Injuries

The head injury could occur due to the vehicle accidents on the road or due to the falls from heights at home. The victim may either be conscious or be comatosed. In some intracranial bleeds, the victim is unconscious initially, recovers consciousness but later lapses back into a coma. There may be an open wound on the skull or it may be intact. If a wound is present, there may be moderate or profuse bleed. Skull fracture may be associated. There may be black eye seen. Ear, nose or throat bleed may be present. There may be vomiting, or convulsion. Even if the victim has no complaints after the head injury, he/she should be observed for atleast 48 hours for development of new signs. The following danger signals should be looked for:

• Bleeding from nose, ear or throat. This implies basilar skull fractures and calls for proper medical attention.
• Drowsiness or deepening of the coma.
• Vomiting.
• Convulsion.

While dealing with such cases, the following should be adhered to:

• Wash your hands first. Wear disposable gloves and press a clean pad / gauze firmly and evenly over the wound to control bleeding. Bandage the head to keep pad in place.
• Check the patient's conscious level, heart rate & respiratory rate.
• Look for ENT (ear, nose or throat) bleed.
• Ask for nausea, vomiting, dizziness and headache. These, if present, means a bad sign and points towards an intracranial complication. (as mentioned previously).
• Always suspect associated neck injury and be careful during the transport of the victim from the site of injury to the hospital.

Neck Injury

In poly trauma, neck injury should always be suspected. When it is present, shifting or turning the patient can be dangerous. This is so because in attempting to move the patient, the fractured parts of the neck bones (cervical vertebrae) may move or displace and in the process injure the adjacent spinal cord. A quadreparesis may ensue and a hemi section of the spinal cord may progress to a complete transection. In cases of neck injury, the following measures should be remembered:

• Do not move patient. Minimal handling is the rule.
• If CPR is required, support neck & move the patient as a whole. Head, neck & spine should be aligned. Use jaw thrusts for positioning head for CPR.
• Before transport, use bandages to support neck & head.
• Urgent orthopedic or neurosurgery opinion is required.

Sprains

Sprain is an injury to the ligaments or tissues around a joint. There is pain, swelling, discoloration of the part and deformity. There may be associated chip fractures and these should be specifically looked for.

When there is a sprain, the following should be done:

• It is vital to give rest to the part. Immobilize the joint with crepe bandage. This will take care of the swelling as well as the pain.
• Ice application may be useful.
• Keeping the limb elevated also aids in early decrease of the edema.
• For ankle sprains that are common, a figure of '8' bandage gives a lot of relief.

Dislocation of Joint

In this, there is displacement of the bone from the joint. The victim has severe pain and inability to move the affected limb. There may be an obvious deformity. The most common joints to dislocate are the shoulder, elbow, thumb and the jaw.

The victim should be reassured. Some mild analgesics can be provided to diminish the felt pain. The limb should be supported in the most comfortable position. Bandages and slings may be used for the purpose. Shift the patient to the hospital. Do not try to relocate the dislocated joint as it may further aggravate the dislocation.

Muscle strain

In this, the muscle is overstretched and torn. There is severe local pain and swelling. The part is painful during movements.

The part affected should be immobilized and elevated. Place it in the most comfortable position. Ice can be applied. If in doubt, consider an associated fracture. Shift to hospital immediately.

Muscle Cramps

These are due to faulty use of the muscles. Excessive loss of salt in the sweat and vomiting and loose motions could also lead to cramps. There is severe pain and the victim cannot move the affected part. The contracted muscles fail to contract.

• The patient should be reassured.
• Analgesics should be given.
• The part should be supported and massaged.

Fractures

A fracture is partial or complete break in the bone. It is due to direct force on the bone or an indirect one. (The bone breaks at a site away from the site of force applied.)The attached muscles may also lead to the avulsion of part of the bone during a forceful contraction. Ligaments can similarly cause bone fractures.

Fractures are of 3 types:

• Simple or closed fracture wherein the skin surface around the fracture is intact.
• Compound or open fracture wherein the skin is broken and the bone is seen through it. This has bleeding and infection.
• Complicated fracture. There is injury to adjacent delicate organs like blood vessel, nerve, heart, lungs etc.

Based on the type of the fracture, it can be transverse, longitudinal, oblique, spiral, impacted, comminuted, depressed, compressed or greenstick (incomplete). There may be severe pain, difficulty in moving the part or a misshapen limb. History of trauma is usually forthcoming. Signs of shock may be present. The aim is to minimize further damage, decrease the pain and make the patient comfortable. The following steps should be done:

• Reassure the patient.
• Immobilize the limb. Keep it in the most comfortable position and splint if needed. The bandaging should not be over the fracture site. It should be such that the pain in reduced and the fracture ends do not move. It should not hamper the blood supply to any part of the body.
• Raise the limbs.
• Direct pressure to decrease the blood loss may be required.
• Monitor the heart & respiratory rate.
• Watch out for shock.
• Keep victim nil by mouth, in case general anesthesia is required.

Wounds

It is an abnormal breach in the skin or mucous membrane. Blood escapes out. There is a risk of shock and infection.

Wounds can be open or closed type. The closed wounds include bruises and internal bleedings. The open wounds can be incised wounds, lacerated wounds with irregular wound margins, contused wounds, avulsions in which an end is hanging, abrasions which are superficial wounds and punctured wounds which are either penetrating or perforating types.

The wound can cause the danger of shock due to the excessive bleeding. Hence:

• Lay the patient quietly.
• Reassure the victim.
• Elevate the limbs.
• Apply pressure over the wound with a sterile pad or cloth.
• Tourniquet could be used to halt the bleeding.
• Immobilize the limb.
• Check for foreign bodies and remove them carefully.
• If the wound is small an antiseptic dressing can be used.

Eye Injury

All eye injuries are serious as they can perforate the eyeball and lead to infection and damage of the visual organs. The injuries may be of the sharp or blunt type. Both are dangerous and require proper scrutiny by a eye surgeon. There may be pain in the eye. Vision may be impaired. Watering of the eye may be seen. The eye may be congested and red.

When an eye injury has taken place, lay victim straight and support the head. Reassure patient and tell to keep eyes shut. Do not touch or rub the eyes. Do not try removal of embedded foreign body. Hold eye always with sterile pad. Wash the eyes with clean water. The head should be inclined towards the injured eye while giving it a wash to remove dirt or foreign body. A moist swab or damp corner of a clean cloth may be used for the removal of the dirt or foreign body.

Foreign Body Eye

There is irritation, redness, watering & blurring of vision. The patient's eye should be brought under proper light. Separate the eyelids with clean hands. Search for & remove foreign body. Do not remove embedded foreign body. One can use clean water to wash away the foreign body. A clean moist cloth can also serve the purpose. Consult eye physician immediately.

Chemical Injury Eye

Hold eye under clean water flow. Do not touch eye other wise. Cover with a sterile pad & take the patient to hospital.