Frequently Asked Questions About Burns & **Types of Fractures:** & **Signs and Symptoms:** & **Special Fracture Locations:** & **General Fracture Response:** & **Basic Splinting Technique:** & **Critical Mistakes:** & **DO vs. DON'T Comparison List:** & When to Perform First Aid vs Calling for Help & **Call 911 Immediately For:** & **Can Transport by Car If:** & **Fractures in Children:** & **Sports-Related Fractures:** & Practice Scenarios and Self-Assessment & 7. Keep talking to maintain consciousness

Q: How can I tell the difference between second and third-degree burns?

A: Second-degree burns are painful, red, and may have blisters. Third-degree burns may be painless (nerves destroyed), appear white, brown, or charred, and have a leathery texture. When in doubt, seek medical evaluation.

Q: Should I pop burn blisters?

A: No. Blisters protect the healing tissue underneath and provide a barrier against infection. If blisters break on their own, keep the area clean and covered. Large or numerous blisters need medical attention.

Q: Can I use antibiotic ointment on burns?

A: For minor burns, a thin layer of antibiotic ointment can be used after cooling and before bandaging. Don't use on major burns—these need medical evaluation first. Some people are allergic to certain antibiotics.

Q: Why shouldn't I use ice on burns?

A: Ice can cause frostbite on already damaged tissue, potentially deepening the burn. It also causes vasoconstriction, reducing blood flow needed for healing. Cool (not cold) water is most effective.

Q: How long should I run water over a burn?

A: Continue cool water for 10-20 minutes for thermal burns, starting within 3 minutes of injury for best effect. Chemical burns require longer flushing—minimum 20 minutes for acids, 30 minutes for alkalis.

Q: When do burns need tetanus shots?

A: Any burn that breaks the skin may require tetanus prophylaxis. If it's been more than 5 years since your last tetanus shot (for dirty/severe burns) or 10 years (for minor burns), you may need a booster.

Q: What's the best thing to put on a healing burn?

A: For minor burns: aloe vera gel, approved burn gels, or antibiotic ointment under non-stick dressings. Keep the burn moist but not wet. For major burns, follow doctor's specific instructions.

Q: Can I shower with a burn?

A: Minor burns can be gently washed with mild soap and water after the first 24 hours. Pat dry carefully and reapply dressing. Major burns need medical guidance for wound care.

Q: How can I reduce scarring?

A: Proper initial treatment, keeping wounds moist during healing, sun protection for 1 year, and following medical advice all reduce scarring. Severe burns may need specialized scar management.

Q: What are signs a burn is infected?

A: Watch for increasing pain after 48 hours, red streaks extending from burn, pus or foul-smelling drainage, fever, or increased swelling. Any of these require immediate medical attention.

> Final Quick Reference Box: > Remember: C.O.O.L. Burns > - Call 911 for major burns > - Obtain safety first > - Only cool water (not ice) > - Loosely cover burns > > Burn Center Criteria: > - 3rd degree burns > - >10% body surface area > - Face, hands, feet, genitals > - Chemical or electrical > - Inhalation injury

Critical Final Reminders:

- First 3 minutes are crucial for cooling - Never use ice, butter, or oils - When in doubt, seek medical care - Burn depth may not be apparent initially - Prevention is the best treatment

Burns are painful, frightening injuries that can have lasting consequences if not treated properly. However, with prompt, appropriate first aid, many burns heal completely without complications. Remember that cooling within the first few minutes is crucial, home remedies often do more harm than good, and professional medical evaluation ensures the best outcomes for anything beyond minor burns. Keep your home safe, know these protocols, and never hesitate to seek professional help when needed.# Chapter 8: Broken Bones and Fractures: First Aid Treatment and Immobilization

The crack was audible from across the basketball court. James had gone up for a rebound when another player undercut him, causing him to land awkwardly on his outstretched arm. He immediately knew something was wrong—his forearm had an unnatural angle, and the pain was overwhelming. His coach, trained in sports first aid, immediately recognized the signs of a fracture. While one assistant called 911, the coach carefully supported James's arm in the position found, using a magazine and athletic tape to create a makeshift splint. By keeping the bone ends from moving, he prevented further damage to surrounding blood vessels and nerves. That quick, knowledgeable response helped James avoid complications and contributed to his full recovery after surgery. Each year, approximately 6.8 million Americans seek medical care for fractures. While modern medicine can repair most broken bones successfully, the immediate care provided in the first hour after injury significantly impacts healing time, complication rates, and long-term function. Understanding how to recognize, immobilize, and properly care for suspected fractures is a crucial first aid skill that can prevent permanent disability and reduce suffering.

Fractures occur when bone is subjected to more force than it can withstand. Recognizing the signs of a fracture quickly allows for proper immobilization and prevents further injury.

Closed (Simple) Fracture:

- Bone breaks but doesn't pierce skin - Most common type - Lower infection risk - May still cause internal bleeding - Can be just as serious as open fractures

Open (Compound) Fracture:

- Bone breaks through skin - High infection risk - Severe bleeding possible - Medical emergency - Never push bone back in

Complete vs. Incomplete:

- Complete: Bone breaks entirely through - Incomplete: Partial break (common in children) - Greenstick: Bends and cracks like green wood - Stress: Tiny cracks from repetitive force

Obvious Signs:

- Visible deformity or angulation - Bone protruding through skin - Limb appears shortened - Abnormal movement - Person heard or felt bone break

Common Symptoms:

- Severe pain that worsens with movement - Immediate swelling - Bruising (may take hours to appear) - Inability to bear weight or use limb - Tenderness at specific point - Muscle spasms around injury

Less Obvious Signs:

- Grinding sensation (crepitus) with movement - Loss of pulse below injury - Numbness or tingling - Pale, cool skin below injury - Reluctance to move area

> Quick Reference Box: > - Time to splint: Within 30 minutes if possible > - Check circulation: Every 15 minutes after splinting > - Common fracture sites: Wrist, ankle, hip, collarbone > - Healing time: 6-8 weeks for most simple fractures > - Complications risk: Increases with movement of broken bones

Skull Fractures:

- May have no visible deformity - Clear fluid from ears/nose (cerebrospinal fluid) - Battle's sign (bruising behind ears) - Raccoon eyes (bruising around eyes) - Always assume spine injury too

Spinal Fractures:

- Back or neck pain - Tingling or numbness - Weakness or paralysis - Loss of bladder/bowel control - Never move unless life-threatening danger

Rib Fractures:

- Pain with breathing - Shallow breathing - Tenderness over ribs - Possible punctured lung - Coughing up blood

Pelvic Fractures:

- Severe pain in hip/groin - Unable to walk - May have massive internal bleeding - Leg may appear shortened/rotated - Life-threatening emergency

Proper immobilization prevents further injury and reduces pain. Follow these steps systematically for any suspected fracture.

Step 1: Ensure Scene Safety (Immediate)

- Check for ongoing dangers - Don't move person unless necessary - Control any severe bleeding first - Protect yourself (gloves if available)

Step 2: Call 911 For:

- Open fractures - Fractures of head, neck, spine, pelvis, hip, or thigh - Multiple fractures - No pulse below fracture site - Severe bleeding - Person is unconscious

Step 3: Initial Assessment

- Keep person still - Reassure them - Check for other injuries - Assess circulation below injury - Look for deformity

Step 4: Control Bleeding (If Present)

- Direct pressure around wound - Never press on protruding bone - Use sterile dressing if available - Elevate if possible without moving fracture

Step 5: Immobilize the Fracture

- Splint in position found - Immobilize joints above and below fracture - Check pulse before and after splinting - Pad bony areas - Secure firmly but not too tight

Materials for Splinting:

- Commercial splints (SAM splints) - Magazines or newspapers - Boards or sticks - Pillows or blankets - Towels or clothing for padding - Tape, bandages, or strips of cloth

Universal Splinting Steps:

1. Explain what you're doing 2. Support the injury in position found 3. Check pulse, sensation, movement below injury 4. Pad bony prominences and hollow spaces 5. Apply splint material 6. Secure with bandages (not too tight) 7. Recheck pulse, sensation, movement 8. Monitor every 15 minutes

> Practice This Now: > - Create practice splints using magazines > - Time how long proper splinting takes > - Practice checking pulse points > - Find suitable splinting materials at home > - Practice the "CSM" check (Circulation, Sensation, Movement)

Arm/Forearm Fracture:

Lower Leg Fracture:

Finger Fracture:

Suspected Spine Fracture:

Special Considerations:

1. Control bleeding without pressing on bone 2. Cover wound with sterile dressing 3. Don't push bone back in 4. Stabilize without straightening 5. Watch for shock (common with open fractures)

Improper handling of fractures can cause additional damage, increase pain, and lead to complications. Know what NOT to do.

1. Moving Without Splinting

- Can damage blood vessels and nerves - Increases pain dramatically - May convert closed to open fracture - Can cause bone ends to shift - Always immobilize first

2. Trying to Straighten Deformity

- Only trained professionals should realign - May damage blood vessels - Could trap nerves - Extremely painful - Splint in position found

3. Applying Splint Too Tightly

- Cuts off circulation - Causes additional tissue damage - Increases swelling - May cause permanent damage - Check pulse after splinting

4. Testing for Fracture by Moving

- Never manipulate to "see if broken" - Causes unnecessary pain - Can worsen injury - If it might be broken, treat as broken - Let X-rays determine

| DO | DON'T | |---|---| | Splint in position found | Try to straighten deformity | | Check pulse before/after splinting | Apply splint too tightly | | Pad bony areas | Forget to immobilize joints above/below | | Control bleeding first | Press on protruding bones | | Remove jewelry before swelling | Move to test if broken | | Monitor circulation every 15 min | Give food/water if surgery likely | | Keep person warm | Massage the injury | | Document time of injury | Delay calling 911 for serious fractures |

"If They Can Move It, It's Not Broken"

- Many fractures still allow movement - Incomplete fractures common - Pain may limit testing - Only X-ray can confirm

"No Swelling Means No Fracture"

- Swelling may take hours - Deep fractures may not swell much - Elderly have less swelling - Some locations swell minimally

"Young Bones Don't Break Easily"

- Children's bones break differently - Greenstick fractures common - Growth plate injuries serious - May have less obvious symptoms

While all suspected fractures need medical evaluation, some require immediate emergency response while others can be transported by private vehicle.

Life-Threatening Fractures:

- Open fractures (bone through skin) - Femur (thighbone) fractures - Pelvic fractures - Multiple fractures - Spine or neck injuries - Skull fractures

Circulation Problems:

- No pulse below fracture - Limb is cold, pale, or blue - Severe bleeding - Numbness or paralysis - Obvious nerve damage

Other Emergency Criteria:

- Person is unconscious - Showing signs of shock - Elderly with hip pain after fall - Child with significant fracture - Fracture with other serious injuries

Minor Fractures Only:

- Suspected finger or toe fracture - Stable wrist or forearm injury - Already splinted effectively - Person is alert and stable - No other injuries

Requirements for Car Transport:

- Injury is well-immobilized - Person can be moved without significant pain - Hospital is close - Someone else can drive - No signs of shock

> Important Disclaimer: > When in doubt, call 911. Moving someone with an unstable fracture can cause permanent damage. Fractures can cause internal bleeding, especially in the thigh and pelvis. What appears minor may be serious. Professional transport provides pain management and proper immobilization.

1. 0-5 minutes: Assess, control bleeding, call 911 if needed 2. 5-30 minutes: Splint if stable, monitor circulation 3. Every 15 minutes: Recheck pulse and sensation 4. Ongoing: Watch for shock, keep person warm 5. Document: Time of injury, what happened, treatment given

Different populations and fracture types require modified approaches for optimal outcomes.

Unique Aspects:

- Bones still growing - Different fracture patterns - May damage growth plates - Heal faster than adults - Less likely to report pain accurately

Growth Plate Injuries:

- Located near joint ends - Can affect future growth - May not show on initial X-ray - Treat any joint injury as potential fracture - Need pediatric orthopedic care

Greenstick Fractures:

- Bone bends and partially breaks - Like breaking a green twig - Common in forearms - May have minimal deformity - Still needs immobilization

Special Concerns:

- Osteoporosis makes bones fragile - May fracture from minor trauma - Hip fractures life-threatening - Slower healing - Higher complication rates

Hip Fractures:

- Often can't walk or bear weight - Leg may be shortened and rotated outward - May have only groin pain - Don't attempt to move - Keep person warm and comfortable

Common Patterns:

- Collarbone from falls - Wrist from falling on outstretched hand - Ankle from twisting - Fingers from ball impact - Stress fractures from overuse

Field-Side Management:

- Remove from play immediately - Don't let athlete "walk it off" - Remove equipment carefully - Ice after splinting - Document mechanism of injury

Fractures from Disease:

- Cancer metastases - Osteoporosis - Bone infections - May occur with minimal trauma - Require gentle handling

Warning Signs:

- Fracture from minor incident - History of cancer - Previous fractures - Elderly patient - Unexplained bone pain before injury

Priority Management:

Special Techniques:

- Log roll for spine protection - Rapid immobilization - Package for transport - Monitor for shock - Document all injuries

Practice these scenarios to build confidence in fracture management.

A 7-year-old falls from monkey bars, landing on her outstretched arm. She's crying, holding her forearm, which appears slightly bent.

Your Actions:

Key Points:

- Don't try to straighten - Greenstick fracture likely - Pediatric evaluation needed

Motorcyclist hit by car, conscious but leg is obviously deformed at mid-thigh. No bleeding visible.

Your Actions:

Critical Recognition:

- Femur fracture = life-threatening - High risk of shock from blood loss - Needs professional transport