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Thread: Emergency Medicine and Management

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    Rusted vineeth aredath's Avatar
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    Post Emergency Medicine and Management

    In this contemporary environment, there are changes happening in the ever growing technology which is the hallmark of the modern world. There is no doubt that science had made our life worth living. The discovery and inventions on medical and diagnostic tools have bought about significant improvement in Human health and in the quality of human life. Admittedly its true that the accessibility of these technologies is limited at certain point of time at certain places. Even with all these technological advancement, people disappear with out getting Basic life saving measures, and there is no decline in this graph. There is few or no sufficient investment in developing the technology to make such strategy feasible for everyone every time everywhere hence serious concern needed for saving life of people during such unexpected emergency situations. There for in the following paragraphs, I would like to discus some solutions to tackle these problems at least to some margin
    Hope this aid my fellow bikers towards great extent

    Steps in Immediate Injury management


    1. Prevention


    The best way to treat any injury is prevention. Know the warning signs and take enough rest. If you notice any pain, you should stop activity and try to identify the cause of the pain. Also pay attention to where exactly the pain occurs. Is it in one specific place or a generalized ache over a large area? Does it travel up or down or radiate to other areas? Understanding your pain can often help you identify the cause, get the right treatment and heal more quickly.

    2. Rest and Recovery


    The primary treatment for soft tissue injuries is R.I.C.E. - rest, ice, compression and elevation. Rest means to stop activity and give the tissues time to heal. Compression of an acute injury is perhaps the next most important immediate treatment tip. By quickly wrapping the injured body part with an elastic bandage or wrap you help keep swelling to a minimum. When muscles fatigue, they are far more likely to become injured. Injured muscles, bones, tendons ligaments take a long time to heal, and once they are injured, are prone to re-injury.

    3. Acute Injuries


    Ice reduces inflammation and relieves pain. Cold therapy with ice is the best immediate treatment for acute injuries because it reduces swelling and pain. Ice is a vaso-constrictor (it causes the blood vessels to narrow) and it limits internal bleeding at the injury site. Apply ice (wrapped in a thin towel for comfort) to the affected area for 10 to 15 minutes at a time. Allow the skin temperature to return to normal before icing a second or third time. You can ice an acute injury several times a day for up to three days. Cold therapy is also helpful in treating some overuse injuries or chronic. It's not helpful to ice a chronic injury before exercise.
    The best way to ice an injury is with a high quality ice pack that conforms to the body part being iced. You can also get good results from a bag of frozen peas, an ice massage with water frozen in a paper cup (peel the cup down as the ice melts) or a bag of ice. For Soft Tissue Injury, Ice Massage Is Best

    Ice massage is the most effective method of applying ice to an injury. The research regarding the use of ice on soft tissue injuries continues to support the following guidelines for icing an injury. These steps result in the best treatment outcomes for many acute injuries.

    How to Perform an Ice Massage

    the easiest way to perform ice massage on an injury is to freeze water in a small paper cup. Rip the cup to expose the ice. With the injured body part elevated above the heart (if possible) to reduce swelling, massage the injured area. Keep moving the ice in a circular motion for 10 minutes; never hold it in one place. As the ice melts, tear down the sides of the cup to expose the rest of the ice.
    Repeating
    The most effective and safest use of ice has been found with a repeated application for 10 minutes at a time. Allow the injured body part to warm for at least an hour before repeating the ice massage. Using repeated, rather than continuous, ice applications helps sustain reduced muscle temperature without compromising the skin. It also allows the superficial skin temperature to return to normal while deeper muscle temperature remains low.
    How Long to Continue
    The amount of time you continue the ice massage cycle is dependent upon the amount of pain and swelling you have, the extent of the injury and your personal preference. In general, repeating the ice massage 3 to 5 times a day in the first 24 to 48 hours is helpful. After 48 hours, there is less evidence that icing the injury will improve your healing time.
    Cautions
    icing an injury too long can cause further damage to the soft tissues, and even result in frostbite.
    Keep in mind that your reflexes and motor functions are also impaired following ice treatment, so you may be more susceptible to injury for up to 30 minutes following treatment. For this reason, avoid using the injured body part until the tissue has warmed back up (about an hour).
    Alternate Icing Techniques
    If you don't want to use an ice massage, you can use a small zipper bag of crushed ice, a package of frozen peas or a commercial ice pack to ice your injury. With these options, as long as you have thin towel or other protective barrier between your skin and the ice, you can leave the ice pack in place for about 15 minutes at a time. Again, be careful not to let ice sit on the skin -- either continually move the ice or use a thin towel between the ice and skin.

    4. Chronic Injuries


    Heat is not recommended for acute injuries, but is often helpful for chronic injuries or injuries that have no inflammation or swelling. Sore, stiff, nagging muscle or joint pain responds well to heat therapy. Heat can also help relax tight muscles or muscle spasms.
    In case of any chronic cases first priority should be given to the Air way then Breathing and finally to Circulation (ABC)

    5. Anti-inflammatory Medication


    Most soft-tissue injuries are painful because of the swelling and inflammation that occurs after an injury. Pain relief is often the main reason that people turn to over-the-counter (OTC) anti-inflammatory medications that work by reducing the inflammation that occurs as a result of the injury.

    There are two basic types of over-the-counter pain relievers:

    1. NSAIDs (nonsteroidal anti-inflammatory drugs). These include aspirin, ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT).
    2. Acetaminophen (Tylenol and Panadol).


    6 Creams and Gels that Relieve Pain


    • Topical Analgesics Containing Salicylates
      Salicylates (Methyl Salicylates), the same ingredients found in aspirin, are effective pain relievers that also reduce inflammation. However, researchers have found that salicylates do not ease muscle pain when used as a topical cream applied to the skin. Although this review of the literature was quite comprehensive, These creams are not recommended for use by those who are allergic to aspirin, due to an association between the development of Reye's syndrome and the use of aspirin (a salicylate compound). Brand name products include Bengay, Aspercreme and creme.

    Get to a physician for a proper diagnosis of any serious injury


    Abrasions, Lacerations, Scrapes, and
    Wound management

    As bikers we are more prone to these injuries. Abrasions are a very common injury that are usually caused by a fall on a hard surface, falls or slides on the ground; friction causes layers of skin to rub off. The skin is composed of an outer layer (the epidermis) which provides protection, and a deep inner layer (the dermis), which provides the firmness and flexibility of the skin. Abrasions typically refer to an injury that removes these layers of skin. A bike crash has the potential to cause a painful and severe abrasion, most abrasions are shallow scrapes that do not extend into the dermis and don't cause a great deal of bleeding. While there is often little or no blood loss from an abrasion, there can be a great deal of pain because of the many nerve endings that are exposed.

    Treatment for Abrasions

    Conventional treatment of abrasions and road rash included treating the area by cleaning the wound with mild soap and water or a mild antiseptic wash and then covering the area with an antibiotic ointment and a dry dressing
    While a severe abrasion should be seen and cleaned by a physician, you can do some things to promote healing. First, because abrasions can easily become infected, you should clean the area thoroughly and remove any dirt and debris. Ideally, you want to irrigate the area with a nontoxic surfactant such as 0.9 sodium chloride or Shur-Clens with a bit of pressure or with clear water in emergency cases (use a syringe if possible). The area must be completely clean. Use clean gauze or cloth to gently scrub the area. Do not scrub vigorously, as this can cause more tissue damage.
    Use a semi permeable dressing to cover the wound and attach the dressing to dry healthy skin with adhesive tape. The dressing should be changed every few days. Keep the wound moist until it has healed. A moist environment promotes healing, improves tissue formation and protects the area from infection.
    Your tetanus status is important to avoiding infection. If you are uncertain when you had your last tetanus shot or if your last booster was more than 10 years ago, you should get one. Tetanus is an acute infectious disease in which the voluntary muscles go into spasm. It is not only caused by stepping on a rusty nail; it can also develop in wounds in which the flesh is torn or burned.

    Deep Lacerations

    While cleaning the skin abrasion, you should look for any deep cuts that may require stitches to heal properly. Cuts that continue to bleed after 15 minutes of direct pressure, or cut that extend deep into the skin and have edges that pull apart, may require stitches.

    Healing

    After an abrasion, the layers of damaged skin will heal from the deeper layers to the surface layers and from the outer edges to the center. As healing begins, the area of the abrasion may look pink and raw, but in time the wound will form new skin that is pink and smooth.

    External wound management


    The type of wound (incision, laceration, puncture etc.) will have a major effect on the way a wound is managed, as will the area of the body affected and the presence of any foreign objects in the wound. The key principles of wound management are
    Keeping the wound above the level of the heart will decrease the pressure at the point of injury, and will reduce the bleeding. This mainly applies to limbs and the head, as it is impractical (and in some cases damaging) to attempt to move the torso around to achieve this. Most protocols also do not use elevation on limbs which are broken, as this may exacerbate the injury.
    Placing pressure on the wound will constrict the blood vessels manually, helping to stem any blood flow. When applying pressure, the type and direction of the wound may have an effect, for instance, a cut lengthways on the hand would be opened up by closing the hand in to a fist, whilst a cut across the hand would be sealed by making a fist. A patient can apply pressure directly to their own wound, if their consciousness level allows. Ideally a barrier, such as sterile, low-adherent gauze should be used between the pressure supplier and the wound, to help reduce chances of infection and help the wound to seal. Third parties assisting a patient are always advised to use protective latex or nitrile medical gloves to reduce risk of infection or contamination passing either way. Direct pressure can be used with some foreign objects protruding from a wound, and to achieve this, padding is applied from either side of the object to push in and seal the wound - objects are never removed.
    In situations where direct pressure and elevation are either not possible or proving ineffective, and there is a risk of exsanguinations, some training protocols advocate the use of pressure points to constrict the major artery which feeds the point of the bleed. This is usually performed at a place where a pulse can be found, such as in the femoral artery. There are significant risks involved in performing pressure point constriction, including necrosis of the area below the constriction, and most protocols give a maximum time for constriction (often around 10 minutes). There is particularly high danger if constricting the carotid artery in the neck, as the brain is sensitive to hypoxia and brain damage can result within minutes of application of pressure. Pressure on the carotid artery can also cause vagal tone induced bradycardia, which can eventually stop the heart. Other dangers in use of a constricting method include rhabdomyolysis, which is a build up of toxins below the pressure point, which if released back in to the main bloodstream may cause renal failure

    Epitasis

    Epitasis or a nosebleed is a special case, where almost all first aid providers train the use of pressure points. The appropriate point here is on the soft fleshy part of the nose, which should constrict the capillaries sufficiently to stop bleeding, although obviously, this will not stop bleeding which originates in the nasopharynx or the tear ducts

    Tourniquet

    Another method of achieving constriction of the supplying artery is via the use of a tourniquet - a tightly tied band which goes around a limb to restrict blood flow. Tourniquets are routinely used in order to bring veins to the surface for cannulation, although their use in emergency medicine is more limited. The use of the tourniquet is restricted in most countries to professionals such as physicians and paramedics, as this is often considered beyond the reach of first aid and those acting in good faith as a good samaritan. A key exception is the military, where many armies carry a tourniquet as part of their personal first aid kit.
    Improvised tourniquets, in addition to creating potential problems for the ongoing medical management of the patient, usually fail to achieve force enough to adequately compress the arteries of the limb. As a result, they not only fail to stop arterial bleeding, but may actually increase bleeding due to the impaired venous blood flow some argue that tourniquets should never be used in the pre-hospital setting, not even for amputations.

    Clotting agents

    Some protocols call for the use of clotting accelerating agents, which can by externally applied as a powder, gel or pre-dosed in a dressing, or as an intravenous injection. These may be particularly useful in situations where the wound is not clotting, which can be due to external factors, such as size of wound, or medical factors such as hemophilia.

    Internal wound management


    Internal wounds (usually to the torso) are harder to deal with than external wounds, although they often have an external cause. The key dangers of internal bleeding include hypovolaemic shock (leading to exsanguinations, causing a tamponade on the heart or a haemothorax on the lung. The aortic aneurysm is a special case where the aortas, the bodys main blood vessel, become ruptured through an inherent weakness. This is one of the most serious medical emergencies a patient can face, as the only treatment is rapid surgery, although exertion, raised blood pressure or sudden movements could cause a sudden catastrophic failure.
    In the event of the bleeding being caused by an external source (trauma, penetrating wound), the patient is usually inclined to the injured side, in order to ensure that the 'good' side can continue to function properly, without interference from the blood inside the body cavity.
    The treatment of internal bleeding is beyond the scope of simple first aid, and should be considered by any first aider to be potentially life threatening. The definitive treatment for internal bleeding is always surgical treatment, and medical advice must be sought urgently for any victim of internal bleeding.

    Management of fracture


    All fractures can be broadly described as:
    Closed (simple) fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection; they require antibiotic treatment and usually urgent surgical treatment (debridement). This involves removal of all dirt, contamination, and dead tissue. Multi-fragmentary fractures, known as comminuted fractures, involve the bone splitting into multiple pieces. A simple, closed fracture is much easier to treat and has a much better prognosis than an open, comminuted fracture.
    Other considerations in fracture care are displacement (fracture gap) and angulations. If angulations or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulations.
    Another type of bone fracture is a compression fracture. It usually occurs in the vertebrae, for example when the front portion of a vertebra in the spine collapses due to osteoporosis (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma).
    Other types of fracture are:

    • Complete fracture: A fracture in which bone fragments separate completely.
    • Incomplete fracture: A fracture in which the bone fragments are still partially joined.
    • Linear fracture: A fracture that is parallel to the bone's long axis.
    • Transverse fracture: A fracture that is at a right angle to the bone's long axis.
    • Oblique fracture: A fracture that is diagonal to a bone's long axis.
    • Spiral fracture: A fracture where at least one part of the bone has been twisted.
    • Compacted fracture: A fracture caused when bone fragments are driven into each other.
    • Holstein-Lewis fracture: A fracture of the distal third of the humerus resulting in entrapment of the radial nerve. Since the triceps brachii and all muscles distal of the break are innervated by the radial nerve, they will be significantly affected by the fracture.

    Immediate measures

    1. Pain management

    2. Immobilization

    Immobilizing the fractured area is the first and foremost thing, its noted that people trying to pull back the open fractured bone which is not recommended for an untrained hand and it can affect the positive outcome, (bone healing is a natural process, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions and maintaining those positions while the bone heals. Often, aligning the bone, called reduction, in good position and verify the improved alignment with an X-ray is all that is needed.) This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass cast or splint which holds the bones in position and immobilizes the joints above and below the fracture. Carefully Transport the causality to the hospital
    Some fractures can lead to serious complications including a condition known as compartment syndrome. If not treated, compartment syndrome can result in amputation of the affected limb. Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner


    First aid kit

    A well-stocked first aid kit can make responding to an accident or injury much faster. The contents of your kit should match your activity, location, season, first aid training and your own medical history. The following list includes some of the most common (as well as some unusual) items you may want in your kit.

    • analgesic (pain reliever)
    • antibiotic ointment
    • antacid
    • antihistamine
    • decongestant
    • fever reducer
    • hydrocortisone cream
    • antiseptic such as hydrogen peroxide
    • adhesive bandages
    • elastic bandages/safety pins
    • adhesive tape
    • gauze pads
    • tweezers
    • thermometer
    • alcohol wipes
    • disinfectant
    • instant cold packs
    • sunscreen
    • Moleskin
    • matches/fire starter
    • space blanket
    • latex gloves
    • prescription medications
    • eye drops or eye wash solutions
    • Emergency phone numbers
    • insect repellent
    • flashlight/batteries
    • splints
    • army knife
    • iodine water purification tablets
    • Emergency First Aid Reference Book /First aid software for java enabled phones are widely available

    Though one cant have all these in their Ride at least dressing materials + band aid + antibiotics will do maximum help and having a well-stocked kit doesn't help much if you don't know how to use it
    Check all the expiration date's on any supplies and refresh as needed.

    Source:
    Wikipedia, the free encyclopedia, About.com, Oxford medical Dictionary for nurses, textbook of Medical surgical nursing by Joyce m black,


    Hope the info provided above will help my fellow bikers especially tourers, Please notify any corrections or updates

    Cheers,
    Last edited by vineeth aredath; 05-06-2010 at 03:05 PM.
    Emergency Medicine and Management

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  2. #2
    Rusted Aryan's Avatar
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    Universal Thread Approved and made Sticky.

    Extremely detailed and important topic, this. Thanks for sharing it with all of us. It's good to see the kind of hard-work you've put in acquiring all this information from all over the internet. Thanks again!
    ...in search of that perfect world - My Travel Blog :)

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    Rusted vineeth aredath's Avatar
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    Quote Originally Posted by Aryan View Post
    Universal Thread Approved and made Sticky.

    Extremely detailed and important topic, this. Thanks for sharing it with all of us. It's good to see the kind of hard-work you've put in acquiring all this information from all over the internet. Thanks again!
    Thank you Brother, i was confused to post it where you really helped me. Am looking forward to add more details once again thank you
    Emergency Medicine and Management

    My Karizma R(Rocket)

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    Rusted Ayson's Avatar
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    Are you a medical student / doctor / nurse? Very detailed article. Lots of useful information. Especialy the abrations, wounds and fracture part, which i believe is the only first aid a biker should attempt unless he is otherwise qualified.

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    Rusted vineeth aredath's Avatar
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    Quote Originally Posted by Ayson View Post
    Are you a medical student / doctor / nurse? Very detailed article. Lots of useful information. Especialy the abrations, wounds and fracture part, which i believe is the only first aid a biker should attempt unless he is otherwise qualified.
    Thank you mate well am a Registered Nurse.

    The info provided above was collected from web as well as some books and dictionary for my project
    Last edited by vineeth aredath; 06-27-2012 at 03:04 AM.
    Emergency Medicine and Management

    My Karizma R(Rocket)

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    I know my imperfections, & there lies all my strength, because it's rare for human-being to know his own limitations.


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    Rusted drvmtm's Avatar
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    Default Bravo,well done,neat...

    i thank you for putting a detailed post.it should help so many if they read it properly.

    i would say.........in case of emergency,this will become very very handy,but always i say again always seek professional medical help.

    god bless and ride safe.
    [SIGPIC][/SIGPIC]
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    my thoughts,my area,my game....
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    Addicted mithun's Avatar
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    vineeth areth: Congrats ! Keep up the good work.

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    A very good thread. Yet to read the contents though.

    I am looking forward to something like 'the basic first aid practice' (how to treat an injured person at the crash site).
    All men dream, but not equally. Those that dream at night in the dusty recesses of their minds, wake in the day to find that it was vanity; but the dreamers of the day are dangerous men, for they may act upon their dreams with open eyes, to make it possible. - T. E. Lawrence

  9. #9
    It's me
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    Too much detail.I don't think it is possible to do more then a banded after a fall.
    for all those things it's good to have an expart.

    Ride safe.
    Last edited by It's me; 06-25-2010 at 04:09 AM.

  10. #10
    Rusted vineeth aredath's Avatar
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    Quote Originally Posted by It's me View Post
    Too much detail.I don't think it is possible to do more then a banded after a fall.
    for all those things it's good to have an expert.

    Ride safe.
    No mate its not, the details above may be too much for you. But that doesn't mean it cannot be implemented by others, i've listed 1% of emergency management which can be done by every educated personals, major parts which need professional assistance including ALS, BLS etc are not listed in the thread.

    Then about Band Aid, Don't think that it's a very easy procedure, there are number of things one must follow before, during and after the application of any band-aid or tourniquet.

    the total concept of the thread is to develop awareness and knowledge in my fellow bikers and i don't think it is that bad
    Last edited by vineeth aredath; 06-27-2012 at 03:06 AM.
    aatifkhan likes this.
    Emergency Medicine and Management

    My Karizma R(Rocket)

    [SIGPIC][/SIGPIC]

    YouTube FaceBook Twitter

    I know my imperfections, & there lies all my strength, because it's rare for human-being to know his own limitations.


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