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    Name 14 February 2007

    London District LINKS Autumn 2008

    Strains, sprains, fracturesand dislocations

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    Strains, sprains, fractures and dislocations London District LINKS

    What well be covering

    What are strains, sprains, fractures anddislocations, and why do they happen?

    How to recognise them on duty

    How to treat them

    What to do and what not to do

    Practical skillsbandaging people with

    these problems

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    The skeleton

    Your body is held togetherby bones

    Together, bones form theskeleton

    The skeleton is very strongall your organs andmuscles are attached to itsomehow

    How many bones does anaverage adult have?

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    The skeleton

    The average adult has 206 bones

    The heaviest is the femurin the thigh

    The smallest is the stapesin the ear

    Any bone in the body can be broken if

    things go wrong

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    Joints

    Bones meet at joints

    Joints allow the body to

    move

    However they areweaker than bone, and

    this makes them

    vulnerable to injury

    Joints contain severalimportant parts

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    A simplified joint

    Ligamentscover the outside of the joint

    Fluidfills the joint space

    Cartilagelines the bone surfaces

    Bone

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    Strains, sprains, fractures and dislocations London District LINKS

    Mechanisms of injury

    Strains, sprains, fractures anddislocations are caused by

    abnormal forces on joints and bones

    These can include:- impacts

    - twisting movements

    - compression or stretching

    - over-bending of joints

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    Mechanisms of injury

    What sort of duty situations might theseproblems occur in?- Sports matches

    - Running events- Ice skating

    - Car or cycle races

    - Crushing in heavy crowds

    - Diving into deep water

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    Strains

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    What is a strain?

    Muscles attach to bones via tendons

    You can see tendons on the back of

    your hand

    If a muscle is pulled too hard, the

    tendon becomes damageda strain

    Pain occurs whilst the tendon heals

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    Common sites for strains

    Strains often occur around:- Neck

    - Ribs

    - Upper arm- Fingers

    - Groin!

    Why are these strains common?

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    Recognising a strain

    How would you recognise a strain?

    - History of injury e.g. casualty slipped over

    - Pain and tenderness

    - Swellingusually not much

    - Reddening of the skin

    - Reduced movement due to the pain

    - Locationoften away from a joint unlike asprain

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    How to treat a strain

    The treatment is RICE

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    RICE is a key first aid acronym:

    - Rest the affected area

    - Ice-pack the affected area

    - Compress the affected area

    - Elevate the affected area

    How to treat a strain

    R

    I

    C

    E

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    How to treat a strain

    Advise the casualty they can buysimple painkillers from a pharmacy

    Strains can take a few days to a week

    to get better (if RICE is followed)

    If it doesnt get better they can see their

    GP or go to A&E

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    Sprains

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    What is a sprain?

    Remember the joint?

    A sprain occurs

    when the ligament

    around a joint isdamaged

    The joint fluid can

    leak out

    This causes painand swelling

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    Common sites for sprains

    What joints are commonly sprained?- Ankle

    - Knee

    - Elbow- Wrist

    - Finger joints

    Tends to be joints in arms and legs that

    sprain the mostwhy?

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    Recognising a sprain

    How would you recognise a sprain?

    - History of injury e.g. fell awkwardly

    - Pain and tenderness

    - Swellingmore than in a strain

    - Reddening of the skin

    - Reduced movement due to the pain

    - Locationaround a joint, by definition

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    RICE is the key again:

    - Rest the affected area

    - Ice-pack the affected area

    - Compress the affected area

    - Elevate the affected area

    How to treat a sprain

    R

    I

    C

    E

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    How to treat a sprain

    Again the casualty can buy simplepainkillers

    Sprains often take longer to heal

    up to two weeks

    Resting the joint is most important

    Again they should see their GP or

    A&E if things dont get better

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    Fractures

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    What is a fracture?

    A fracture is a brokenbone

    This includes chips and

    cracks in bones as well

    as full snaps

    Bones usually fracture in

    their shafts

    A strong force is usuallyrequired

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    Types of fractures

    Doctors like to classify fractures

    There are only 2 classes you need to

    know about

    - Closed fracturewhere the broken ends ofthe bones are in their normal place

    - Open fracturewhere the ends of the

    bones have moved e.g. sticking out of skin

    Why is this important?

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    Types of fractures

    Closed fracture Open fracture

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    Common sites for fractures

    Which bones commonly break?- Upper arm (humerus)

    - Forearm (radius/ulna)

    - Wrist

    - Lower leg (tibia/fibula)

    - Ankle

    Why are these fractures common?

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    Recognising a fracture

    How would you recognise a fracture?- History of injury e.g. fell onto arm

    - Snapping or cracking noise heard

    - Lots of pain- Swelling of the area

    - Obvious deformity e.g. bone looks bent

    - Inability to move the area- Bone sticking out or a wound if open fracture

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    Recognising a fracture

    You should be more suspicious of afracture in people with weaker bones:

    - children

    - older people

    - people with bone disease e.g. osteoporosis

    (thinning of the bones)

    - people taking steroids for a long time

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    How to treat a fracture

    Try to move the area as little as possible

    Support the area:- Arm sling for an arm or wrist fracture

    - Elevation sling for a collar bone fracture- Blanket padding for a leg fracture

    Dress any wounds that are present

    Cover any bone ends with dressingssoaked in sterile saline

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    How to treat a fracture

    The casualty needs to go to hospital assoon as possible

    Dont let the casualty eat or drink,

    smoke or walk around

    Treat for shock if necessary

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    Further treatment

    The ambulance crewmay use a splint to

    hold the bones in

    place

    They may give the

    casualty painkillers:- gas and air (Entonox)

    - into the bloodstream

    e.g. morphine

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    Further treatment

    Many fractures canbe treated with a

    plaster cast

    Others needoperations and

    metalwork to hold the

    bones in place

    This is a tibia fracture

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    Dislocations

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    What is a dislocation?

    Remember the joint? A dislocation occurs

    when the two bone

    ends come apart

    This stops the joint

    from moving

    It is usually due to

    an impact to the joint

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    Common sites for dislocations

    Which joints commonly dislocate?- Shoulder

    - Finger joints

    - Hip (often hip replacements)

    - Kneecap

    - Ankle

    Due to the forces involved, fractures

    may occur with dislocations

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    Recognising a dislocation

    How would you recognise a dislocation?- History of injuryimpact to a joint

    - Crunching noise heard

    - Deformity of the joint- Swelling and redness

    - Lots of pain

    - Inability to move the joint- Signs of a nearby fracture

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    How to treat a dislocation

    Keep the joint still and supportedusea sling or padding if necessary

    Never try to put the bones back into the

    normal position:- Without x-ray cant be sure its a dislocation

    - May cause more damage

    - Its cruel without painkillers!

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    How to treat a dislocation

    The casualty needs to go to hospital assoon as possible

    Dont let the casualty eat or drink,

    smoke or walk about

    Treat for shock if necessary

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    Further treatment

    Sometimes the ambulance crew maymove the bones position if they are

    worried about nerve or artery damage

    Otherwise the dislocation will be movedin hospital after an x-ray

    The casualty will need painkillers and

    sedationits very painful!

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    Anyquestions?

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    Practical skills

    Well now teach you how to:- Apply an arm slinguseful for arm

    fractures

    - Apply an elevation slinguseful for collarbone fractures

    - Apply padding and bandages to a leg

    to support a leg fracture

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    Quiz

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    Question 1

    A sprain is where:A. The ligaments around a joint have

    been damaged

    B. The bones in a joint have become

    displaced

    C. A muscle and its tendon have been

    damaged

    D. The soft tissues around a bone havebeen bruised

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    Question 1

    A sprain is where:A. The ligaments around a joint have

    been damaged

    B. The bones in a joint have become

    displaced

    C. A muscle and its tendon have been

    damaged

    D. The soft tissues around a bone havebeen bruised

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    Question 2

    How long does a strain take to heal, ifRICE is followed?

    A. A few hours

    B. A few days to a week

    C. Up to two weeks

    D. Up to a month

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    Question 2

    How long does a strain take to heal, ifRICE is followed?

    A. A few hours

    B. A few days to a week

    C. Up to two weeks

    D. Up to a month

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    Question 3

    The C in RICE stands for:

    A. Calm the patient

    B. Circulation

    C. Call for medical help

    D. Compress the injury

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    Question 3

    The C in RICE stands for:

    A. Calm the patient

    B. Circulation

    C. Call for medical help

    D. Compress the injury

    Q i 4

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    Question 4

    The most important risk with an openfracture is that:

    A. The bones might erode each other as

    they rub togetherB. Infection can enter the body

    C. The doctor might scratch himself on

    the protruding bone

    D. There might be lots of bleeding

    Q ti 4

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    Question 4

    The most important risk with an openfracture is that:

    A. The bones might erode each other as

    they rub togetherB. Infection can enter the body

    C. The doctor might scratch himself on

    the protruding bone

    D. There might be lots of bleeding

    Q ti 5

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    Question 5

    Which of these joints is not commonlydislocated?

    A. Wrist

    B. Ankle

    C. Shoulder

    D. Finger

    Q ti 5

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    Question 5

    Which of these joints is not commonlydislocated?

    A. Wrist

    B. Ankle

    C. Shoulder

    D. Finger

    S i

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    Scenario

    You are called at the ice rink to a 75-year-old lady who has slipped on the

    ice and fallen. She put her left arm out

    as she landed. She is now complainingof severe pain in her upper arm. She

    cannot move her shoulder or elbow.

    There is a tender swelling halfway

    between her shoulder and elbow.

    Q ti 6

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    Question 6

    What is your diagnosis?

    A. She has strained her biceps muscle

    and tendon

    B. She has fractured her humerus bone

    C. She has dislocated her shoulder

    D. She has sprained her elbow

    Q ti 6

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    Question 6

    What is your diagnosis?

    A. She has strained her biceps muscle

    and tendon

    B. She has fractured her humerus bone

    C. She has dislocated her shoulder

    D. She has sprained her elbow

    Q ti 7

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    Question 7

    Which of these features is least usefulfor making your diagnosis?

    A. The severity of the pain

    B. The mechanism of the injury

    C. The presence of skin reddening

    D. The age of the patient

    Q ti 7

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    Question 7

    Which of these features is least usefulfor making your diagnosis?

    A. The severity of the pain

    B. The mechanism of the injury

    C. The presence of skin reddening

    D. The age of the patient

    Q estion 8

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    Question 8

    What will you do to help the casualtybefore taking her to the first aid post?

    A. Give her a hot cup of tea

    B. Massage the injury site

    C. Tie a crepe bandage tightly around

    the swollen area

    D. Apply an arm sling

    Question 8

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    Question 8

    What will you do to help the casualtybefore taking her to the first aid post?

    A. Give her a hot cup of tea

    B. Massage the injury site

    C. Tie a crepe bandage tightly around

    the swollen area

    D. Apply an arm sling

    Question 9

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    Question 9

    As you get the casualty to the first aidpost in a wheelchair, she complains of

    feeling sick and faint. What do you do?

    A. Walk her to the toilet to be sickB. Lay her down and raise her legs

    C. Give her two paracetamol tablets

    D. Leave her sat outside in the wheelchairto get some fresh air

    Question 9

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    Question 9

    As you get the casualty to the first aidpost in a wheelchair, she complains of

    feeling sick and faint. What do you do?

    A. Walk her to the toilet to be sickB. Lay her down and raise her legs

    C. Give her two paracetamol tablets

    D. Leave her sat outside in the wheelchairto get some fresh air

    Question 10

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    Question 10

    The casualty has left for hospital in anambulance. What is your priority now?

    A. Have a cup of coffee

    B. Go back to your station at the ice rinkC. Radio control to tell them the casualty

    has left the first aid post

    D. Fill in a PRF, RIDDOR form and the ice

    rinks accident book

    Question 10

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    Question 10

    The casualty has left for hospital in anambulance. What is your priority now?

    A. Have a cup of coffee

    B. Go back to your station at the ice rinkC. Radio control to tell them the casualty

    has left the first aid post

    D. Fill in a PRF, RIDDOR form and the ice

    rinks accident book

    The end

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    The end

    Any more

    questions?