You are caring for a male patient who was ejected from the passenger side of a vehicle that was traveling at a high rate of speed when it left the roadway and overturned several times. During your primary assessment, you note the patient to have blood in the airway, rapid and shallow breathing, an absent radial pulse, and a weak and rapid carotid pulse. You also visualize that his left leg is severely injured, with gross visible angulations from suspected multiple fractures. Your partner is triaging the other occupants of the vehicle and you can hear the wail of the arriving fire department vehicles. Given this situation, what should you do first?

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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