be sprained, sprains of the ankle, wrist, knee, and
finger are most common.
Symptoms of a sprain include pain or pressure at
the joint, pain upon movement, swelling and
tenderness, possible loss of movement, and
discoloration. Treat all sprains as fractures until ruled
out by X-rays.
Emergency care for a sprain includes application
of cold packs for the first 24 to 48 hours to reduce
swelling and to control internal hemorrhage; elevation
and rest of the affected area; application of a snug,
smooth, figure-eight bandage to control swelling and
to provide immobilization (basket weave adhesive
bandages can be used on the ankle); a follow-up
examination by a medical officer; and X-rays to rule
out the presence of a fracture.
NOTE: Check bandaged areas regularly for
swelling that might cause circulation
impairment and loosen bandages if necessary.
After the swelling stops (24 to 48 hours), moist heat
can be applied for short periods (15 to 30 minutes) to
promote healing and reduce swelling. Moist heat can be
warm, wet compresses, warm whirlpool baths, etc.
CAUTION: Heat should not be applied until
24 hours after the last cold pack.
Injuries caused by the forcible overstretching or
tearing of muscles or tendons are known as strains.
Strains may be caused by lifting excessively heavy
loads, sudden or violent movements, or any other
action that pulls the muscles beyond their normal
The chief symptoms of a strain are pain, lameness
or stiffness (sometimes involving knotting of the
muscles), moderate swelling at the place of injury,
discoloration due to the escape of blood from injured
blood vessels into the tissues, possible loss of power,
and a distinct gap felt at the site.
Keep the affected area elevated and at rest. Apply
cold packs for the first 24 to 48 hours to control
hemorrhage and swelling. After the swelling stops,
apply mild heat to increase circulation and aid in
healing. As in sprains, heat should not be applied until
24 hours after the last cold pack. Muscle relaxants,
adhesive straps, and complete immobilization of the
area may be indicated. Evacuate the victim to a
medical facility where X-rays can be taken to rule out
the presence of a fracture.
Contusions, commonly called bruises, are
responsible for the discoloration that almost always
accompanies injuries to bones, joints, and muscles.
Contusions are caused by blows that damage bones,
muscles, tendons, blood vessels, nerves, and other
body tissues. They do not necessarily break the skin.
The symptoms of a contusion or bruise are familiar to
everyone. There is immediate pain when the blow is
received. Swelling occurs because blood from the broken
vessels leaks into the soft tissue under the skin. At first
the injured place is reddened due to local skin irritation
from the blow. Later the characteristic black and blue
marks appear. Perhaps several days later, the skin turns
yellowish or greenish before normal coloration returns.
The bruised area is usually very tender.
As a rule, slight bruises do not require treatment.
However, if the victim has severe bruises, treat for
shock. Immobilize the injured part, keep it at rest, and
protect it from further injury. Sometimes the victim
will be more comfortable if the bruised area is
bandaged firmly with an elastic or gauze bandage. If
possible, elevate the injured part. A sling may be used
for a bruised arm or hand. Pillows or folded blankets
may be used to elevate a bruised leg.
LEARNING OBJECTIVE: Recall the
classification and evaluation process for
burns, and determine the appropriate
treatment for each type of burn.
Under the broad category of environmental
injuries, we will consider a number of emergency
problems. Exposure to extremes of temperature,
whether heat or cold, causes injury to skin, tissues,
blood vessels, vital organs, and, in some cases, the
whole body. In addition, contact with the suns rays,
electrical current, or certain chemicals causes injuries
similar in character to burns.
True burns are generated by exposure to extreme
heat that overwhelms the bodys defensive
mechanisms. Burns and scalds are essentially the same
injury: Burns are caused by dry heat, and scalds are
caused by moist heat. The seriousness of the injury can