Seven Nights with Her Ex by Louisa Heaton Page B

for any pain or deformities. But remember—even if the patient seems okay, their condition could change at any moment. You need to be alert. You may miss an injury because the patient is focusing on the pain from a bigger injury. And then what? Beau?’
    â€˜Then you swap hats,’ said Beau, happy to answer. ‘You take off the hat that states you’re treating a fracture and put on the hat that says you’re treating someone who’s unconscious—you put them into the recovery position. If it gets worse again, you put on the CPR hat.’
    Mack nodded. ‘So, now let’s focus on the fractures themselves. You look for the signs and symptoms of a fracture. Gray, can you tell us what they are?’
    â€˜Inability to bear weight on a limb, disabled body part, obvious deformity, pain, tenderness or swelling, angulation or bone protruding through the skin or stretching it. The patient might also mention hearing a crack.’
    â€˜Good. Did you all get that? You need to treat all possible skeletal injuries as if they are fractures. Even if you suspect a sprain or a dislocation, treat as a fracture until proved otherwise.’
    â€˜Okay, so how do we do that with no splints available?’ asked Rick.
    â€˜There’s always something you can use,’ Gray continued. ‘You’ve just got to think outside the box. Splinting is correct. It stabilises the break and helps prevent movement on the splintered ends—which, believe you me, can be excruciatingly painful.’
    He rubbed at his leg, as if remembering an old injury.
    â€˜If you don’t splint an injury, it can lead to further damage—not just to the bone, but to muscle, tissue and nerves, causing more bleeding and swelling, which you do not want.’
    â€˜So what do we do?’ asked Rick.
    â€˜You need to get the bones back into the correct anatomical position. Which means traction—which means causing yourself or your patient more pain. But you must do it—particularly if you’re hours or even days from medical help.’
    Claire grimaced. ‘I’m not sure I could do that.’
    â€˜You’d have to. It can be upsetting, but it’s best for the patient. Causing pain in the short-term will help in the long-term.’
    Claire nodded quickly, her face grim.
    Mack took over. ‘Let’s imagine a break on the lower left leg, near the ankle. This will be the most common injury you’ll come across. People hiking and trekking across strange open country, falling down between rocks, not putting their feet securely down—all that contributes to this kind of injury. Claire, why don’t you be my pretend patient?’
    She got into position before him.
    â€˜You need to grasp the proximal part of the limb—that means the part of the limb closest to the body—and hold it in the position it was found. Then, with your other hand, you need to apply steady and firm traction to the distal part of the limb—this is the furthest point—like so.’
    He demonstrated by gripping above and below Claire’s ‘fractured’ lower leg.
    â€˜You do this by applying a downwards pull, and even though your patient may cry out, or try to pull away, you must slowly and gently pull it back into position. This will help relieve the patient’s pain levels. Okay?’
    Everyone nodded, even if they were looking a bit uncertain about their ability to do it in a real-life situation.
    â€˜Before you apply a splint, there’s a rule of three again. You need to check CSM—their circulation , their sensation and their movement . Can you feel a pulse below the injury? In the case of this one, can you find a pulse in the foot?’ He demonstrated where to find it. ‘Is the skin a good colour? Or is it pale and waxen, indicating that the positioning may still be off? Does the patient feel everything below the injury? Can they wiggle their toes? If