Your Actions

VIDEO 27 BANDAGING - SLINGS

 

 

VIDEO 28 BANDAGING - SLINGS

 

VIDEO 29 BANDAGING - HOW TO TIE A SLING

 

Your Aims

  1. Prevent movement at the site of the injury.
  2. Prevent blood loss and infection, in the case of an open fracture.
  3. Try to get medical help while continuing to support the injury.

Your actions:

The treatment for a fracture is a very simple process known as steady and support. How you do this will depend on where the fracture is. For an open fracture, you will also need to take care of the wound itself.

As always, assess D R A B, respond as needed, and treat any more urgent injuries.

Tell the casualty to keep still.

 

If the fracture is an open fracture (if not, go to Step 7):

Put on disposable gloves, if available.

Control any bleeding from the fracture site by loosely covering the wound with a clean dressing or cloth, and press on the sides of the wound – DO NOT press on any bone that is sticking out.

Place padding over and around the dressing. If a bone is sticking out, build up pads of clean cloth around the bone, until you can bandage over the pads without pressing the bone.

Secure the dressing and the padding with a bandage. Be careful not to bandage too tightly.
For all fractures:

Steady and support the affected area by bandaging it to an unaffected part of the body, making sure that the bandage is tied on the uninjured side (for how to apply slings see the end of this unit):

Action to steady and support

 

Arm

Place padding around the affected part.
Make sure the arm cannot move by using an arm or elevation sling.
Support with a broad-fold bandage around the arm and body avoiding (keeping away from) the affected part.

Collar bone

Put on an elevation sling, add padding between elbow and body, support with a broad-fold bandage around the arm and body.

Leg

Give support with your hands above and below the injury.
Carefully move good leg to bad, place padding between legs, and bandage above and below the fracture site, tying the bandage on the uninjured site.

You might need to use a well-padded splint (eg. a wooden pole or strong stick wrapped in a towel) if the casualty is to be transported a long distance.

Knee

DO NOT try to straighten the leg.
Help the casualty to lie down, on a blanket if possible.
Place soft padding (like a pillow, blanket or coat) under the injured knee to support it in the most comfortable position.

Keep the casualty in this position until you get medical help.

Jaw

Place a soft pad under the jaw and allow the casualty to support it himself or herself. Sit the casualty with his or her head tilted forwards.

Ribs

Sit the casualty down in the most comfortable position for him or her and ask the casualty to support the arm on the injured side.
Support the arm with an elevation sling.

Neck and spine

Support the head and neck in the position you find the casualty in. See Unit 18 for more on head and spinal injuries.

Treat for shock if necessary (see Unit 9).

Remember to keep checking the casualty’s vital signs and writing down (or remembering)
what you found and what you did, so that you can report this to any health worker who takes over from you.

Keep checking circulation after the bandage every 10 minutes.

Pelvis

Soft support may be placed under the knees.
Put the casualty in the most comfortable position for him or her.
Place padding between legs, and put a broadfold bandage around the legs at the ankles
and knee.

DO NOT:

  1. Do not move the casualty until you have steadied and supported the injured part, unless he or she is in danger
  2. Do not allow the casualty to eat, drink or smoke.
  3. Do not try to put a dislocated bone back into the joint – you may cause further damage.

Many people are worried about moving an unconscious casualty with fractures into the recovery position. However, a person is more likely to die or suffer lasting disability from an obstructed airway than from a fracture, even a spinal injury. The golden rule is, if you suspect a fracture in the unconscious casualty, move them very carefully providing as much support as possible to the place where the injury is (see Unit 10, ) for more on moving a casualty with a suspected spinal injury into the recovery position).

Words you need to know

Disability
cannot do something eg. move an arm or leg or think properly

Pads, bandages and slings

You will use different pads and bandages depending on what kind of fracture or dislocation it is, and where it is on the body.

Pads

A pad could be a thin one made from folded gauze or some other material that will absorb blood from an open wound, but NOT leave any bits in the wound. For an open wound, you can also use clean cotton cloths which have been boiled before use. You will have to burn these after you have used them. Remember that anything used on an open wound should be sterile.
Pads for a closed wound could be made from any available material, such as a jacket or other piece of clothing, a towel or blanket, a pillow, and so on. How thick the pad should be will depend on what you are using it for.

Bandages and slings

Bandages can be used to hold a pad or dressing or cold compress or splint in the right place, or for support, for example as a sling.

Bandages to hold something in place

A bandage to hold a pad or dressing or cold compress or splint in place can be a stretchy roller bandage, a strip of material, or some old stockings or a long sock, or you could fold a triangular bandage to make it long and thin. It does not really matter what you use as a bandage as long as it is clean – it is better not to use a bandage at all than to use a wet or dirty bandage for an open wound.

You can buy different kinds of bandages to do different things:
Adhesive plaster, clear plaster and stretch plaster are used for tying on gauze dressings.

Elastic net bandage is used on the head and face.

Crepe (elastic conforming) bandage is used for bandaging joints. A triangular bandage can be used to tie on dressings or pads, or to stop movement, or as a sling.

Splints

A splint is something strong and straight that you can tie onto a limb to hold it still.
You can use many different things as a splint, for example:

  1. a straight stick
  2. a walking stick
  3. an umbrella
  4. a broom handle
  5. a bicycle pump
  6. a plank from a wooden box
  7. thickly rolled up newspapers.

 

Folding a triangular bandage

You can fold a triangular bandage so that it is wide (this is called a broad-fold bandage) or thin (this is called a narrow-fold bandage).

Folding a broad-fold bandage:

  1. Open out a triangular bandage and lay it flat on a clean surface:
  2. Fold the top point of the bandage to the middle of the bottom of the bandage:
  3. Fold the bandage down again, so that the top of the bandage meets the bottom, and you have a wide strip:

 

Folding a narrow-fold bandage:

Fold a broad-fold bandage once more, so that the bandage is even thinner:

Bandaging techniques (how to wrap a bandage)

Wrap the bandage around the part of the body where the injury and dressing or pad is, so that it keeps the dressing or pad over the wound (if there is an embedded object still in the wound, see page 60). You will need to wrap the bandage differently for different parts of the body.


 


Bandaging a limb (i.e. the straight part of an arm or a leg)

You would use this on, for example, a forearm.

1. The first two rolls of the bandage should bE in the same place. This is to hold it in place.

2. The next few rolls should wrap around with two-thirds of the bandage overlapping.

3. The last two rolls should be in the same place to hold it in place.

4.Secure the bandage with a pin or piece of tape.

Always ask the patient if the bandage is too tight. If it feels too tight, it might be stopping blood from flowing into the area. If the bandage is around an arm or a leg, you can check if blood is flowing well by looking at his or her finger or toenails. If the nails look a bit blue, the bandage is too tight. You will need to remove it and reapply it more loosely.

Bandaging an ankle

The first two rolls of the bandage should be in the same place. This is to hold it in place. You should do this on the ankle.

Take the bandage across the foot at an angle and around the bottom of the toes, then back across the top of the foot to the ankle, forming a figure of eight.

Take the bandage across the foot at an angle and around the bottom of the toes, then back across the top of the foot to the ankle, forming a figure of eight.

Secure the bandage with a pin or piece of tape.

Always ask the patient if the bandage is too tight.

If it feels too tight, it might be stopping blood from flowing into the area. If the bandage is around an arm or a leg, you can check if blood is flowing well by looking at his or her finger or toenails. If the nails look a bit blue, the bandage is too tight. You will need to remove it and reapply it more loosely.

Bandaging elbows and knees

You would use this for example on a bent elbow or knee.

The first two rolls of the bandage should be in the same place. This is to hold it in place. You should do this over the flexed (bent) joint.

Roll the bandage below and then above the joint in a figure of eight.

Continue in this way until you have covered the dressing.

Secure the bandage with a pin or piece of tape.

Always ask the patient if the bandage is too tight. If it feels too tight, it might be stopping blood from flowing into the area. If the bandage is around an arm or a leg, you can check if blood is flowing well by looking at his or her finger or toenails. If the nails look a bit blue, the bandage is too tight. You will need to remove it and reapply it more loosely.

Bandaging a finger

The most important thing to remember about any injury to a finger is to take off any rings as soon as possible. This is because the finger may swell, and a ring could stop the blood from flowing properly. Taking a ring off also stops any dirt from the ring getting into an open wound. You should put the ring onto another of the casualty’s fingers, preferably on the other hand, to keep it safe.

There is a special kind of bandage that can be used to bandage a finger. It is made of gauze, and is a tube. The tube of bandage is fitted over the finger using a special tool (called an applicator). This is the best way to bandage a finger. If you do not have this, use an adhesive dressing, or a small, clean dressing stuck on with a plaster. If you have no other choice, you can bandage the finger with a very thin bandage using the same method as for a limb, starting at the end of the finger closest to the hand.
BE CAREFUL NOT TO MAKE THE DRESSING OR BANDAGE TOO TIGHT.

Slings

It is often very important to support or elevate (lift) an injured arm. This is done using a sling. A sling can be made from a triangular bandage, or you can make a sling from other things that are available, such as a jacket, shirt, or belt.

 

 

 

 

Arm sling

This is used to support an injured arm.

Hold the injured arm, or get the casualty to hold his or her injured arm, so that it is supported. The hand should be slightly lifted.

Place the triangular bandage under the injured arm, so that one end of the longer side is at the neck on the other side of the body from the injured arm, and the top end of the bandage is near the elbow of the injured arm.

Lift the third end of the bandage up to the other side of the casualty’s neck (i.e. the side of the neck where the injured arm is).

Tie the bandage using a reef-knot (see below), so that the arm is well-supported. Tuck the ends of the bandage under the knot to pad it. Fold the end of the bandage next to the casualty’s elbow to the front, and fasten it to the sling with a safety-pin after tucking in any loose material around theelbow. If you do not have a safety pin, twist the end of the bandage until the material is quite tight around the elbow, and then tuck it into the sling behind the arm.

 

 

 

 

 

 

 

 

Elevation sling

Hold the injured arm, or get the casualty to hold his or her injured arm, so that the fingers of the injured arm rest on the casualty’s shoulder and the forearm is lifted.

Place the triangular bandage OVER the injured arm, so that one end of the longer side is at the neck on the other side of the body from the injured arm, and the top end of the bandage is near the elbow of the injured arm.

Ask the casualty to let go of his arm. Tuck the loose part of the bandage under his or her hand, forearm and elbow.

Lift the loose end of the bandage around the casualty’s back to meet the other end at his or her shoulder. Tie the ends in a reef-knot in the hollow just in front of the shoulder. Tuck the ends under the knot to pad it.

Fold the end of the bandage next to the casualty’s elbow, and fasten it to the sling with a safety-pin. If you do not have a safety-pin, twist the end of the bandage closest to the casualty’s elbow until the material fits tightly around the elbow, and tuck the end in just above the elbow.

Improvised slings

If you need to support a casualty’s injured arm but do not have a triangular bandage, you can
improvise (make) a sling by using strong cloth or part of clothing.

 

Jacket corner

Use the casualty’s jacket or someone else’s jacket.The casualty needs to put it on. Undo the jacket. Fold the lower part of the jacket on the injured side up over his or her arm. Join the corner of the bottom part of the jacket to the jacket breast with a large safety pin. Tuck and pin any other jacket material closely around the elbow.

Button-up jacket

Undo one button of a jacket or coat (or waistcoat). Place the hand of the injured arm inside the jacket or coat at the hole which is made by the button which is undone (not closed). Tell the casualty to rest his or her wrist on the button just below the hole.

 

Long-sleeved shirt

Put the injured arm across the casualty’s chest. Pin the cuff of the sleeve (the end part of the sleeve) to the opposite breast of the shirt. To improvise an elevation sling, pin the sleeve at the casualty’s opposite shoulder, to keep her arm raised.

Belt or thin garment

Use a belt, a tie, a scarf, a pair of braces (things to hold trousers up with) or stockings to make a “collar-and cuff” support. Tie the belt or garment to make a loop. Put it over the casualty’s head, then twist it once to form a smaller loop at the front. Put the casualty’s hand into the loop.

Fastening a bandage

You can fasten the bandage by pinning it in place with a safety-pin, or by tying it, using a reef knot:

  1. Pass one end over and under the other end.
  2. Hold up the two ends of the bandage.
  3. Pass the other end over and under the first end.
  4. Pull the two ends to tighten the knot, and tuck them under the bandage.

It is VERY IMPORTANT that you do not tie the bandage too tightly, because this will stop the blood from flowing to the part of the body after the bandage. You can tell that the bandage is too tight if the part of the body after the bandage changes colour, or the casualty says it feels strange.