5 Bone, joint, and muscle injuries 骨头、关节、肌肉损伤

-Injuries to bones, muscles, or joints are common on board ship. 

-a fracture of the spine脊椎, pelvis 骨盆or a long bone (urgent evacuation)

－injuries of collar bone 锁骨受伤(minor problem)

-injuries of thumb,  wrist or knee (minor, but can cause severe,long-term problems)

-strain 拉伤

-sprain 扭伤

-ligament   韧带

-tendon 筋

-compound fracture 复合骨折( with a wound, always serious and require evacuation)

-nose fracture鼻子骨折 (caused by a direct blow, as in a fight)

-the lower jaw fracture 下巴骨折(or mandible下颌骨 fracture is usually by a direct blow , as in a fight or fall)

-the upper jaw and face fracture (with very high-impact injuries)

-neck (cervical spine颈椎) injuries

 (there are seven vertebrae脊椎 in the neck, number C1 to C7 from the top down. Most severe injuries occur between C4 and C7. Fractures most often arise when the neck is forcibly bent backwards, as in a fall on the head or from a heavy blow to the front of the head when the body is held immobile. A neck injury is often associated with a brain injury.)

-collar bone (clavicle锁骨) injury

-shoulder injury 肩膀受伤(shoulder dislocation脱臼, pain, often severe)

-injury to the upper arm 上臂受伤(humerus肱骨) 

(sudden, severe pain at the site of the injury; bruising and swelling soon after)

-elbow fracture or dislocation 手肘骨折或脱臼(pain, obvious deformity畸变, inability to move the elbow)

-wrist and forearm fracture手腕和前臂骨折 (a fall on the outstretched hand跌落时手张开)

-hand and finger injuries ( are common; metacarpal 掌骨fractures,thumb fractures, cuts on the hands and fingers)

-fracture of the pelvis骨盆, hip髋骨 and femur股骨

－knee injuries 膝盖受伤

-ankle injuries 脚踝受伤(due to a fall from height, are often severe)

-fractures of the foot and toes 脚和脚趾骨折

6 Abdominal and chest injuries 腹部和胸部受伤

Abdominal injuries

(1) blunt abdominal injuries腹部钝器伤 (occurs when a person is crushed by a heavy object or struck by a blunt object or falls from a height, usually more than 5 metres. In all these circumstances, major trauma to the chest, head, or limbs is often associated with abdominal trauma.)

Either type of abdominal injury can be life-threatening, as a result of :

*rupture破裂 and bleeding of solid organs in the abdomen, especially the liver, spleen脾, and kidneys;

*bleeding can be immediate, resulting in death within minutes or hours, or delayed, causing death afters several days or weeks;

*damage to major blood vessels;主动脉受损

*penetration of the bowel肠, leading infection of the peritoneum腹膜, and death within hours or days.

Evacuate any patient who shows evidence of blood loss失血, namely any one of the following signs:

-persistently rapid pulse 出现持续急促的脉搏

-low or falling blood pressure 低血压

-pallor (脸色等）苍白

Check and make a record of:

-pulse rate 脉搏率

-blood pressure 血压

-level of consciousness 意识程度

-movement of all four limbs 四肢活动情况

-pupil size 瞳孔的大小

(2) penetrating abdominal injuries 腹部穿透伤

-such as those caused by knife, gunshot wounds or other accidental event

-Evacuation should not be delayed

Chest injuries

The chest cavity contains several vital organs胸腔里有主要的器官, such as the heart, lung, and great vessels (including the aorta主动脉). Chest injuries should, therefore, always be regarded as serious. Internal bleeding 内部出血and respiratory failure 呼吸衰竭can cause death in minutes. Crush injuries of the chest are nearly always more extensive than they seem at first sight and they are always serious. 

QUESTION

-How did the injury occur?

-Are there any other injuries ?

-Are there likely to be other injuries?

Simple rib fracture 单纯肋骨骨折

 -The cause of a simple rib fracture is usually a blow to the chest wall, not a crush injury. 

-chest wall pain, especially with movement, coughing, laughing or breathing.

Penetrating chest wounds 胸部穿透性伤

-a penetrating chest wound can be life-threatening. 

-usually caused by a gunshot or a stab wound, or a fall onto a protruding object, such as metal scaffolding. 

-might penetrate the lung

abdominal pain

How intense is the pain: slight, mild, moderate, or severe?

When did the pain begin?

What makes the pain worse?

What makes the pain less intense?

What medication, if any, are you taking?

7 Wounds 伤口

-Wounds to lips, tongue, ears, nose and eyelids

-Puncture wounds of the soles 脚掌of the feet (caused by nails, class, sewing needles, or wood splinters尖碎片. 

-wound infection (signs and symptoms: redness, heat, swelling, and pain more than 48 hours after the injury.

8  Burns, chemical splashes,  smoke inhalation吸入烟雾, and electrocution触电受伤 

-clothing on fire

-heat burns and scalds烫伤

Question

-How deeply does the burn go into the skin?

-How extensive is the area of skin affected by the burn?

-first-degree burn一度烧伤 (redness which turn pale on pressure; mild swelling, tenderness压痛, pain)

-second degree二度烧伤， or partial-thickness, burn(pain, tenderness to pressure and to air blown on the skin, redness, burn area turns pale when pressed, blisters)

-third-degree三度烧伤, or full-thickness, burn (skin possibly charred black or dark brown, skin leathery or white, usually no pain (nerve ending destroyed))

-infection of a burn (Infection in a burn wound is dangerous: it can cause bloodstream infection and can worsen tissue damage in the wound.)

-Respiratory tract burns 呼吸道灼伤

A respiratory tract burn should be suspected in any patient with burns around the nose and mouth. The patient must be evacuated urgently. Burns caused by the inhalation of dry gas and smoke do not usually go beyond the throat. Inhalation of superheated steam can cause burns to the lungs as well as to the throat.

-electrical burns 电击伤（电烧伤）

*internal burns内烧伤: these occur when an electrical current pass through the tissues of the body and heat is generated by tissues that have high resistance to electricity: 

skin, fat and bone have high resistance to electricity and are usually severely burned; nerves and blood vessels have lower resistance and are less severely burned; entry and exit wounds are usually present, but can be small even with large internal burns;

*arc burns电弧烧伤: these occur when an electrical arc strikes the skin but does not enter the body.

*flame burns火焰烧伤: these occur when clothing is set on forby an arc or by lightning. 

-electrocution 触电

-electrical shocks from electronic weapons 电子武器的电击

-smoke inhalation 烟雾吸入 ( Smoke is toxic because it contains carbon monoxide and often hydrogen cyanide, as well as other combustion products that are toxic to the lungs. Severe lack of oxygen causes coma and cardiac arrest.