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at the end of an hour, and allow it to remain loose, but in place, if no bleeding appears, By watching you can tighten the tourniquet at any time if

necessary.

c. Precautions to be observed in the application of a tourniquet :

(1) Never cover over or bandage a tourniquet.

(2) Mark the diagnosis tag plainly “tourniquet.”

(3) If the injured man is conscious, he should be instructed to tell every medical officer with whom he comes in contact that he has a tourniquet on. (4) Lastly, remember if a tourniquet is left on a wound for six hours the limb will surely die.

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10. General instructions.-a. The next injury you must know how to help is a broken bone. The lower extremities, thigh and leg, are more frequently wounded than the upper, arm and forearm; and so you will find more fractures of the thigh and leg bones than of the bones of the arm and forearm. You will usually know when one of these long bones is broken by the way the arm or leg is held, for the wounded man loses power of control over the limb, and it is no longer firm and straight. What you must do is much the same in all cases-straighten the limb gently, pulling upon the end of it firmly and quietly when this is necessary, and fix or retain it in position by such splints or other material as you may have. This is called "setting" the bone. If you have none of the splint material supplied, many common materials will do for immediate and temporary use a shingle or piece of board, a carbine boot, a scabbard, a tin gutter or rain spout cut and fitted to the limb, a bunch of twigs, etc. Whatever material you choose must be well padded upon the side next to the limb, and afterwards secured or bound firmly in place, care being taken never to place the bandage over the fracture, but always above and below. Some of these methods are shown in the accompanying figures. In connection with applying first aid to fractures, always remember that you should

(1) Gently straighten the limb.

(2) Never use force.

(3) Dress the wound, if there be one.

(4) Splint the limb. You will find a description of splints and their uses and illustrations showing the method of application in this chapter.

b. Fracture of the arm.-Apply two splints, one in front, the other behind, if the lower part of the bone is broken; or to the inner and outer sides if the fracture is in the middle or upper part; support by sling, as in plate 9.

c. Fracture of the forearm.-Place the forearm across the breast, thumb up, and apply a splint to the outer surface, extending to the wrist, and to the inner surface, extending to the tips of the fingers; support by sling, as in plate 10.

d. Fracture of the thigh.-Apply a long splint, reaching from the armpit to beyond the foot, on the outside and a short splint on the inside. (PI. 11.) The military rifle may be used as an outside splint, but its application needs care. A blanket rolled into two rolls forming a trough for the limb

is useful. The bayonet and scabbard may be used to advantage in splinting fractures of the thigh and leg, as illustrated in plates 12 and 13. The carbine boot may also be used.

e. Fracture of the leg.-Apply two splints, one on the outside, the other on the inside of the limb. When nothing better can be had, support may be given by roll of clothing and two sticks, as shown in plates 14 and 15.

Many surgeons think that the method of fixing the wounded leg to its fellow and of binding the arm to the body is the best plan for the field, as the quickest, and as serving the immediate purpose.

f. The object of all this is to prevent, as far as possible, any motion of the broken bone and so limit the injury to the neighboring muscles and to

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Plate 9.-Extemporized splint and sling support for fractured arm.

lessen the pain. Be very careful always to handle a broken limb gently. Do not turn or twist it more than is necessary to get it straight, but secure it quickly and firmly in one of the ways shown, and so make the patient comfortable for carriage to the dressing station or hospital. Time is not to be wasted in complicated dressings.

11. Other wounds.-There are, of course, many wounds of the head, face, and of the body, but for the most part you will have little to do with these except to protect the wound itself with the contents of the first-aid packet; or, if bleeding makes it necessary, use in addition several of the packet compresses to control it. As the surface blood vessels of the head and face

lie over the bones and close to them, it will generally not be difficult to stop the bleeding by this means or by pressure with the fingers, as already shown. Remember, as you were told, to make the pressure between the heart and the bleeding point. With wounds about the body, the chest, and abdomen you must not meddle, except to protect them, when possible without much handling, with the materials of the packet.

12. Cautions.-You have already been warned to be gentle in the treatment of the wounded, and the necessity for not touching the wound must be

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Plate 10.-Extemporized splint supporting sling and fixation
bandage for fractured forearm.

always in your mind; but there are some other general directions which you I will do well to remember:

a. Act quickly but quietly.

b. Make the patient sit down or lie down.

c. See an injury clearly before treating it.

d. Do not remove more clothing than is necessary to examine the injury, and keep the patient warm with covering if needed. Always rip or, if you can not rip, cut the clothing from the injured part, and pull nothing off.

e. Give alcoholic stimulants cautiously and slowly and only when necessary. Hot drinks will better suffice when obtainable.

f. Keep from the patient all persons not actually needed to help him.

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Plate 13.-Bayonet scabbard used as splint for fractured leg.

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