be sprained, sprains of the ankle, wrist, knee, andfinger are most common.Symptoms of a sprain include pain or pressure atthe joint, pain upon movement, swelling andtenderness, possible loss of movement, anddiscoloration. Treat all sprains as fractures until ruledout by X-rays.Emergency care for a sprain includes applicationof cold packs for the first 24 to 48 hours to reduceswelling and to control internal hemorrhage; elevationand rest of the affected area; application of a snug,smooth, figure-eight bandage to control swelling andto provide immobilization (basket weave adhesivebandages can be used on the ankle); a follow-upexamination by a medical officer; and X-rays to ruleout the presence of a fracture.NOTE: Check bandaged areas regularly forswelling that might cause circulationimpairment and loosen bandages if necessary.After the swelling stops (24 to 48 hours), moist heatcan be applied for short periods (15 to 30 minutes) topromote healing and reduce swelling. Moist heat can bewarm, wet compresses, warm whirlpool baths, etc.CAUTION: Heat should not be applied until24 hours after the last cold pack.StrainsInjuries caused by the forcible overstretching ortearing of muscles or tendons are known as strains.Strains may be caused by lifting excessively heavyloads, sudden or violent movements, or any otheraction that pulls the muscles beyond their normallimits.The chief symptoms of a strain are pain, lamenessor stiffness (sometimes involving knotting of themuscles), moderate swelling at the place of injury,discoloration due to the escape of blood from injuredblood vessels into the tissues, possible loss of power,and a distinct gap felt at the site.Keep the affected area elevated and at rest. Applycold packs for the first 24 to 48 hours to controlhemorrhage and swelling. After the swelling stops,apply mild heat to increase circulation and aid inhealing. As in sprains, heat should not be applied until24 hours after the last cold pack. Muscle relaxants,adhesive straps, and complete immobilization of thearea may be indicated. Evacuate the victim to amedical facility where X-rays can be taken to rule outthe presence of a fracture.ContusionsContusions, commonly called bruises, areresponsible for the discoloration that almost alwaysaccompanies injuries to bones, joints, and muscles.Contusions are caused by blows that damage bones,muscles, tendons, blood vessels, nerves, and otherbody tissues. They do not necessarily break the skin.The symptoms of a contusion or bruise are familiar toeveryone. There is immediate pain when the blow isreceived. Swelling occurs because blood from the brokenvessels leaks into the soft tissue under the skin. At firstthe injured place is reddened due to local skin irritationfrom the blow. Later the characteristic “black and blue”marks appear. Perhaps several days later, the skin turnsyellowish 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 forshock. Immobilize the injured part, keep it at rest, andprotect it from further injury. Sometimes the victimwill be more comfortable if the bruised area isbandaged firmly with an elastic or gauze bandage. Ifpossible, elevate the injured part. A sling may be usedfor a bruised arm or hand. Pillows or folded blanketsmay be used to elevate a bruised leg.ENVIRONMENTAL INJURIESLEARNING OBJECTIVE: Recall theclassification and evaluation process forburns, and determine the appropriatetreatment for each type of burn.Under the broad category of environmentalinjuries, we will consider a number of emergencyproblems. Exposure to extremes of temperature,whether heat or cold, causes injury to skin, tissues,blood vessels, vital organs, and, in some cases, thewhole body. In addition, contact with the sun’s rays,electrical current, or certain chemicals causes injuriessimilar in character to burns.THERMAL BURNSTrue burns are generated by exposure to extremeheat that overwhelms the body’s defensivemechanisms. Burns and scalds are essentially the sameinjury: Burns are caused by dry heat, and scalds arecaused by moist heat. The seriousness of the injury can4-56
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