It’s important not to move the neck, head, or spine if it looks crooked or misaligned because you could cause permanent nerve damage and make the situation worse. While looking for deformities, compare side-to-side (left leg to right leg, for example) to better notice anything strange or unusual that’s indicative of a broken bone. Noticing an open fracture is much easier due to it poking out of the skin. Open fractures are considered more serious due to significant blood loss and risk of infection. You may have to loosen or remove some clothes to check thoroughly, but make sure to ask permission if the person is conscious.
Swelling produces a visible lumpiness, inflating, or ballooning of tissue around the broken bone, but don’t mistake it for fat deposit. Swelling makes the skin tight and warm to the touch, whereas fat is jiggly and cool to the touch. Swelling and color changes happen due to broken blood vessels that bleed into surrounding areas beneath the skin. Red, purple, and dark blue are common colors associated with broken bones. [3] X Trustworthy Source Cleveland Clinic Educational website from one of the world’s leading hospitals Go to source An open fracture causes external (visible) bleeding, which should be easy to see because it will soak through most types of fabrics pretty quickly. [4] X Research source
Gently touch (palpate) the person’s limbs and torso (especially around the ribs) and look for any wincing if she is conscious but not communicating clearly. If the person is unconscious, then a pain assessment can’t be done. Pain sensations can be greatly enhanced (from fear) or reduced (from adrenaline) when people are hurt, so it’s not always reliable for an injury assessment.
Ask him to start with wiggling his toes, then bending his knees, then lifting his legs off the ground, then moving his hands and arms. Even if the person can move his limbs (suggesting the spinal cord has not been injured), there may be damage to the bones of the spine. Unless it is necessary to get the person out of immediate danger, patients should not be moved until assessed by a medical professional due to the risk of paralyzing a patient. Loss of strength in a limb, even with some movement, is another indication of a fracture or dislocation, or a spine or nerve injury.
Loss of sensation in the limbs indicates some type of nerve involvement, either in a peripheral nerve[9] X Trustworthy Source Johns Hopkins Medicine Official resource database of the world-leading Johns Hopkins Hospital Go to source running down the leg/arm, or a spinal nerve within the spinal column. [10] X Trustworthy Source Cleveland Clinic Educational website from one of the world’s leading hospitals Go to source In addition to numbness and pins and needles, she may also feel strange temperature changes — either too cold or burning hot sensations. [11] X Research source [12] X Trustworthy Source Cleveland Clinic Educational website from one of the world’s leading hospitals Go to source
Discourage the injured person from moving around too much. Slightly changing position for comfort is fine, but trying to get up (especially if he is in shock) risks further injury. Supporting the injured body part for comfort or to stop the person from moving it is fine. Use a pillow, cushion, or rolled-up jacket or towel.
Protect yourself and the patient from blood-borne disease by wearing gloves. Coming into contact with the injured person’s blood puts you at risk for diseases like hepatitis, HIV, and other viral infections. [15] X Trustworthy Source Centers for Disease Control and Prevention Main public health institute for the US, run by the Dept. of Health and Human Services Go to source Even if the fracture is closed, there may be surrounding cuts and abrasions that are bleeding and need attention. For an open fracture, once the bleeding is under control, cover the wound with a sterile dressing or something clean (to help prevent infection and debris getting in there) and secure it with a bandage. Do not remove the bandage or cloth you used to stop the bleeding — simply lay the new dressing over the old. You can lightly rinse the wound with water to remove any dirt or debris, but don’t vigorously scrub it because it will make it bleed more.
Secure the splints around the arm or leg with elastic bandages (Ace or Tensor bandages), rope, a belt, or strips of cloth or items of clothing. Don’t tie it too tight and cut off circulation. Padding the splints with cloth or large bandages can help reduce discomfort. Consider making a simple sling to support a broken arm. Use a shirt and tie the sleeves around the person’s neck for support. If you have no idea what a splint or sling is, then it’s likely best not to try to make them. Stick with bleeding control and waiting for emergency services.
Feel for a pulse in the wrist with a broken arm and the ankle area for a fractured leg. If you can’t feel a pulse, loosen the ties on the splint and check again. You can also check visually. Press firmly over the skin downstream from the fracture site. It should first “blanch” white and then turn pink again in about two seconds. Signs of poor circulation include: pale or blueish skin, numbness or tingling and loss of pulse.
Remember not to apply ice (or anything cold) directly to the skin. Always wrap the ice in a thin towel, piece of cloth, or some other material before applying it to an injury. Leave the ice on for about 15 minutes or until emergency medical personnel arrive.
Even if people are seemingly not seriously injured, you should still call 9-1-1 for help because you’ll be unable to make an appropriate diagnosis due to either lack of training or necessary medical equipment. No one expects you to play doctor and fix any injuries. Focus on getting help to arrive and doing the basics — stopping any serious bleeding, offering support, and trying to prevent shock (see below).
If you do not have CPR training, you should not worry about administering rescue breaths — focus on chest compressions instead. If you are trained and confident in your abilities, then proceed with CPR that includes rescue breathing. Carefully position the person on her back and kneel next beside her, near her shoulders. Place the heel of your hand on the person’s breastbone, between her nipples. Place your other hand on top of your first hand and use all your body weight to press down on the chest. Administer chest compressions at a rate of about 100 pumps per minute (imagine pressing to the rhythm of the Bee Gee’s song “Stayin’ Alive”). Give chest compressions until help arrives. If you become tired, see if someone can switch off with you. If you are trained in CPR, then check the person’s airway after 30 compressions and begin to deliver rescue breathing.
To combat shock: control bleeding first, lay the person down with his head slightly lower than his torso, elevate his legs, keep him warm with a blanket and offer him liquids to drink if he is able. [21] X Research source Calm him down by not panicking yourself and make sure he knows that help is on the way. Reassure him that he’ll be okay (even if you don’t think he will be) and distract him from looking at his injuries.
