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Dislocation of Bones

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What is Dislocation of Bones?

A fracture means a bone is broken. In accidents, several may be affected. As bleeding, injury to surrounding structures, pain, shock or infection may all occur, emergency treatment is advisable. The key to success is to get the patient to emergency professional help as quickly as possible. Make the casualty comfortable and attend to any emergency symptoms that are amenable to first aid help.

The break in the bone is usually complete, but in children in whom growing bones are soft, it may be bent, cracked and incompletely broken (called a “greenstick” fracture).

The fracture may be closed or open (simple or compound), depending on whether it communicates with the air outside. Open fractures are more serious, for this allows contamination to enter the wound and probably the bone. Some fractures are “complicated,” which means surrounding structures, such as internal organs, blood vessels or nerves are also injured. These too are more serious, for they can lead to important complications. Fractures may be produced by direct force (such as receiving a direct blow by a car). They may be indirect, such as falling on the outstretched arm, which causes fracture of the shoulder bones. for instance. Occasionally sudden muscle contraction may cause a fracture.

Bones are well endowed with blood vessels, and any fracture, especially of major bones, is invariably accompanied by a heavy blood loss and consequent shock. (For example, a fractured femur, the large bone in the upper part of the lower limb, may hemorrhage a liter or more of blood if broken.) Pain invariably occurs. The first aider will endeavor to prevent further damage and minimize risks from blood loss, reduce pain, and if possible reduce the chances of infection.

The basic essential of immobilizing (stopping further movement) the injured part is to disturb the patient as little as possible, inflict minimum pain and avoid complications. Injured parts should be supported in a natural a position as possible.

Dislocation of Bones Symptoms

  1. The fracture site is painful, swollen and bruised.
  2. There is loss of function of the part, particularly noticeable in limbs.
  3. The part may be obviously deformed.
  4. There may be abnormal mobility of the part.
  5. Shock, to some extent, is usually present. In injuries to larger bones, this may be severe.

What to Do in the Case of Fractures

  1. Aim at bringing relief to the major injuries as quickly as possible, without making the condition worse, and then getting the casualty to expert medical attention (preferably the emergency ward of a large hospital) as soon as possible. Often assistance is necessary.
  2. Keep calm. Don’t panic. Often the sight is distracting, and may nauseate you. Keep a cool head and act deliberately, but calmly and methodically. Rushing breeds confusion.
  3. Immobilize the fracture (i.e. prevent further movement).
  4. Control bleeding if present.
  5. Handle gently, for it is easy to convert a simple fracture into a more complicated one.
  6. Reassure the patient with words of comfort and confidence.

Dislocation of Bones Treatment

Often the use of broad bandages can help this. If not possible, narrow ones may be used. Triangular and crepe bandages are often useful in an emergency. Every effort should be made not to disturb or hurt the patient. Avoid jerking movements, particularly when bandaging or securing them.

Sometimes splints are necessary to prevent movement of the injured parts during transport. Anything that is wide, long and firm may be suitable. They should be well-padded, and securely applied, so as to immobilize the joints above and below the break.

Adequate padding will improve the efficacy of the splints, and this helps to bring relief to the patient. These can be improvised from any sort of material in an emergency.

Rather than run risks of bringing further damage to the patient (such as in suspected spinal fractures, where care in handling may be vital), it is advisable to make the patient as comfortable as possible, and call the ambulance. Ambulance officers are specially trained to handle potentially serious fractures, and know the special movements necessary. Also, some are equipped with special stretchers that can pick up the patient from the ground, thus ensuring minimum movement and risks.

Most people will not be conversant with the various first aid bandaging techniques that have been worked out for the different kinds of fractures. For practical purposes, general principles may be adhered to, and the patient transferred to expert help as a matter of urgency. Some general principles will be outlined that may be of assistance. This is not the time to teach bandaging.

However, anyone interested in learning full techniques is advised to take a St John First Aid instruction course, which gives excellent instruction in these useful techniques.

Jet Lag

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In today’s world of jet setting and cheap, high-speed international transport, jet lag is common. It merely means that the body’s internal biorhythms are thrown out of gear as successive time zones are crossed, and a person is suddenly confronted with a totally new “local time” when that person’s internal time clock is set at the time “back home,” probably 18,000 km and many time zones away. In short, while the brain is saying the sights of London are there to enjoy, the body is clamoring for a deep, refreshing sleep in Melbourne or Wellington.

Jet Lag Treatment

Some drug therapies such as melatonin are claimed to help, but there is no universal cure by medication. Ideally, plan the trip so that you arrive at your destination in the evening, can have a bath and slip into a fresh bed and a good sleep. The next day, one would often feel much more mentally and physically refreshed. Do not plan any important appointments for the first day, and do not drive a car for 24 – 36 hours after arrival.

Accidents are much more probable when your mental awareness is taking time to adjust. Sitting in the sun or under fluorescent lighting for two to four hours is claimed to help reset the internal time clock. Flying with the sun (east to west) is usually less mentally tiring than coming in the reverse direction (west to east). Flying from Sydney or Auckland to Los Angeles, for example, is more tiring than the reverse trip.

Flying Sydney or Auckland to London is easier than the reverse. If possible, buy a round-the-world ticket rather than having to retrace your steps, and fly in the “wrong” direction. Try to get sleep on the plane, even if it means taking a mild sedative. Go easy on food; do not eat everything offered on every occasion. Walk around the cabin often, and disembark at stopovers, even if only for an hour or so. Water-based drinks in abundance are best. Perspiration (often without you being aware of it) draws large volumes of fluid from the system. This must be replaced otherwise dehydration occurs and aggravates symptoms. These simple suggestions often help.

Wound Care

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Wound Care

BRUISES AND HEMATOMAS
Bruises (also called contusions) usually form a bluish discoloration at the site of the injury and fade from blue to green to yellow over one to two weeks.
A hematoma (goose egg) is a collection of blood and swelling in the skin or just underneath it. Depending upon its size and location, this swelling will go down in one to ten days.
Apply ice intermittently to the injured area for a few days. The ice can be applied for 20 minutes every two to four hours and will help to limit bleeding into the tissues. If your child won’t allow you to put ice on the bruised area, it will still heal fairly quickly in most cases.
ABRASIONS
Abrasions (or scrapes) are broad areas of superficial skin damage; they seldom result in any deep underlying damage and rarely leave a significant scar. They heal quickly and usually do not become infected.
Treatment
Cleanse the wound gently with warm soapy water to remove any dirt and debris. A painless antiseptic such as hydrogen peroxide can help cleanse an abrasion.
Apply an antibiotic ointment such as a neomycin-polysporin mixture (Neosporin) or one prescribed by your child’s physician. Cover with a nonstick wound dressing to keep it clean.
Change the dressing once or twice daily until the wound is no longer moist and sensitive.
LACERATIONS
A laceration can range from a minimal break in the skin surface, requiring only a brief cleansing and a day or two of a simple dressing, to a long, gaping wound requiring extensive repair. A deep laceration may damage tendons, nerves, joints, or other underlying tissues. It may also contain dirt or other foreign material that can lead to infection. Because of these potential complications, most wounds deeper or wider than I or 2 mm should be examined by a physician to determine appropriate treatment.
Treatment First aid for lacerations that might require sutures (stitches) includes the following:
Apply steady pressure with clean gauze or washcloth to stop bleeding.Keep the area clean.
Rinse with clean water if available.
Keep covered with a sterile bandage, or at least a clean cloth, until the wound can be examined by a medical professional.
A laceration should be closed within 24 hours. The sooner the
wound is treated, the less likely it will become infected. If a laceration is not sutured, the consequences are usually not serious, but healing could take longer and the resulting scar is likely to be wider or more prominent.
Sometimes lacerations are deep enough to involve injury to a nerve or tendon. For this reason, any laceration that looks deep at all should be examined and cleaned by your child’s physician or another medical professional.
WHEN SUTURES ARE NOT USED
With some contaminated lacerations or certain types of animal or human bites, the physician may not use sutures because closing the wound could increase the risk of infection. In such cases the wound will be left open, but it will gradually heal as the body’s repair processes close the defect.
CONCERNS ABOUT TETANUS
Any laceration, puncture, bite, abrasion, or burn should prompt a review of a child’s tetanus
Immunization status. Tetanus is a potential threat following any wound, but it is a greater, tern following punctures or contaminated wounds. If a child is on schedule for Isis or hernunizations or is fully immunized, no tetanus update will be needed. Otherwise a tetanus booster should be given.
SIGNS OF INFECTION
Signs and symptoms of infection include local pain, swelling, and redness, which may cover a large area around the wound. There may also be fever. Inflammation of local lymph channels may form a red streak that extends away from the wound. Some bacteria can the production of discolored drainage (or pus). If a wound appears to be level wing an infection, show it to a physician. Mild heat on the affected area, rest, elevation of the affected area (if an arm or leg), and antibiotics will most likely be recommended.
THE IMPORTANCE OF FOLLOW-UP
Be sure to obtain specific wound-care instructions before leaving the office or emergency facility. In general, if sutures or sterile strips have been used, the wound should be kept dry for a few days. This will mean that the child should not go swimming or soak the wounds while bathing. In some cases, the physician may instruct you to clean the wound and apply fresh dressings. He or she should also tell you when the strips or bandages should be removed. A follow-up appointment is usually required when stitches need to be removed.

Urinary Tract

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The kidneys produce urine and serve a number of important functions, including maintaining fluid balance and blood pressure and eliminating waste products. They are very complex and efficient filters of the blood, allowing unnecessary components to pass into the urine while returning 99 percent of the filtered fluid to the circulatory system.

The kidneys adjust to the body’s fluid needs. For example, a dehydrated individual will produce less urine, allowing the body to conserve water. The kidneys also adjust the salt and mineral composition of the blood. When a kidney is damaged, diseased, or receiving an inadequate supply of blood, it cannot carry out its filtering functions properly. When this occurs, certain components of blood such as protein, sugar, and red blood cells may leak into the urine.

Normally the clear yellow urine produced by each kidney flows continuously through a narrow, muscular tube called the ureter to the bladder, where it is stored until automatic or voluntary input from the nervous system causes it to be eliminated. This process involves simultaneous contraction of muscles within the bladder wall and relaxation of muscles (called the sphincter) at the bladder’s outlet.

Painful urination (dysuria)

Discomfort while passing urine can he caused by one of the following situations:

• Infection (see below)

• Irritation from something coming in direct

contact with the genital area, such as bubble bath

or other soapy material in the tub, new laundry

soap, creams, or lotions

• Trauma

• A foreign body in the vagina or urinary tract (see genital care and concerns)

Any time your child complains of painful urination or if you notice a distinctly abnormal color of the urine (especially a reddish tinge that could indicate that blood is present), contact your child’s physician as soon as possible. If a child is having difficulty urinating because of pain, you can help by placing her in a bathtub of warm water and allowing her to urinate there.

Kidney disease

Changes in the characteristics or amount of urine  may result from a disorder of the kidney itself or from a problem in the ureter or bladder. Decreased urine production may be caused specifically by dehydration or kidney disease, or obstruction to the flow of urine. There are  many types of kidney diseases, but they cause only a limited number of symptoms.

Decreased or (more rarely) increased urine production

Passage of blood, which may be visible to the naked eye or detected only by chemical tests or microscopic examination

Sugar (glucose) in the urine, which is virtually always associated with a high level of glucose in the blood (diabetes)

Increased amounts of protein in the urine, which can usually be detected by a simple chemical test in the physician’s office

Swelling of the hands, ankles, feet, scrotum, or eyelids (called edema)

Pain in the mid-back or flank area on one side of the body

Fever, which may be a sign of infection within or adjacent to a kidney

Inceased urine production (polyuria)

Inceased urine production can be a normal response if a child drinks a lot of fluid, or it can indicate are serious problem. Kidneys will produce an abnormal amount of urine for three basic reasons:

Kidney damage prevents the kidneys from concentrating urine.

The hormones that control the kidneys’ concentrating abilities are not being produced or are not functioning properly.

A disease such as diabetes causes a marked elevation of certain substances (especially glucose or blood sugar) in the bloodstream. When the concentration of glucose in blood exceeds a certain level, the kidney can no longer prevent some from spilling into the urine. This results in a higher volume of urine and can eventually lead to a substantial fluid loss in the urine (hematuria)

Seeing blood in the urine can be frightening for both parent and child. But not everything that looks red is blood. It is not uncommon to see a small amount of pinkish red, paste like material in a newborn’s diaper. This is usually caused by urate crystals that form in concentrated urine. If these are seen in a breastfed baby, it may be helpful to nurse more frequently. If you are bottle-feeding, consider giving a few ounces of water. Urate crystals will usually disappear by the second week of life.

Some foods such as beets and certain medications cause a child’s urine to change color. You should consult with your child’s physician if this occurs.

Blood in an infant’s diaper area may come from the urinary tract, from the vagina in little girls, or from the gastrointestinal tract. If you notice blood in the diaper, take the diaper with you to your physician.

Blood in the urine is sometimes clearly visible but at other times may be present in quantities so small that it can be detected only by a microscopic evaluation and/or a dipstick-a thin test strip that identifies a variety of substances in the urine. The following conditions cause red blood cells to be present in the urine, and it is important that the underlying cause be determined if at all possible:

•Urinary tract infection

•Trauma, including injuries to the kidneys or genitalia

•Kidney diseases, including hereditary kidney problems, that leak small amounts of blood into the urine

•Kidney stones

•Blood-clotting problems

•Abnormalities of immune function

•Exposure to toxic substances

•Tumor, which in children would nearly always involve the kidney rather than ureter, bladder, or external genitalia

•Vigorous exercise-running, jumping, etc.

Your physician will examine your child and ask questions to sort through these possibilities. A urine specimen will be evaluated. If a urinary tract infection does not appear to be the problem, the physician will probably do a careful evaluation of the genital area and order special blood and/or imaging tests (X-ray or ultrasound)to help determine the cause of the hematuria.

Obstruction: hydronephrosis

Malformations of any portion of the urinary system can occur during fetal development. The most common ofthese in both girls and boys is an obstruction that decreases or completely stops the flow of urine. The resulting increase in pressure causes swelling within the urinary tract. When one or both kidneys are involved, the condition is called hydronephrosis (literally, “water kidney”). Sometimes this type of obstruction can be diagnosed during pregnancy through an ultrasound. One of the first surgeries developed for preborn babies was the treatment of hydronephrosis by removing the obstruction while the kidneys still had time to grow.

Obstruction: persistent urethral valves

In boys, the urine flows through the urethra inside the penis. During fetal development, small flaps called valves stop the flow of urine. Before the baby is born, these valves normally disappear, allowing urine to pass freely. If the flaps of tissue remain after birth, they can obstruct the urine flow and cause bladder distention. One clue that a baby may have urethral valves is that the urine stream is weak and dribbling rather than forceful. (Most parents of boys have been sprayed during diaper changes, an indication that the flow of urine is not obstructed.)

Obstruction: meatal stenosis

The opening at the end of the penis through which urine passes is called the meatus. If the baby boy is circumcised at birth, the head of the penis (glands) is exposed to urine and stool in the diaper. The sensitive cells of the meatus may become irritated and heal with scar tissue, which can cause a narrowing known as meatal stenosis.If the boy’s urine stream appears narrowed – a thin, jet like stream as if coming from a nozzle – or if it deviates to one side so much that he must deliberately aim his penis to keep the urine stream within the toilet bowl, he should be examined by a physician. If meatal stenosisis severe, a urologist may perform minor surgery to dialate the meatal opening.


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