First aid for winter’s slips and trips
Thursday, January 04, 2018
Winter has truly arrived. Just ask anyone living on the East Coast who is dealing with the "bomb cyclone." Just today I was innocently walking — steadily I might add — and slipped on an icy patch of pavement, narrowly avoiding a nasty fall.
This near miss got me thinking. Falling in icy conditions is a regular occurrence, and injuries vary from simply a dent in the victim's pride to serious injuries like fractures and concussions.
Would you know what to do if either you, a friend, a relative or even a complete stranger slipped on some ice and injured themselves? If the answer is anything less than a resounding yes, then read on.
A contusion is a fancy way of saying a nasty bruise, and it's probably the most common type of injury resulting from a slip on the ice. But that doesn't mean it should be dismissed.
In fact, a bruise larger than the size of your fist should be checked out by a medical professional. This is especially true if the contusion is on the abdomen — around vital organs such as the liver or kidneys or the head or neck.
If someone close to you falls and lands heavy on a hard surface, provided they do no other damage, they will at least have a contusion. Bruising and mild swelling will start to appear within minutes, but they shouldn't have any considerable restriction in their movement.
If they do, consider going to the ER or urgent care for an X-ray. The initial pain should subside quickly — within a few minutes. Again, if it doesn't, seek medical advice.
To treat a contusion, apply ice and compression to the area as soon as possible. This will help to slow the bleeding and reduce the swelling and subsequent bruise. The ice should be applied for 15 minutes at a time and then repeated every 1-2 hours for the first 12 hours.
Compression can be applied using a compression bandage. Ensure it's not so tight that it is cutting off the blood flow altogether. Keep an eye on this as swelling can cause a once-snug bandage, to soon become too tight.
Avoid taking aspirin as this will thin the blood. Acetaminophen or ibuprofen-based painkillers are more appropriate, if necessary. Anyone routinely taking aspirin or other blood-thinning medications such as Warfarin or Heparin should get any contusions checked.
A contusion should start to clear within a week. Avoid hot baths and any strenuous exercise or massage in this time to prevent a condition known as myositis ossificans (bone growth within the injured muscle).
A twisted ankle usually occurs when the individual rolls over on the ankle so the sole of the foot faces in toward the other foot. It can roll the other way, although this is much less common.
Most frequently, this results in damage to the ligaments on the outside of the ankle. Often, the person can't fully weight bear and the ankle swells very big, very quickly. Bruising may then develop at the outside of the ankle and down to the foot.
The important thing to consider here is the risk of a fracture also being present. It is common with twisted ankles to either chip a little piece of bone off the outer ankle where the ligament pulls it off (avulsion fracture) or to fracture the lower part of the fibula (outer lower leg bone).
In cases where the person cannot bear weight at all, it is advisable to seek medical attention. A trip to the ER or urgent care may be necessary for an X-ray.
Either way, apply ice and compression to the ankle as soon as possible and sit the patient with the foot elevated to help reduce swelling. Continue to apply ice regularly, for 15 minutes at a time for the first 1-2 days.
The use of ibuprofen can be helpful to reduce pain, swelling and inflammation. Try to get the patient to stay off their feet for a few days, using a stick or crutches if necessary.
If the ankle does not appear to be improving at all within 3-5 days, seek medical attention.
Falling onto an outstretched hand
The natural reaction when we are falling either forward or to the side is to put your hand out to save yourself. While this is a good reaction to save your head and other vital organs, usually the hand, elbow or shoulder pays the price. Injuries such as fractures to the collarbone, arm or wrist are common in this situation.
If this happens, sit the person down and try to take the weight off their arm. This can be done with a sling or pillow.
Sometimes just bringing their arm into their body and holding it there can be the most simple, comfortable and effective way of supporting a fractured arm or collarbone. Once in a comfortable, supported position, try not to move the arm at all.
With this kind of fall, abrasions are common injuries to sustain, usually to the hand or arm where it scuffed along the sidewalk. While this type of wound doesn't usually cause much bleeding, it is a high infection risk and should be cleaned with water or saline and then covered with a sterile dressing.
The person will most likely need to go to the ER or urgent care for an X-ray, especially if the area looks at all misshapen. If a fracture is present in the wrist or arm, a cast will usually be applied, unless it is a severe fracture requiring surgical repair. Collar bone fractures are usually left to heal, using a collar and cuff to reduce the weight of the arm on the bone.
Head injuries are by far the most serious injury that could occur as a result of a fall on ice. An impact to the head could cause anything from a mild headache to concussion, neck injuries, skull fractures and even brain bleeds, which can be fatal.
If you see someone hit their head on the road or sidewalk when they fall, call for medical assistance immediately. Try not to move them unless it is really necessary. This will avoid doing any further damage if a spinal or skull fracture is present.
If they are conscious:
- Try to keep them warm and comfortable with the use of whatever you have on hand — blankets, items of clothing, etc.
- Do not give them anything to eat or drink
- Keep talking to them until help arrives
- Ask how they are feeling or what symptoms they have — e.g., nausea, headache, dizziness
- Find out about any medical conditions or medications they take
- Tell the paramedics what happened, along with any information the patient has told you and if you have noticed any symptoms such as slurred speech or jumbled sentences
If the person is not conscious:
- Check whether they are breathing
- If not, you or someone close by will need to start CPR as soon as possible and continue until help arrives
- If there is a defibrillator in the area, send someone to fetch this and follow the recorded instructions, which start as soon as you open the box
- If they are breathing but remain unconscious you need to decide between rolling them to put them into the recovery position which would prevent them choking on their tongue or vomit/blood, or keeping them still in case of neck injuries
- If you decide to move them, use the log-roll technique, where one person turns the head while 2-3 others roll the body onto the side at the same time
- Observe the patient from blood or a straw-colored fluid leaking from their ears or nose, which can suggest a skull fracture
- Keep checking that they are still breathing until help arrives
A conscious patient may well be cleared by paramedics or taken to the ER and later cleared and sent home by a doctor. They should still not be left unaccompanied for at least 24 hours after the incident.
Concussion can have delayed side effects such as memory loss, confusion, lack of coordination. For this reason, following an impact to the head, a patient should not drive or operate heavy machinery for at least 24 hours post-injury.
This is by no means an exhaustive list of injuries that can result from falls in wintry conditions, but it does cover the most common ailments and how to react in these situations. If you want more information, attending a first aid course is highly recommended to ensure you have the knowledge and skills to offer someone potentially life-saving care in their moment of need.
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