Part 36

A complicated fracture is one associated with a serious injury to some important adjacent part—e.g., a large vessel.

A green stick or incomplete fracture occurs where the bone is soft and bends, and is only partially fractured; it is most frequent in children.

=Symptoms= of fractures are usually pain, loss of function, deformity (seen or felt by passing the fingers over the seat of pain), crepitus or the grating sound produced and felt on rubbing the broken ends against each other, abnormal mobility in the course of the bone, swelling, and discoloration.

The principal point is to keep the part immovable and in a position to give as little pain as possible. Support the limb with something stiff and padded with cotton or remnants of yielding material. Bandages can be made of handkerchiefs, strips of linen, ribbon, etc., to keep the splint firm.

For the forearm padded splints long enough to take in the hand from above the elbow should be applied. Tie firmly with bandages and suspend in a sling.

If the upper arm be fractured, bind it tightly to the side. For the thigh, the splints should extend from under the arm to the ankle and should be bound to the body and leg with long towels or sheets torn into strips. A splint made of blankets, rolled up tightly from both sides on broomsticks, allowing space for the limb to rest between the supports, is a good and ready appliance. Always make extension to prevent contractions of the muscles, as this would result in shortening the leg.

For a broken clavicle (collar-bone) bind the arm to the chest. Put the patient on the flat of his back with a small pad between the shoulder-blades. This will keep the broken ends in a normal position.

N. B.—In every case elevate and support the injured member on a pillow, keep in position and give complete rest until medical aid arrives.

DISLOCATIONS.

Dislocation is a displacement of the joint. It may occur with a break of the limb, but usually results from a fall or strain.

There may be deformity and inability to move the injured part. Sometimes an abnormal projection is the first sign. If inflammation arises, apply cold applications. The only treatment a nurse may give is to keep the patient quiet and await skilled help.

SPRAINS.

There may be extreme pain, swelling, inflammation, discoloration, and inability to use the joint. Support and elevation of the limb is of the greatest importance. Use hot or cold applications to allay the inflammation and pain. Cover with a thin soft pad, and bandage evenly and firmly. A sprain should not be neglected, as it may cause future disease of the injured part.

For recent bruises cold applications are best. Give the patient complete rest, support and elevate the injured limb, apply cold or hot applications, and await skilled help.

BURNS AND SCALDS.

In severe cases the constitutional treatment is of more importance than the application of local remedies. If the patient is in shock wrap him in warm blankets, and give him stimulants. In superficial cases where the skin is not broken powder with bicarbonate of soda (baking soda). A ready domestic application is sweet oil. Exclude the air at all times. When vesicles have been produced they should be punctured with a sharp instrument, and the serum gently evacuated with absorbent cotton. Apply soothing ointments or wet dressings. IN CASE OF SEVERE BURNS OF THE BODY immerse the patient in a warm bath, keeping it at even temperature. Separating a layer of common white cotton wadding, and wrapping it about the injured part will allay the pain, and the cotton has the advantage of not adhering to the raw surface. Splints and bandages should be employed to prevent contractions.

BURNS OF THE EYE.

For burns resulting from molten lead, strong alkalies, lime, or acids, flush freely with warm water or boric-acid solution, and anoint with pure vaselin or a few drops of castor oil. Do not rub the injured tissues. The applications should be made quickly and very gently. Put on cold compresses until medical aid arrives.

INJURIES TO THE EYE.

For surface injuries a drop of castor oil may be applied, and the eye kept closed for the day with a pad of wadding and a bandage.

SYNCOPE (FAINTING OR SWOONING).

Place the patient in a recumbent position. Loosen all clothing, and dash cold water on the face and chest. Spirits of ammonia or smelling salts should be used with caution, and not brought too near the nostrils. The pulse and general appearance will indicate if condition is serious. Give whisky and strychnin sulphate (¹/₃₀ gr.) hypodermically if necessary.

HYSTERIA.

In hysteria the patient may be apparently unconscious; the body is normal to the touch, the pulse is full and regular, the color is natural, and if an attempt is made to raise the eyelid it will be met with resistance. Do not leave the patient alone, but do not disturb her until she recovers.

EPILEPSY.

The attack comes on very suddenly. The patient utters a sharp cry, and falls to the ground. The muscles are rigid, the eyes staring, and there may be frothing at the mouth. The muscles soon relax, and there are twitchings of the whole body. The attack may last only a few minutes. Place the patient on his back with the head slightly elevated, and loosen all clothing. Put a wedge between the teeth, give him plenty of fresh air, and do not attempt to stop the movements.

DROWNING.

Begin artificial respiration at once, then soon as possible remove or loosen all clothing about the back, chest, and abdomen. Free the throat and mouth from mucus and foreign substances. Secure the tongue with a dry cloth or handkerchief; keep it drawn forward and to one side, as this opens the windpipe. Then turn the patient face downward, allowing the abdomen to rest on a roll of goods. Make firm pressure on the back and on both sides of the thorax to evacuate the lungs. Envelop the body in warm blankets, apply heat to the feet, and stimulate with hypodermic of strychnin, whisky, and coffee.