by Brian Springer, M.D.

Reference: Schimelpfenig T and Lindsey L. National Outdoor Leadership
School Wilderness First Aid, second edition, NOLS and Stackpole books

Soft Tissue Injuries

• Controlling bleeding
• Direct pressure
• Elevation
• Tourniquets

• Treatment for Soft Tissue Injuries
Closed Injuries (RICE)

Rest to allow clot to form
Ice, 20 minutes every 2-4 hours
Compression to reduce swelling and bleeding
Elevate above heart level
Open Injuries

Stop bleeding
Assess damage
Clean wound.
Dress and bandage
Monitor for infection
• Signs of Infection
Redness and swelling
Pus, heat and pain
Red streaks radiating from wound
Fever and chills
Swollen lymph nodes
• Treatment for Infected wounds
Pull edges apart and clean wound
Soak in antiseptic solution
Indications for evacuation
Fever, chills and swollen lymph nodes
Streaking
Wound cannot be drained

Fractures and Dislocations

Fracture: a break in a bone.
Dislocation: displacement of a bone from its normal position in a joint.

Signs and Symptoms

• Consider mechanism of injury
• Pain and tenderness
• Crepitus
• Swelling and discoloration
• Deformity
• Loss of function

• Assessment
Assess the bone or joint
    — Remove clothing, visualize the injury
Look for deformity, swelling, discoloration
Feel for tenderness, deformity, swelling
• Assess circulation
Distal pulse in wrist or foot
Temperature and color in hand or foot
• Assess nerve
Ask person to move fingers or toes
Test for sensation to touch or pain
• Treatment
Immobilize the injury
    — Bones above and below dislocations
Joints above and below fractures
Clean and dress wounds
Remove jewelry, watches and tight clothing
Splint before moving
Elevate to reduce swelling
Assess circulation, temperature and sensation before and after splinting
Assess for other injuries
Treat for shock
• Consider relocation of dislocation or angulated fracture if:
Femur is fractured
Limb is unsplintable or untransportable in its current position
Pulse/sensation is absent

Athletic Injuries

Strain: Injury to muscle or tendon (connects muscle to bone)
Sprain: Injury to ligament (connects bone to bone) General Signs and Symptoms

Swelling and discoloration
Pain
Instability at joint
Loss of range of motion
Inability to bear weight

• General Treatment (RICE)
Rest: allow tune for healing
Ice: 20 minutes every 2-4 hours
Compression: elastic bandage to reduce swelling
Elevation: reduces swelling
Acetaminophen, ibuprofen for pain and inflammation
• Treatment for Ankle Sprains
RICE
Taping for support
• Treatment for Achilles Tendinitis
RICE
Stretching
Heel lifts
• Treatment for Forearm Tendinitis
RICE
Stretching
Taping to limit range of motion