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 muscle injuries. 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). Dislocations 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 helpful: 1. Loosen the clothing around the injured part. 2. Place the victim in the most comfortable position possible. 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 4-54 Figure 4-44.—Immobilizing a fractured pelvis.