IMMOBILISATIONS AND BANDAJES

IMMOBILISATIONS ACCORDING TO BODY AREA (from head to foot, from limb root to fingers)

1. Face
   
   
   • Ensure airflow and block the haemorrhage
   • Place in lateral recumbent position (see Chapter 1.5). If he has difficulty breathing, open his mouth and keep it open (see Chapter 1.2).
2. Jaw
   
   
   • Bandage as chinstrap.
     
     
     
     
     Picture 7-59: Jaw bandage.
   
   
   
3. Neck
   
   Use the NECK COLLAR FOR IMMOBILISATION (DRAWER 15, first aid kits A, B, and C). There are two sizes (first aid kits A and B). Choose the collar size.
   
   
   1. Patient lying face up or sitting down.
   
   
   • Pull the patient's head slowly and firmly, aligning it, if necessary, with the column axis(see picture 7-60).
   • Place with the notched area under the chin, attaching the Velcro strap.
     
     
     
     
     Picture 7-60.
   
   
   2. Patient lying face down.
      
      
      • Place the narrow end of the collar under the neck and jaw (see picture 7-61).
      • Adjust the collar notch to the jaw.
      • Close the collar.
      
      If the neck collar is not available, it may be improvised with a newspaper (refer to Chapter 2.4, TRANSPORT OF THE VICTIM).
      
      
      
      
      Picture 7-61.
   
   
4. Clavicle
   
   
   • Reduce it, asking the patient to bring the shoulders backwards (see picture 7-62).
   • Immobilise with an eight-shaped bandage (Anteriorly padding the whole bandage area with cotton wool) (see picture 7-63 to 7-67).
   
   
   
   
   
   
   Pictures 7-62 to 7-67: Fractured clavicle reduction
   and immobilisation.
   
   
5. Shoulder and scapula
   
   
   • Fill the space between the shoulder and the body with cotton wool.
   • Place the forearm in angle with the Arm and hold it with a sling, with the palm of the hand inwards (see pictures 7-57 and 7-58).
   • Bandage the body, without pressing.
     
     
     
     
     Picture 7-68: Shoulder immobilisation.
   
   
6. Arm
   
   Several methods may be used:
   
   
   1. Inflatable splint (whole arm).
   2. Two splints, one on the inner side, from elbow to armpit; the other on the outer side. Both must stick out below the elbow.
      
      
      • Hold with bandages, above and below the lesion.
      • Place the arm on a sling, with the palm of the hand facing inwards.
      • Bandage the body, filling the gaps between the arm and the body.
      
      
   3. Immobilise in the same way as the SHOULDER.
      
      
      
      
      Picture 7-69: Shoulder immobilisation.
   
   
7. Elbow
   
   Immobilise in the given position.
   
   
   1. IN A STRAIGHT LINE.There are two options:
      
      
      
      1. Inflatable splint (whole arm).
      2. Previous side splint from the armpit to the palm of the hand, and attach with bandage.
      
      
   2. AT AN ANGLE.There are two options:
      
      
      1. Inflatable splint (in angle).
      2. Place forearm in splint (see pictures 7-57 y 7-58)
         
         
         
         
         
         Picture 7-70 Inmovilización de codo en línea recta
   
   Attach to the body with a bandage all around it (see picture 7-68).
   
   In minor trauma, immobilise with a bandage (see picture 7-71).
   
   
   
   
   Picture 7-71: Elbow bandage.



8. Forearm
   
   Align if necessary (see FRACTURES). There are two treatment options:
   
   
   1. Inflatable splint (half arm).
   2. Place elbow in a 90 degree angle with the thumb upwards. Two splints, from the elbow to the root of the fingers, one on the Anterior side, so that the palm of the hand rests on it, and the other on the posterior side (refer to picture 7-72). Bandage. The splints may be improvised with magazines (see picture 7-73). Hold the forearm with a sling.
      
      
      
      
      Picture 7-72: Forearm immobilisation
      with splints.
      
      
      
      
      
      Picture 7-73: Forearm immobilisation with magazines.
   
   
9. Wrist
   
   There are two treatment options:
   
   
   1. Same as FOREARM.
   2. In the case of a sprain, it may be bandaged (see picture 7-74).
      
      
      
      
      Picture 7-74: Wrist bandage.
   
   
10. Hand
    
    
    • The patient holds a roll of bandage, to keep the fingers half bent.
    • Place splint from the elbow to the fingers, with the palm of the hand resting on it. Bandage.
    • Hold the forearm with a sling.
      
      
      
      
      Picture 7-75: Hand immobilisation.
    
    
11. Fingers of the hand
    
    There are two options:
    
    
    1. Malleable aluminium splint (DRAWER 15, first aid kits A, B, and C), from the mid forearm to the tip of the finger, attaching it with spiral tape straps or with a bandage. The finger must be half bent. (see picture 7-76).
       
       
       
       
       Picture 7-76: Finger immobilisation with aluminium splint
    
    
    
    2. Immobilisation of adjacent finger to a healthy one with tape straps (see picture 7-77) or with a bandage.
       
       Keep hand in a sling.
       
       
       
       
       Picture 7-77: Immobilisation of adjacent finger.
    
    
12. Ribs
    
    
    • It is not necessary to immobilise in case of lesion or fracture of a single rib. Place the subject in the most comfortable position, half sitting or lying on the affected site.
    • In case of multiple rib fractures, immobilise by placing padding over the fractured area and bandage around the chest.
      
      
      
      
      Picture 7-78: Immobilisation of a multiple rib fracture.
    
    
13. Spinal column
    
    The main idea is to KEEP THE SUBJECT IMMOBILISED WITHOUT ALLOWING HIM TO BEND HIS BACK.
    
    
    • Immobilise the neck, (refer to NECK section).
    • To handle the subject, ask at least two other people for help. One of them should hold the head in place.
    • Immobilise the feet with a triangular or normal bandage (see picture 7-79).
    • Move as a block, twisting to the side (see 7-80 and 7-81) or using the «spoon method» (see 7-82, 7-83 and 7-84), to place on a flat hard surface, where we can immobilise the patient (see picture 7-85).
      
      
      
      
      Picture 7-79: Foot immobilisation.
      
      
      It may be necessary to make some of the Neil-Robertson stretcher models rigid (refer to Chapter 7.8, STRETCHER TRANSPORT).
      
      
      
      
      
      Picture 7-80: Block mobilisation (twist to the side)
      
      
      
      
      
      
      
      
      Pictures 7-82, 7-83 and 7-84: Block mobilisation (spoon method).
      
      
      
      
      
      Picture 7-85: Immobilisation over a hard surface.
    
    
14. Pelvi
    
    Mobilise and immobilise as in SPINAL COLUMN lesions.



15. Hip and femur (thigh)
    
    There are two options:
    
    
    1. Place the subject on their back, trying to align the fractured leg with the healthy one by slightly pulling the foot (refer to Chapter 7.4, GENERAL TREATMENT ADVICE).
       
       
       • Pad armpit, hip, groin, knees and ankle.
       • Place eight bandages, six for the leg and two for the trunk.
       • Place two splints, one on the external side, from armpit to the heel; other on the internal side, from groin to heel. Attach with bandages (see picture)
         
         
         
         
         Picture 7-86: Hip and femur immobilisation.
       
       
    2. If splints are not available, wrap the injured lower lim Siguiente to the other one, filling the gaps between them with a blanket or pillows (see picture 7-89).
    
    
16. Knee
    
    Align the leg, if possible (refer to Chapter 7.4, GENERAL TREATMENT ADVICE).
    
    Two methods are possible:
    
    
    1. Inflatable splint (for the whole leg).
    2. Posterior splint, from the heel to the buttock, padding below the knee and ankle. Attach with bandages, without covering the knee (see picture).
       The Kramer splint may be used (DRAWER 15, first aid kits A and B).
       
       
       
       
       Picture 7-87: Knee immobilisation.
    
    
17. Leg
    
    Align the leg, pulling carefully (refer to Chapter 7.4, GENERAL TREATMENT ADVICE).
    
    Four methods are possible:
    
    
    1. Inflatable splint (for the whole leg).
    2. Posterior splint, from the heel to the buttock, keeping ankle at 90 degrees (refer to KNEE).
    3. Two splints, one on the external side of the leg and the other on the internal, from the heel to the thigh. Attach with bandages (see picture 7-88).
       
       
       
       
       Picture 7-88: Leg immobilisation with two splints.
    
    
    
    4. Splint on the external side: fill the gap between the two legs and attach with bandages around both of them (see picture 7-89).
       
       This method may be used in combination with the one for the other side in case of bilateral limb lesion.
       
       
       
       
       Picture 7-89: Leg immobilisation with splint.
    
    
18. Ankle and foot
    
    Remove shoes, untying or cutting them, without trying to take them off by pulling.
    
    Four methods are possible:
    
    
    1. Inflatable splint (for half LEG).
    2. Posterior splint, as in the LEG.
    3. Two splints, as in the LEG.
    4. In slight trauma or sprains, bandage (see picture).
       
       
       
       
       Picture 7-90: Ankle bandage.
    
    
19. Toes
    
    Immobilise attaching with tape to the adjacent toes. Do not stick the adhesive to the fracture.
    
    
    
    
    Picture 7-91: Toe immobilisation.