b'Chapter hapterHow to RecogniseIntense pain at the injury site.Deformity or angulation over and around the affected area.Tenderness, bruising, swelling, inflammation and discolouration.Loss of powerpatient may be unable to move the limb.You may hear the bone ends grating against each other (crepitus).Numbness and tingling sensations in the limb.How to ManageKeep the patient as still as possible to help minimise pain and reduce further bleeding. Cover any open wound with a clean, preferably sterile pad. Apply pressure around the bone to minimise bleeding. Do not press directly down on any protruding bone end.If bone is protruding, build up plenty of soft padding either side until the padding is higherthan the bone. Secure the padding with bandages.Immobilise the injured limb(refer below) .How to ImmobiliseDo not straighten the injured limb.Generally you do not need to apply a splint if ambulance assistance is reasonablyclose by. In this situation, gently support the injury in the position in which you find it and do not move the patient unnecessarily. Use a pillow or clothing for general comfort and support. Immobilisation helps to reduce movement and also helps minimize associated pain. f necessary, gently support the injured limb and secure against a sound part of the body I(secure a fractured arm across the chest with a sling or bandage, the sound leg against the injured one) or;Apply a rigid, improvised splint such as rolled up newspaper, magazine or piece of wood.Place soft padding between the splint and natural contours of the limb. Firmly secure the splint above and below the injured limb by using broad or triangular bandages. Check to make sure the bandages are not too tight or restrictive. A sling is used to hold, support and immobilise an upper extremity. If no bandages are available, the patients clothing can be used to provide support, for example, turn up the lower edge of the shirt, use a belt or a tie or place the hand inside the shirt or jacket. Ensure the sling is positioned to provide maximum stabilisation and comfort.Check for any possible signs of impaired circulation every 10 minutes(there may be discolouration and numbness or tingling sensations).Rest, reassure, and comfort the patient. Keep the patient warm.Closely monitor patient for response, airway, normal breathing while waiting for Ambulance.Muscle, Joint and Bone Injury 113'