First Aid/Musculoskeletal Injuries

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Sprain or Fracture?

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Communitive mid-shaft humeral fracture: a compound fracture of the left upper arm.

Sprains, strains, dislocations, and fractures can all present with the same symptoms. It is very difficult to determine what the injury may be. It is not necessary to know which injury the victim has as the treatment will be the same for all of them. Sprains only occur when a ligament is stretched past its normal limits. Strains occur when a muscle or tendon is stretched past its normal limits. Dislocations are when a bone comes out of its normal joint. Fractures are actual breaks in the bone.

When assessing an injury, the history will inform the practitioner almost as good as anything. The anatomy, the way it feels, hearing a "pop," loss of function, and what the pain feels like are good indicators to having a musculoskeletal injury. If the patient has any of the following symptoms, you should treat for a possible muscle or skeletal injury.

  • Deformity at the injury site
  • Crepitus - A grinding or cracking sound when the affected area is moved (usually accompanied by extreme pain). (Do not test for this! It should be reported by the patient.)
  • Bruising and swelling
  • No pulse below injury site
  • Inability to use the affected body part normally

If the injury appears to be severe, EMS should be activated as soon as possible. These injuries include open fractures, shoulder/hip dislocations, and any injury that compromises nerve or circulatory function.


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The acute treatment for muscle, bone or joint injury can follow the simple acronym "RICE".

Rest - Rest is very important for soft tissue injuries, both in the short term and for longer term care.
Immobilize - Sprains, strains and dislocations can be slinged; fractures should be splinted and slinged.
Cold - Ice should be applied periodically, for around 10-20 minutes at a time. After the 10-20 minutes, you need at least a 20 minute off period before you ice again. Any person sensitive to cold should have a layer of clothing between the skin and the ice.
Elevation - Where appropriate, the injury should be elevated above the heart, as this may help reduce the localized swelling which occurs. Do not elevate if this causes more pain to the victim.

If the injury is bad enough, the victim should be referred to a physician.


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