One of the most important phases of emergencycare is to clear the upper respiratory passage of anyobstruction. If the fractured jaw interferes withbreathing, pull the lower jaw and the tongue wellforward and keep them in that position.Apply a four-tailed bandage, as shown in figure4-41. Be sure that the bandage pulls the lower jawforward. Never apply a bandage that forces the jawbackward, since this might seriously interfere withbreathing. The bandage must be firm so that it willsupport and immobilize the injured jaw, but it must notpress against the victim’s throat. Be sure that thevictim has scissors or a knife to cut the bandage in caseof vomiting. Treat the victim for shock and evacuate assoon as possible.Skull FractureWhen a person suffers a head injury, the greatestdanger is that the brain may be severely damaged;whether or not the skull is fractured is a matter ofsecondary importance. In some cases, injuries thatfracture the skull do not cause serious brain damage;but brain damage canand frequently doesresultfrom apparently slight injuries that do not causedamage to the skull itself.It is often difficult to determine whether an injuryhas affected the brain because the symptoms of braindamage vary greatly. A person suffering from a headinjury must be handled very carefully and givenimmediate medical attention.Some of the symptoms that may indicate braindamage are listed below. However, you mustremember that all of these symptoms are not alwayspresent in any one case and that the symptoms that dooccur may be greatly delayed.Bruises or wounds of the scalp may indicate thatthe victim has sustained a blow to the head.Sometimes the skull is depressed (caved in) atthe point of impact. If the fracture is open, youmay find glass, shrapnel, or other objectspenetrating the skull.The victim may be conscious or unconscious. Ifconscious, the victim may feel dizzy and weak,as though about to faint.Severe headache sometimes (but not always)accompanies head injuries.The pupils of the eyes may be unequal in size andmay not react normally to light.There may be bleeding from the ears, nose, ormouth.The victim may vomit.The victim may be restless and perhaps confusedand disoriented.The arms, legs, face, or other parts of the bodymay be partially paralyzed.The victim’s face may be very pale, or it may beunusually flushed.The victim is likely to be suffering from shock,but the symptoms of shock may be disguised byother symptoms.It is not necessary to determine if the skull isfractured when you are giving first aid to a person whohas suffered a head injury. The treatment is the same ineither case, and the primary intent is to prevent furtherdamage to the brain.Keep the victim lying down. If the face is flushed,raise the head and shoulders slightly. If the face is pale,have the victim lie so that the head is level with, orslightly lower than, the body. Watch carefully forvomiting. If the victim begins to vomit, position thehead to prevent choking on the vomitus.If there is serious bleeding from the wounds, try tocontrol that bleeding by the application of directpressure, using caution to avoid further injury to theskull or brain. Use a donut-shaped bandage to gentlysurround protruding objects. Never manipulate thoseobjects.Be very careful about moving or handling thevictim. Move the victim no more than is4-51Figure 4-41.—Four-tailed bandage for the jaw.
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