Dislocation

Adislocation is an injury in which one end of a bone making up a joint is separated or displaced from its normal position. A dislocation is caused by a violent pulling or pushing force that tears the ligaments. Dislocations usually result from falls, sports injuries, and motor vehicle accidents. The signs and symptoms of a dislocation include significant deformity of the joint, pain and swelling, and loss of function.

Sprain

Asprain is a tearing of ligaments at a joint. Sprains may result from a fall, a sports injury, or a motor vehicle accident. The joints most often sprained are the ankle, knee, wrist, and fingers. The signs and symptoms of a sprain include pain, swelling, and discoloration. Sprains can vary- in seriousness from mild to severe, depending on the amount of damage to the ligaments.

Strain

Astrain is a stretching and tearing of muscles or tendons. Strains are most likely to occur when an individual lifts a heavy object or overworks a muscle, as during exercise. The muscles most commonly strained are those of the neck, back, thigh, and calf. The signs and symptoms of a strain are pain and swelling. Strains do not usually cause the intense symptoms associated with fractures, disloca-, tions, and sprains.

Emergency Care for a Fracture. It is often difficult to determine whether a patient has a fracture, dislocation, or sprain because the symptoms of these injuries are similar. Because of this, any serious musculoskeletal injury to an extremity should be treated as if it were a fracture.

The primary goal of emergency care for a fracture is to immobilize the body part. Immobilization reduces pain and prevents further damage. Asplint is any item that will im­mobilize a body part, In an emergency situation, a length of wood, cardboard, or rolled newspapers or magazines are items that can be used for splinting. The splint should be padded with a soft material such as a rolled-up towel.

The body part should be splinted in the position in which you found it. However, severely angulated fractures may have to be straightened before splinting. If you attempt to straighten an angulated fracture, be careful not to force the affected part. A dislocated bone end can become "locked" and will have to be realigned at the hospital. If you straighten an angulated bone and encounter pain, stop and splint it in the position in which you found it. The splint should also immobilize the area above and below the injury. For example, when splinting an injury to the wrist, the hand and forearm also should be immobilized (Figure 4, A). When splinting an injury to the shaft of the bone, the joints both above and below the injury should be immobilized. For example, when splinting the forearm, both the elbow joint and the wrist joint should be immobilized.

The splint should be held in place with a roller gauze bandage or other suitable material such as neckties, scarves, or strips of cloth (Figure 4, B). The splint should be applied snugly but not so tightly that it interferes with proper circulation. After applying the splint, check the pulse below the splint to make sure the splint has not been applied too tightly. If you cannot detect a pulse, immediately loosen the splint until you can feel the pulse (Figure 4, C).

Whenever possible, elevate an injured extremity after it has been immobilized to reduce swelling (Figure 4, D). An ice pack can also be applied to the injured part. The cold limits the accumulation of fluid in the body tissues by constricting blood vessels and reducing leakage of fluid into the tissues. In addition, cold temporarily relieves pain because of its anesthetic or numbing effect, which reduces stimulation of nerve receptors.

Once you have properly immobilized the injury, transport the patient to an emergency care facility, or if the injury is serious enough, activate the local emergency medical services. In any situation in which an injury to the spine is suspected, activate the local EMS system.

Figure 4. Emergency care of a fracture. A, The splint should immobilize the area above and below the injury. B, The splint is held in place with a gauze roller bandage. C, After the splint is applied, the pulse below the splint should be checked to make sure the splint has not been applied too tightly. D, A sling can be used to elevate the extremity to reduce swelling. (From Henry M, Stapleton E: EMTprehospital care, 2nd ed. Philadelphia, Saunders, 1997.)

Burns

A bum is an injury to the tissues caused by exposure to thermal, chemical, electrical, or radioactive agents. The severity of a burn depends on the depth of the burn, the percentage of the body involved, the type of agent causing the burn, the duration and intensity of the agent, and the part of the body.

Burns are classified according to the depth of tissue injury, as illustrated in Figure 5, and are described as follows:

Figure 5. Тур es of burns. (From Polaski AL, Tatro SE; Luckmann's core principles and practice of medical-surgical nursing. Philadelphia, 1996, Saunders.)

Superficial (First-Degree) Burn, A superficial bum is the most common type of burn. It involves only the top layer of skin, the epidermis. With this type of burn, the skin appears red, is warm and dry to the touch, and is usually painful. Sunburn is a common example of a superficial burn. A superficial burn heals in 2 to 5 days of its own accord and does not cause scarring.

Partial-Thickness (Second-Degree) Burn. A partialthickness burn involves the epidermis and extends into the dermis but does not pass through the dermis to the underlying tissues, The burned area usually appears red, mottled, and blistered. In most cases, the blisters should not be broken because they provide a protective barrier against infection. Partial-thickness burns are usually very painful and the area often swells. This type of burn usually heals within 3 to 4 weeks and may result in some scarring.

Full-Thiekness (Third-Degree) Burn. A fall-thickness burn completely destroys both the epidermis and the dermis and extends into the underlying tissues such as fat, muscle, bone, and nerves. The affected area appears charred black, brown, and cherry red, with the damaged tissues underneath often pearly white. The patient may experience intense pain; however, if there has been substantial damage to the nerve endings, the patient may feel no pain at all. During the healing process, dense scars typically result. Infection is a major concern, and the patient must be carefully monitored.

Thermal Burns. Thermal burns usually occur in the home, often as a result of fire, scalding water, or coming into contact with a hot object such as a stove or curling iron.