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 position. After putting the heel of your foot in the victim’s 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 victim’s elbow slightly. Grasp the arm below the elbow, apply traction from the point of the elbow, and gently rotate the arm into the external or outward position. If three reduction attempts 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 patient’s elbow may be substituted. Gradually add sand or water to the bucket to increase traction. Grasping the wrist and using the elbow as a pivot point, gently rotate the arm into the external position.
Sprains
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 common.
Symptoms of a sprain include pain or pressure at the joint, pain upon movement, swelling and tenderness, possible loss of movement, and discoloration. Treat all sprains as fractures until ruled out by x-rays.
Emergency care for a sprain includes application of cold packs for the first 24 to 48 hours to reduce swelling and to control internal hemorrhage; elevation and rest of the affected area; application of a snug, smooth, figure-of-eight bandage to control swelling and to provide immobilization (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 circulation 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 compresses, warm whirlpool baths, etc. CAUTION: Heat should not be applied until 24 hours after the last cold pack.
Strains
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 excessively 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 knotting of the muscles), moderate swelling at the place of injury, discoloration due to the escape of blood from injured blood vessels into the tissues, possible 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 swelling 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 a fracture.
Contusion
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 treatment. However, if the victim has severe bruises, 4-62