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Immobilization

Slings

The standard triangular bandage (available in any drugstore and costing about $1) is compact and light, and can fit in virtually any portable first aid kit. The package is about 2x3 inches, and 3/8" thick.

It has other uses besides a simple sling: tying on dressings and splints, for example.

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bf-slng2.jpg (10603 bytes) Create a sling by folding the middle of the long edge under the arm, with the 90 corner of the triangle at the elbow. Pull the long ends up and around the neck. It's most comfortable if the inner side of the sling goes around the neck on the hand side, while the outer side goes around on the elbow side. Tie the sling with a square know behind the neck, so the wrist tips slightly upward in relation to the elbow.

Pull the extra cloth out from the elbow and tie a simple overhand knot in it. This keeps the arm in place within the cradle of the sling.

 

To give extra protection to the shoulder for upper arm fractures, collarbone or AC joint separations, add a binder to the sling. This can be a second sling wrapped around chest over top of the first sling, a shirt placed over the sling (putting only the "good" arm through the sleave), or an ace wrap around the chest as shown at right.

For temporary immobilization of a dislocated shoulder, place the sling, then wad up a biking shirt and put it between the elbow/forearm and the chest. (In a dislocation, the elbow is usually slightly out sideways, about 6 inches away from the body.) Now place a binding wrap. If it hurts to bind the arm, add more padding between elbow and chest.

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If you're treating the injury at home, you may want to upgrade your sling once you're back at civilization. Buy a standard sling at your local medical supply store. Slings are available with one strap (as shown), two straps, and with a binding strap. Select one that will keep you comfortable during your required activities.

The triangular bandage sling has a lot of other uses:

Securing a head wound compression dressing (as at right).
Bulk for compression of hemorrhage.
Binding a compression pack for severe extremity hemorrhage (beware of a tournequet effect).
Providing padding and bulk for a dressing.
Tying temporary splints to an extremity (see below).

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Splints

When splinting a painful injury, it's best to "splint it where it lies." In other words, place the splint so the extremity stays in the position you found it in. It's best not to try to straighten out a deformity, unless it's necessary to get the victim out of the wilderness.

bf-slng5.jpg (12409 bytes) An excellent splint is made by wrapping a pillow around the injured arm or leg, then binding it tight with tape around the pillow. Or, roll a magazine around an arm as a temporary "cast." Tie the magazine with a triangular bandage (sling), tape, or a bike inner tube.

After placing the splint, watch the color of the skin downstream. If the skin becomes pale or dusky, loosen the straps that bind the splint.

You can tell that a splint is effective if other people can move you without creating severe pain in the injury.

If you're treating a wrist sprain at home (be careful about this -- painful "sprains" are often subtle wrist fractures), you can purchase a splint at your local medical supply store. While a pull-on elastic tube splint can give some support, it's not enough to allow you to lift. Consider a splint with metal strips top and bottom.

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lac1d.jpg (18197 bytes) For finger injuries, I recommend a foam-backed aluminum splint. The splint is placed on the underside of the finger. You can cut the splint to length with EMT snips and bend it to the most comfortable position. Bind it with a couple of strips of tape. Stretchy cloth tape, while more expensive and harder to find than non-stretch tape) is far superior for holding a splint.
EMT snips are handy for your car first aid kit. You'd be surprised how often they come in handy for non-first-aid purposes. They'll cut an aluminum split to side readily, and can be used to custom-fit gauze pads for efficient dressings.

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splint.jpg (14014 bytes) Popsicle sticks and most drugstore off-the-shelf splints have one big problem: they force your finger straight. This is painful for most finger sprains -- it stretches the injured ligaments and may actually interfere with healing. Plus, a straight finger gets in the way more.

Usually it's best to splint the finger in the most comfortable position, which is with all joints slightly bent.

Specialty splints such as ankle and knee braces can be purchased without prescription at a medical supply store. But you need to know what you're treating, and how to adjust and use the splint properly. If an injury seems bad enough to cough up $60 for a special splint, you should probably go to the ER and have it checked.

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Wraps

There are three ways you can provide a wrap: (1) a standard compression wrap ("Ace wrap"), which is heavy and thick but provides a fair amount of stability and "squeeze," (2) self-adhering (Coban) wrap, which is thin and light, and (3) compression sleeves, which are pre-fab pull-on wraps for knee, elbow, and wrist that you can buy at the drugstore.

spr-ank2.jpg (10748 bytes) The compression (Ace) wrap is the standard wrap for orthopedic injuries. It provides a fair amount of padding, modest immobilization, and compression. You can increase the stiffness of the immobilization and the pressure of compression by wrapping tighter. Cold-packs can be placed over the wrap.

When wrapping an ankle, use a figure-eight or two (see below) for stability. A 4-inch ace works best for the ankle.

An altered "extra loop" figure-eight provides stability. When wrapping the ankle or elbow, position the joint as close to 90 degrees as possible. Make two or three circular passes below the joint, moving the wrap towards the joint. Once the wrap reaches the joint crease, cross directly in front of it, then wrap around the back above the joint. Wrap around once above the joint (the "extra loop"), then cross back down in front of the joint to complete the figure-eight.

Self-adhering wrap (sample brand Coban) is light and thin. While I use it mostly to secure dressings, it can also provide immobilization and compression of an orthopedic injury.

Use it just as you would an Ace wrap, with one precaution: because the wrap sticks to itself as you unroll it, you can easily make the wrap too tight. Pull a length off the roll first, then adjust the tension before applying it to the joint.

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spr-wr2.jpg (15509 bytes) When applying an ace to the wrist, come up onto the hand, passing the wrap between the thumb and index finger. A two-inch wrap works best for the wrist.
A compression wrap can be used to immobilize broken ribs. A 4-inch ace is the size you're most likely to have available, and it will usually work, but a 6-inch is ideal.

Have the victim blow their air out and hold the arms up. Wrap around snugly. The wrap should be just tight enough to ease the sharp pain with breathing, but not tight enough to make breathing difficult.

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