Question

Scenario 1: You see a skateboarder going down a hill and suddenly lose control, crashing into the gravel on the side of the bike path. The skateboarder was wearing a helmet and did not hit their head on the ground when they fell. You walk over to the skateboarder to see if you can help them and notice them struggling to sit up and moaning in pain. You notice blood on the pavement and look to find a large deep gash on the skateboarder’s thigh that is spurting blood. You are first aid certified and want to help. (1) What are the initial steps you should take when responding to this emergency? (2) How would you determine what your plan of care would be, and how would you care for the victim? Describe in detail.

Scenario 1 Continued: You have been applying pressure to the thigh with gauze pads, but the bleeding still continues and is still spurting. (1) With this new information how would you change your care? Describe in detail.

Scenario 2: You are playing a pickup game of basketball with your friends. During the game, one of the players trips over an untied shoelace and falls forward. As they are falling, they put their hands out in front of them to break their fall. They fall to the ground then yell in pain. You look over at them and they are sitting on the ground holding their arm close to their body. When you look at the arm you can see that their elbow is pointed at a weird angle and there is an obvious bump on the back of it. The athlete says that they felt a pop and they are unwilling to move their arm. (1) Describe in detail the initial steps you would take in this situation. (2) Explain how you would determine what your plan of care for the athlete should be.

Scenario 2 Continued: You have determined that the athlete has dislocated their elbow and they need more medical attention. (1) Explain what steps you would take when giving care for the athlete. (2) When would you stop providing care for the athlete?

Answer 1

QUESTIONS:

1.Scenario 1: You see a skateboarder going down a hill and suddenly lose control, crashing into the gravel on the side of the bike path. The skateboarder was wearing a helmet and did not hit their head on the ground when they fell. You walk over to the skateboarder to see if you can help them and notice them struggling to sit up and moaning in pain. You notice blood on the pavement and look to find a large deep gash on the skateboarder’s thigh that is spurting blood. You are first aid certified and want to help. (1) What are the initial steps you should take when responding to this emergency? (2) How would you determine what your plan of care would be, and how would you care for the victim? Describe in detail.

2.Scenario 1 Continued: You have been applying pressure to the thigh with gauze pads, but the bleeding still continues and is still spurting. (1) With this new information how would you change your care? Describe in detail.

3.Scenario 2: You are playing a pickup game of basketball with your friends. During the game, one of the players trips over an untied shoelace and falls forward. As they are falling, they put their hands out in front of them to break their fall. They fall to the ground then yell in pain. You look over at them and they are sitting on the ground holding their arm close to their body. When you look at the arm you can see that their elbow is pointed at a weird angle and there is an obvious bump on the back of it. The athlete says that they felt a pop and they are unwilling to move their arm. (1) Describe in detail the initial steps you would take in this situation. (2) Explain how you would determine what your plan of care for the athlete should be.

4.Scenario 2 Continued: You have determined that the athlete has dislocated their elbow and they need more medical attention. (1) Explain what steps you would take when giving care for the athlete. (2) When would you stop providing care for the athlete?

ANSWERS:

Scenario 1: You see a skateboarder going down a hill and suddenly lose control, crashing into the gravel on the side of the bike path. The skateboarder was wearing a helmet and did not hit their head on the ground when they fell. You walk over to the skateboarder to see if you can help them and notice them struggling to sit up and moaning in pain. You notice blood on the pavement and look to find a large deep gash on the skateboarder’s thigh that is spurting blood. You are first aid certified and want to help. (1) What are the initial steps you should take when responding to this emergency? (2) How would you determine what your plan of care would be, and how would you care for the victim? Describe in detail.

1. Remove any clothing or debris on the wound. Don't remove large or deeply embedded objects. Don't probe the wound or attempt to clean it yet. First job is to stop the bleeding. Wear disposable protective gloves if available.

2. Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with palm to control bleeding. Apply constant pressure until the bleeding stops. Maintain pressure by binding the wound with a thick bandage or a piece of clean cloth. Don't put direct pressure on if any embedded object.

Secure the bandage with adhesive tape or continue to maintain pressure with y hands. If possible, raise an injured limb above the level of the heart.

3. Help the injured person lie down. If possible, place the person on a rug or blanket to prevent loss of body heat. Calmly reassure the injured person.

4. Don't remove the gauze or bandage. If the bleeding seeps through the gauze or other cloth on the wound, add another bandage on top of it. And keep pressing firmly on the area.

5. Immobilize the injured body part as much as possible. Leave the bandages in place and get the injured person to an emergency room as soon as possible.

Scenario 1 Continued: You have been applying pressure to the thigh with gauze pads, but the bleeding still continues and is still spurting. (1) With this new information how would you change your care? Describe in detail.

Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb. Tourniquets and haemostatic dressings have been introduced as additional options to treat severe catastrophic bleeding. However, direct pressure remains the main choice of treatment and it will control bleeding in the vast majority of cases. Haemostatic dressings and tourniquets should be used when direct pressure is either not possible or ineffective.Here is one of the easiest ways to make an improvised tourniquet from the contents of a standard first aid kit. Use a triangular bandage folded into a broad fold bandage and to tighten the tourniquet using scissors as a windlass.A tourniquet should be at least 4cm wide to prevent localised damage to nerve tissues.Tie the bandage around the bare limb on a single bone (i.e. if the lower part of the arm or leg   are bleeding, you should tie the tourniquet on the upper part, where there is only one bone rather than two).The tourniquet should be at least 5cm above the wound, or 5cm above the joint if the wound is on the lower limb. Never place a tourniquet over a joint.

1. Place the knife or your scissors on top of the knot and tie another knot on top of them

2. Use the knife or your scissors as a windlass to wind round and tighten the tourniquet

3. The windlass can be secured either by tying another triangular bandage to stop it unwinding or by wrapping and tying both ends of the triangular bandage around the ends of the windlass to ensure it remains in place.

It is important to note the exact time in which it is  applied the tourniquet. To arrange for urgent transfer for medical help, ensure to tell them where and when the tourniquet was applied.Please note it will be extremely painful for the casualty to have a tourniquet. Howewver it is absolutely vital that apply the tourniquet tight enough to entirely stop the bleeding.If a tourniquet is not on tight enough it can make things worse as it can occlude the veins. Arteries may be harder to stop as they are less easy to get to. Moreover, if the venous return is stopped by the tourniquet, the only place for blood to come out is from the wound.Never be tempted to loosen or remove a tourniquet. Once applied, tourniquets should only ever be removed by a doctor in a hospital setting.

Scenario 2: You are playing a pickup game of basketball with your friends. During the game, one of the players trips over an untied shoelace and falls forward. As they are falling, they put their hands out in front of them to break their fall. They fall to the ground then yell in pain. You look over at them and they are sitting on the ground holding their arm close to their body. When you look at the arm you can see that their elbow is pointed at a weird angle and there is an obvious bump on the back of it. The athlete says that they felt a pop and they are unwilling to move their arm. (1) Describe in detail the initial steps you would take in this situation. (2) Explain how you would determine what your plan of care for the athlete should be.

Check for a few signs that will show if the artery in the arm and the nerves are intact.

1. To check for the artery, feel below thumb at the base of wrist. There should be able to feel your pulse. Press on the tips of fingers. They should blanch (turn white) and then return to a normal pink colour within three seconds. If either of these tests is abnormal, seek medical care immediately.
2. Three nerves run by the elbow. Each nerve has portions that help with strength and feeling. First check for strength by bending the wrist up as if saying, "Stop" (radial nerve function), then spread fingers apart (ulnar nerve function), then try to touch thumb to little finger (median nerve function). If the injured person has trouble with any of these tests, go to the doctor immediately.
3. Check for feeling or sensory changes by touching all over the hand and arm. If any feeling of numbness results, see a doctor immediately.

Scenario 2 Continued: You have determined that the athlete has dislocated their elbow and they need more medical attention. (1) Explain what steps you would take when giving care for the athlete. (2) When would you stop providing care for the athlete?

• The recommended treatment for most acute injuries is referred to as the PRICE principle. This is an acronym for protection, rest, ice, compression, and elevation.
• The goal of this treatment is to:
  • Reduce pain and swelling
  • Lay the foundation for a good rehabilitation
• It is recommended that continuing the treatment for at least 48 hours after the time of the injury. However, some of the elements are more applicable than others.
• Protection
  • In this context, it means to remove the athlete from play to protect against further injury. This is especially important in the first 48 hours after the injury occurred.
• Rest
  • The athlete should not continue with any sporting activity following an elbow injury.
• Ice
  • The aim of applying ice is to relieve pain. 20 minutes with an ice pack every other hour for a day or two has a good effect.
  • Even though there are many commercial ice products available, the best solution is often a plastic bag filled with crushed ice and some water. Place a damp towel between the ice pack and skin.
• Compression
  • Applying compression minimises swelling, which in turn may decrease stiffness. Use an elastic bandage and roll it out in a herringbone pattern. Start below the elbow joint and finish putting compression on above the joint. The compression bandage should be as tight as possible without cutting off blood circulation. The use of a pressure bandage should be continued for the first 2-3 days.
• Elevation
  • Swelling can be reduced further by keeping the elbow elevated, preferably above heart level. This is particularly important in the first few hours, but it is best to continue to keep it elevated as much as possible for the first 24 hours. Remember that compression should be maintained around the clock to keep internal bleeding (swelling) to a minimum.