First Aid - When Disaster Strikes - page 110

3. Skull. Blood or straw-colored fluids seeping from the ear or nose may indicate a skull fracture.
Do not block the drainage of these fluids, as this may cause brain damage from internal pressure
buildup.Iftherearenosignsofneckorbackinjury,placethevictimintherecoveryposition,with
the leaking side down to drain. Cover wounds lightly with sterile dressings if a fracture is sus-
pected. Dilated pupils, dizziness, difficulty breathing, nausea, unclear thinking, vision problems,
unconsciousness, and severe, unrelenting headaches are signs of potential brain injury. Monitor
the ABCs and call EMS.
Reducing Dislocations
When traveling in the wilderness or when emergency medical services are hours away, try to
pop dislocated joints back into place (“reduction”). Do not wait too long, or else swelling and
muscle spasms will make this task difficult or impossible. Gently probe the area to try to ensure
that the dislocation is not actually a fracture.
• Fingers are easy to relocate. Simply grasp the fingertip and pull steadily outward un-
til the joint pops back into place. After relocation, tape the injured finger to an adja-
cent finger for support.
• For shoulders, try to position the victim lying flat on her or his stomach with the arm
hanging down over an edge. Either hang a weight of 10 to 15 pounds from the wrist
for 10 minutes, or pull steadily downward on the victim's wrist until the shoulder
pops back into place. Separated shoulders are often confused with shoulder disloca-
tions. Separated shoulders are usually caused by falls directly onto the shoulder,
which tears some of the tissue connecting the collarbone to the shoulder. If you de-
tect a “spongy” feel while gently probing the collarbone, the injury is probably a sep-
aration and should be treated by immobilization with a sling. After reduction, support
the arm with a sling.
• Elbows are more difficult to treat, and you may not be able to get the elbow to relo-
cate while you are in the backcountry. Check pulse and circulation in the fingers.
Have the victim lie on his or her belly, draping the injured elbow over a padded ledge
or edge so the elbow bends 90 degrees and the forearm hangs straight down. Grasp
the wrist and pull downward while another rescuer pulls upward on the upper arm
just above the elbow. Rocking the forearm back and forth gently may assist the pro-
cess. Recheck pulse and circulation in the fingers. After relocating the elbow, splint
as if it were fractured.
• Hips are tough, but if successfully relocated, will prevent further damage to the hip
joint and sciatic nerve. Lay the victim on his or her back and, keeping the knee bent
at a right angle, lift the leg until the thigh is pointing straight up. Have an assistant
hold the victim's hips down while you straddle the victim. Grasp just below the knee