Physical

Introduction

So I was watching my grandsons under 11s footy match a few weeks ago and couldn’t help overhearing a conversation between a couple of elderly gentlemen, also watching the game. Their conversation highlighted some of the effects of head injuries. It went something like this:

Gent one. ” Remember the good old days when we played footy? The coach never worried if we got concussions or head injuries, he would just send us back in.”

Pause

Gent two. “No.”

It made me smile. I could relate. As a youngster, and even into my twenties playing sport, there was a very casual approach to head injuries. ” You’ll be ok” was the general panacea for all knocks to the Uncle Ned. ” In ya go”! No thought at all for any long-term damage to anyone’s brain.

Memory loss, long-term brain damage, major trauma in the short term, or even – worst case scenario – death could be the end result of what appears to be a minor head injury.

Never considered.

Then I thought about how the attitude to head injury has changed. How there is a greater understanding now of the impact a head injury can have on a person.

Now in sports, players who suffer a head injury, no matter how minor, are removed from the game, assessed, rested, reassessed and either sent back on or sent to hospital for even more assessment and tests.

And rightly so.

Damage to the brain can result from even minor head trauma as this causes the brain to move inside the head and collide into the skull.

A bit about the BRAIN

The brain is a soft and delicate organ, approximately 75% water that can generate more electrical impulses in one day than all the telephones on the planet.

One hundred billion neurons processing information, 161,000 blood vessels to keep them all functioning, generating enough electricity to power a light bulb.

It is a miracle of natural computing power and an absolutely vital element for your quality of life.

That’s all very interesting, but as this blog is about head injuries and not the brain, the important bit for us is “soft and delicate”.

Although your soft and delicate brain is protected by your skull, which is very strong, a hard blow to the head can cause a brain injury. There may even be no visible signs of trauma to the scalp or face.

And, as the brain itself does not feel pain because it has no pain receptors you will have no warning – pain – if any damage has occurred.

Indications that something is seriously wrong may come later.

Head Injuries

Head injuries may be caused by a number of mechanisms including, falls, assaults, motor vehicle crashes, sporting injuries and, less commonly, penetrating injuries.

It is important to note that a head injury does not always result in a loss of consciousness or memory.

Even if there is a suspected head injury it should be treated with the utmost care.

A final assessment of the injury should still be done by a health care professional.

Be aware that if the head is injured, the neck and spine may be injured too.

There are two types of head injury

• Open – with bleeding wounds to the face or head
• Closed – no visible signs of injury to the face or head

Head Injuries – signs and symptoms

Blood is not a reliable indicator of the seriousness of a head injury. This is because minor cuts on the head often bleed heavily as the face and scalp have many blood vessels close to the surface of the skin.

Although this amount of bleeding may be alarming, many times the injury is not severe.

 Apart from wounds, other symptoms of serious head injuries can include:

• Altered consciousness – for example, loss of consciousness for even a short period then regains consciousness but is confused and or drowsy. Their condition improves for a while, deteriorating again later. They may even experience a small seizure or persistent headache.

• Skull deformities – signs of Fracture are indications there may be compressions or deformities. A serious head injury.

• Clear fluid from the ears or nose – a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.

• Black eyes and bruised skin behind the ears – this indicates that the blow was of sufficient force to rupture blood vessels around the eyes and ears.

• Vision changes – dilated (enlarged) pupils or different pupil sizes often indicate serious head injuries. The casualty may also complain of double or blurred vision.

• Nausea and vomiting – these are common side effects of serious head injuries and should always be considered important if they persist.

Remember, a victim may have a brain injury without any external signs of injury to the head or face. Serious problems may not be obvious for several hours, or even days, after the initial injury.

Management of head injuries

Follow the initial action plan DRSABCD with a focus on assessing and managing the airway and breathing.

For a conscious casualty

• Encourage the injured person to minimise any movement of their head or neck and control any significant blood loss from head wounds with direct pressure and a dressing.

• Reassure the casualty and monitor their condition.

• Call 000 if the casualty lost consciousness, suffered altered consciousness even for a short time, or any of the above symptoms indicating head injuries are present.

• If 000 called do not give the casualty any food or drink.

Unconscious Casualty

• Call 000.

• The casualty should not be moved unless they are in immediate danger. Be aware that any movement may cause greater complications to their head injury as well as their spine.

• If they are lying on their back, you will need to place them in the recovery position.

• If the person stops breathing or has no pulse, cardiopulmonary resuscitation (CPR) may be needed.

Once again follow the initial action plan DRSABCD with a focus on assessing and managing the airway and breathing, whilst caring for the neck until expert help arrives.

Remember, if they have a serious head injury, the neck may be injured too.

After any head injury, advise your casualty to seek professional medical advice as soon as possible.

Concussion

As far as head injuries go, concussion is the most common place. But what is concussion?

According to the university of Qld. –

“Concussion is the most common and mild form of traumatic brain injury. Within the skull, the brain floats in a protective suspension of cerebrospinal fluid. Concussion occurs when either a direct impact or whiplash effect – either through a blow to the skull or the body — causes the brain to move inside the head and collide into the skull. As a result, neurons are damaged and the brain may bruise at the site of impact. You don’t have to lose consciousness to have a concussion, and the force required for it to occur is small.”

Concussion is quite a common sporting injury, predominately contact sports, such as Australian rules football, rugby league and rugby. The AFL website has a great blog on concussion in AFL and some very useful tools.

Other activities such as horse riding, cycling and skiing, with a high risk of falls, are also common causes of concussion.

Traumatic Brain Injury (TBI)

A Traumatic Brain Injury ( TBI ) is an injury to the brain caused by an external force and is classified according to its severity: mild, moderate or severe.

Signs and symptoms of TBI

According to the same University of Qld. study, a staggering 89% of concussions will not be assessed by a medical professional, and 70 to 90% of concussions are TBIs! (Here is the link to the study: https://qbi.uq.edu.au/concussion/what-is-concussion )

The message here is clear – ANY head injury must be taken seriously and professional medical attention should be sought.

Recovery from concussion

Generally, most people recover fully within 2 weeks, however, children usually take longer to recover.

For some people, symptoms can continue for longer, especially if they have had a head injury before.

A small number of people have longer-term complications such as ‘persistent post-concussive syndrome’ when concussion symptoms continue for longer than 3 months after the event.

Of course, see your doctor if you are concerned about ongoing symptoms after a concussion.

I found lots of great stuff while researching this blog so watch this space for some more on head and brain trauma.

So, for this blog on head injuries, I’ll give the last word to my old friend Publilius

“Even when the wound is healed, the scar remains.” Gives me goosebumps….

Well, that’s that. Until next time….. stay safe

Adrian

Introduction

According to the Urban Dictionary Australia, the meaning of Ricer is:

“Ricer – any person who spends more money to make their car look like it goes fast than they spend on actually making it go fast”

And accordingly, they are subjected to scorn and derision as in – “Dude, that lame ass Honda ricer sucks.!”

As interesting as that is, it’s not what this Blog is about of course.

In this Blog, I want to talk about RICER for First Aid.

In other words, how to recognise the signs and symptoms of, and apply the correct first aid management for, dislocations and  sprains and strains i.e., RICER

RICER is our initial first aid action plan to manage joint injuries such as sprains and strains.

Created in 1978 by Dr Gabe Mirkin in his book ” The Sports Medicine Book” the acronym RICE – Rest, Ice, Compression and Elevation, was the standard initial first aid action plan for the management of soft tissue injuries.

In recent years, Referral was added on the end to make it RICER, recognising the need for the first aider to recommend the injured person seek medical advice for their injury. In 2019/20 there were 11,573 hospitalisations for dislocations and soft tissue injuries  (AIHW-INJCAT-225-A-tables) so if you are the first aid officer for your local sporting club on the weekend, it is more than likely you have had to manage soft tissue injuries.

Joints

I reckon the best place to start is with an understanding of the parts of the body likely to suffer dislocation, sprains and strains.

These are the joints.

Ligaments support parts of the joints while tendons join the muscles to the bone.

Smooth cartilage prevents friction as the bones move against one another.

In freely movable joints, the entire joint is enclosed inside a membrane filled with lubricating synovial fluid, which helps to provide extra cushioning against impact.

In General, the greater the range of movement, the higher the risk of injury. This is because the strength of the joint is reduced.

There are different types of joints allowing different movements.

• Ball and socket joint –  where the rounded head of one bone sits within the cup of another, for example, the hip joint or shoulder joint. Able to move in all directions
• Saddle joint – allows movement back and forth and from side to side, but does not allow rotation, such as the joint at the base of the thumb.
• Hinge joint –where the two bones open and close in one direction only such as the knee and elbow joints.
• Condyloid joint –movement without rotation, such as in the jaw or finger joints.
• Gliding joint –where the smooth surfaces slip over one another, allowing some movement, such as the wrist joints.

Common joint injuries include

• Dislocations – when two connected bones slip out of position in a joint.
• Fractures and breaks
• Sprains and strains – of the Ligaments and Tendons around the joint
• Overuse injuries such as tendonitis –  making the same movements repeatedly over time, the body’s joints and surrounding tendons and muscles become irritated and inflamed.
• Osteoporosis – bones that are weakened from a loss of bone density, due to a lack of calcium. As a result, the bones that make up the joint may break easily.

Signs and Symptoms of Dislocations

Management of Dislocations

For a dislocation, DO NOT try to replace or reduce the dislocation! Leave that for the Ambulance or Medical Professional. You might pinch nerves or further injure the arm if the joint is reset incorrectly.

Follow these steps

1. Follow DRSABCD (Always a good place to start!)
2. If the injury is to a limb: Check for circulation and, if absent, move the limb gently to try and restore it.
3. Call 000 for an ambulance.
4. Place and support the limb using soft padding and bandages.
5. Use icepacks, if possible, over the joint.
6. If the shoulder is dislocated, support the arm in a position of least discomfort use a sling if needed and apply an ice compress.
7. If the wrist is dislocated, support using a sling and apply an ice compress.

When using ice, make sure to apply it for ten minutes with 1 Hour rest in between or 20 minutes on/2hrs off

Sprains and Strains

The difference between a sprain and a strain is that a sprain injures the bands of tissue that connect two bones, while a strain involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone.

Sprain

A common injury seen in ligaments is a sprain.

Ligaments are bands of tough elastic tissue around your joints. They connect bone to bone, give your joints support, and limit their movement. You have ligaments around your knees, ankles, elbows, shoulders, and other joints.

A Sprain is when a ligament supporting a joint is overstretched or torn. Sprains commonly happen in the ankle, knee, or wrist.

Strain

Strains on the other hand occur when a tendon, or muscle, is overstretched or torn.

Tendons are tough, flexible, and inelastic bands of fibrous connective tissue that connect muscles to bones.

Common areas affected by strains are the leg, foot, calf, groin, hamstring and back.

Strains are often the result of repetitive movements and athletics.

Athletes who overtrain their bodies without adequate time for rest and muscle repair in between workout sessions are at increased risk

Signs and Symptoms for Strains and Sprains

Signs of strains include:

• Pain
• Swelling in the affected area
• Bruising in the affected area

Symptoms of strains include:

• Sudden pain in the affected area
• Loss of power in the affected limb
• The muscle in the affected limb is tender to the touch

Management of Strains and Sprains – RICER

To manage strains and sprains we can follow our primary action plan DRSABCD

and, of course, RICER

• REST: encourage the casualty to stop any activity and make them comfortable
• ICE: Apply an icepack, wrapped in cloth, to the injured area
• COMPRESSION: apply an elastic bandage, if available, over the injured area. Not too tight, you need to allow for circulation
• ELEVATE: elevate the injured area above their heart height if practical
• REFER: refer them to a medical professional to have the area looked at

HARM

When treating using RICER you should also do no HARM.

Meaning

• Heat: NO application of heat to the injury
• Alcohol: NO alcohol
• Running: NO activity that might affect the injury
• Massage: NO massaging the injury.

This method should be used within the first 48–72 hours (depending on severity) after the injury to speed up recovery.

Sprains, strains, and Dislocations are common incidents for First Aiders so remember

• DRSABCD
• DO NOT try to relocate a dislocated joint
• Support the joint and  apply an ice pack
• RICER for sprains and strains
• When applying ice pack ensure it is wrapped in material and applied 10 minutes on/1hr off, or 20mins on/2hrs off

And

• Do no H.A.R.M.

Well, that’s that. Until next time….. Stay safe

Adrian