A 57-year-old male fell 20 feet while setting up holiday lights on his roof. He impacted the ground feet first and has suffered open fractures to both tibias, with both bones protruding through the skin. Your assessment reveals him to be responsive to painful stimuli. His airway is open, his breathing is rapid, and his radial pulse is weak. The skin is cool and diaphoretic. Vital signs are pulse 132 beats/min, respirations 24 breaths/min, and blood pressure 106/90 mmHg. According to family, the patient has no pertinent medical history. Your partner is providing positive pressure ventilation. At this point in the patient's care, it is a priority for you to:

Here are some guidelines for handling musculoskeletal trauma and nontraumatic fractures: Splinting: Use ample padding when splinting possible fractures, dislocations, sprains, and strains. Splint limbs in the position of function or normal anatomic alignment. If circulation or neurological functions are compromised, gently reposition the limb. This may require administration of pain medications prior to any movement. Immobilization: To perform a reduction of a fracture, EMS providers start by checking for distal circulation, sensation, and motor function. Next, stabilize above and below the... Show more

Here are some guidelines for handling musculoskeletal trauma and nontraumatic fractures:
Splinting: Use ample padding when splinting possible fractures, dislocations, sprains, and strains. Splint limbs in the position of function or normal anatomic alignment. If circulation or neurological functions are compromised, gently reposition the limb. This may require administration of pain medications prior to any movement.
Immobilization: To perform a reduction of a fracture, EMS providers start by checking for distal circulation, sensation, and motor function. Next, stabilize above and below the injury, followed by applying gentle traction to the distal extremity in the direction it is facing.

First aid
For fractures, take these actions right away while waiting for medical help:
Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
Keep the injured area from moving.
Apply ice packs to limit swelling and help relieve pain.
Treat for shock. 

Closed injuries can be managed with the R.I.C.E.R. regime: Rest, Ice, Compression, Elevation, and Referral for appropriate medical treatment. 

Open injuries can be divided into: Abrasions, Lacerations, Incisions, Punctures, Avulsions, and Amputations. 

Treatment for open injuries includes: Protecting yourself from disease with medical gloves, Washing or irrigating the wound, Controlling bleeding with direct pressure, Applying pressure dressings or an air splint, and Avoiding contamination. 

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