive nosebleed.
Stop the nosebleed. Have the victim sit quietly, with the head tipped slightly backward. Tell the victim to breathe through the mouth and not to blow the nose. If the bleeding does not stop within a few minutes, apply a cold compress or an ice bag over the nose.
