Fractures

A fracture is a break or crack in a bone. It usually requires considerable force to fracture a bone unless it is old and diseased, or young and supple. Fractures fall into two broad categories:

• 'Open fractures' where the bone is protruding through the skin. An open fracture is usually accompanied by significant blood loss - the main priorities in this case are to control the bleeding, keep the injured area still and prevent infection of the open wound.
• 'Closed fractures' where the damaged bone is contained within the skin. A closed fracture is contained within the skin and there is no external bleeding, although there is usually some internal bleeding caused by contusions (bruises) and tissue damage - the priority here is to keep the injured area still.

Recognition of fractures:
Us first aid trainers have a useful mnemonic to help us remember the signs and symptoms of a fracture: PLUSDICT:

• Pain
• Loss of power
• Unnatural movement
• Swelling or bruising
• Deformity
• Irregularity
• Crepitus (grinding sound of the bones)
  
• Tenderness
  

Treatment of an open fracture:

• Put on gloves, if available. Ask the casualty to keep still.
• Loosely cover the wound with a large, clean, non-fluffy pad or sterile dressing. Apply pressure to control the bleeding but DO NOT press on the protruding bone.
• Place clean padding over and around the dressing.
• Secure the dressing and padding with a bandage. Bandage firmly but not so tightly that it impairs circulation.
• Immobilise the injured area by supporting it with your hands or padding around it with clothing etc.
• Arrange for the casualty to get proper medical attention.
• Treat the casualty for shock if necessary - DO NOT raise a fractured leg. Monitor the casualty's level of response, breathing and pulse. Check circulation beyond the bandage every 10 minutes.
• DO NOT move the casualty until the injured area is supported unless they are in immediate danger. DO NOT press down on the protruding bone. DO NOT allow the casualty to eat, drink or smoke.
  

Treatment of a closed fracture:

• Ask the casualty to keep still.
• Immobilise the injured area by supporting it with your hands or padding around it with clothing etc.
• Arrange for the casualty to get proper medical attention.
• Treat the casualty for shock if necessary - DO NOT raise a fractured leg. Monitor the casualty's level of response, breathing and pulse.
• DO NOT move the casualty until the injured area is supported unless they are in immediate danger. DO NOT allow the casualty to eat, drink or smoke.

Asthma

Calm and reassure the casualty, get them comfortable
and ask them to use their 'reliever' inhaler.

During an asthma attack the muscles of the air passages in the lungs go into spasm and the linings of the airways swell. This results in the airway becoming narrow and breathing becoming more difficult. Sometimes an asthma attack is triggered by an allergy, cold, cigarette smoke or some other external stimulus. Sometimes there is no recognised trigger for the attack - some asthma sufferers have sudden attacks at night. People with asthma usually deal with their own attacks using a 'reliever' inhaler, usually coloured blue, at the first sign of an attack. Asthma sufferers may also have a second 'preventer' inhaler, coloured brown, that reduces the risk of having an attack. The preventer inhaler will not help when an asthma attack in progress.

The main priorities are to calm and reassure the casualty, treat the asthma attack and maintain the casualty's airway.

Recognition:

• Difficulty in breathing, with a very long breathing-out phase.
• Wheezing when the casualty breathes out.
• Difficulty speaking.
• Signs of hypoxia (low blood oxygen) such as grey-blue lips, earlobes and nailbeds.
• Distress and anxiety.
• Coughing.
• Eventually the casualty may become unconscious and stop breathing.

Treatment:

• Calm and reassure the casualty.
• Ask the casualty to take a puff of their reliever inhaler.
• Ask the casualty to breathe slowly and deeply.
• Let the casualty adopt the most comfortable position, usually sitting. Do not let the casualty lie down.
• A mild asthma attack should ease within 3 minutes - if not, ask the casualty to take a second dose from their inhaler.
• Ring for an ambulance if:

• this is the casualty's first ever asthma attack.
• the inhaler has no effect after 5 minutes.
• the casualty is getting worse.
• breathlessness makes talking difficult.
• the casualty is becoming exhausted.

• Be prepared to give resuscitation if the casualty stops breathing.

Nosebleeds

Nosebleeds are a very common problem in the home and work place. They are caused when the tiny blood vessels in the nostrils become ruptured. This normally occurs due to violent sneezing, nose picking or high blood pressure (hypertension). The main priorities are to stop the bleeding and maintain the casualty's airway.

Treatment:

• Ask the casualty to sit down, tilt their head forward and pinch the soft part of their nose for 10 minutes. DO NOT allow the casualty to tilt their head backwards - this will cause them to swallow blood, possibly inducing vomiting and choking.
  
• Reassure the casualty. Advise them to breathe slowly through their mouth. The casualty should avoid coughing, sniffing and swallowing during the nose pinch.
  
• After 10 minutes ask the casualty to release their nose pinch. If bleeding persists they should re-pinch for up to 2 further periods of 10 minutes.
• If bleeding has stopped cleanse the casualty's face with lukewarm water. Be sure to dispose of any used cleaning materials hygienically.
• Advise the casualty to avoid exertion for a few hours after the bleeb. They should not blow their nose during this time.

IMPORTANT: If the bleed persists after the 3 x 10 minute nose pinches the casualty should seek medical attention.