injuries and poisoning
Overview of Dislocations
Treatment of Dislocations
Treatment of any serious complications Pain relief Protection, rest, ice, compression, and elevation (PRICE) Realignment (reduction) of parts that are out of place Immobilization, usually with a splint or cast Sometimes surgery Serious complications of dislocations require immediate treatment. Without treatment, complications may get worse, becoming more painful and making loss of function more likely. Also, some complications, such as Compartment Syndrome , require emergency care. Without treatment, these complications can cause serious problems or even death. If people think that they have a fracture or another severe injury, they should go to an emergency department. If they cannot walk or have several injuries, they should go by ambulance. Until they can get medical help, they should do the following: Prevent the injured limb from moving (immobilize it) and support it with a makeshift splint, sling, or a pillow Elevate the limb, above the level of the heart if possible, to limit swelling Apply ice (wrapped in a towel or cloth) to control pain and swelling In the emergency department, doctors check for injuries that require immediate treatment. If arteries are damaged, doctors surgically repair them unless the arteries are small and blood flow is not affected. The goal is to make sure the injured part is not deprived of blood. Compartment Syndrome , if present, is treated. Severed nerves are also repaired surgically, but this surgery can be delayed until several days after the injury if necessary. If nerves are bruised or damaged, they may heal on their own. If the skin is torn, the wound is covered with a sterile dressing, and the injured person is given a Diphtheria-Tetanus-Pertussis Vaccine and antibiotics to prevent infection. Also, the wound is cleaned, usually after a local anesthetic is used to numb the area. Most moderate and severe dislocations, particularly very unstable ones, are immobilized immediately with a splint. This measure helps decrease pain and prevent further injury to soft tissues by unstable dislocations. Pain is treated, typically with Opioid Pain Relievers and/or nonsteroidal ani-inflammatory drugs (NSAIDs). People with a dislocation may benefit from PRICE. PRICE refers to the combination of protection, rest, ice, compression (pressure), and elevation. Protectionhelps prevent further injury that could worsen the original one. Typically, a splint or other device is applied. Restprevents further injury and may speed healing. People should limit their activity and avoid putting weight on and/or using the injured body part. For example, they may need to use crutches or to not participate in contact sports. Iceandcompressionminimize swelling and pain. Ice is enclosed in a plastic bag, towel, or cloth and applied for 15 to 20 minutes at a time, as often as possible during the first 24 to 48 hours. Usually, compression is applied to the injury with an elastic bandage or a splint. Elevatingthe injured limb helps drain fluid away from the injury and thus reduce swelling. The injured limb is elevated above heart level for the first 2 days. After 48 hours, people can periodically apply heat (for example, with a heating pad) for 15 to 20 minutes at a time. Heat may relieve pain. However, whether heat or ice is best is unclear, and what works best may vary from one person to another. Dislocations are moved back into their normal position (realigned, or reduced). Reduction is usually done without surgery (called closed reduction), by manipulation—for example, by pulling and/or turning a limb. After reduction is done, doctors usually take x-rays to determine whether the injured parts are in their normal position. Some dislocations must be realigned surgically (called Surgery ). Usually, because reduction is painful, people are given pain relievers, sedatives, and/or an Anesthesia before the procedure. The types of drugs that are used depend on how severe the injury is and how reduction is to be done: Closed reduction of minor dislocations (such as those of the fingers or toes): A local anesthetic, such aslidocaine, injected near the injured part, may be all that is needed. Closed reduction of major dislocations (such as those of the arm, shoulder, or lower leg): People may be given a sedative and pain relievers by vein. The sedative makes them drowsy but not unconscious. They may also be given a local anesthetic by injection. For example, if people have a shoulder dislocation,lidocainemay be injected into the shoulder joint. Open reduction: People are given a general anesthetic by injection or through a face mask, making them unconscious. This procedure is done in an operating room. After being realigned, the injury must be kept from moving (be immobilized). Casts, splints, or slings are usually used after closed reduction of a dislocation. Some dislocated joints require only a sling or splint, which is applied after the joint is returned to its normal position. Immobilization reduces pain and helps with healing by preventing further injury to surrounding tissues. Immobilization is helpful for most moderate or severe dislocations. Joints on both sides of the injury are immobilized. If immobilization lasts too long (for example, for more than a few weeks in young adults), the joint may become stiff, sometimes permanently, and muscles may shorten (causing contractures) or shrink (waste away, or atrophy). Blood clots may develop. Such problems can develop quickly, and contractures can become permanent, usually in older people. Consequently, doctors encourage movement as soon as possible. Castsare usually used for injuries that must be kept immobilized for weeks. To apply a cast, doctors wrap the injured part in cloth, then apply a layer of soft cottony material to protect the skin from pressure and rubbing. Over this padding, doctors wrap dampened plaster-filled cotton bandages or fiberglass strips, which harden when they dry. Plaster molds well and is less likely to rub against the body. Fiberglass casts are stronger, lighter, and longer-lasting. After a week or so, the swelling goes down. Then, the plaster cast can sometimes be replaced with a fiberglass cast to fit the limb more snugly. People who require a cast are given special instructions for its care. If a cast is not correctly cared for, problems can develop. For example, if the cast becomes wet, the protective padding under the cast may become wet, and drying it completely may be impossible. As a result, the skin can soften and break down, and sores may form. Also, if a plaster cast gets wet, it can fall apart and thus no longer protect and immobilize the injured area. People are instructed to keep the cast elevated as much as possible at or above heart level, especially for the first 24 to 48 hours. They should also regularly flex and extend their fingers or wiggle their toes. These strategies help blood drain from the injured limb and thus prevent swelling. Rarely, casts cause pain, pressure, or numbness that remains constant or worsens over time. Such pain must be reported to a doctor immediately. These symptoms may be due to a developing Pressure Sores or When bathing, enclose the cast in a plastic bag and carefully seal the top with rubber bands or tape or use a waterproof cover designed to cover a cast. Such covers are commercially available, convenient to use, and more reliable. If a cast becomes wet, the padding under the cast may retain moisture. A hair dryer can remove some dampness. Otherwise, the cast must be changed to prevent skin from breaking down. Never put an object inside the cast (for example, to scratch an itch). Check the skin around the cast every day, and report any red or sore areas to a doctor. Check the edges of the cast every day, and if they feel rough, place soft adhesive tape, tissues, cloth, or another soft material to pad them and keep them from injuring the skin. When resting, position the cast carefully, possibly using a small pillow or pad, to prevent the cast's edge from pinching or digging into the skin. Elevate the cast regularly, as directed by the doctor, to control swelling. Contact a doctor immediately if the cast causes persistent pain or feels excessively tight. These symptoms may result from pressure sores or swelling, which may require immediate removal of the cast. Contact a doctor if the cast gives off an odor or if a fever develops. These symptoms may indicate an infection. Contact a doctor if the cast causes worsening pain or new numbness or weakness. These symptoms may indicate compartment syndrome. Asplintcan be used to immobilize some stable dislocations, particularly if they need to be kept immobile for only a few days or less. During initial treatment, splints are also used to immediately immobilize moderate and severe dislocations, particularly very unstable ones, until the person can be evaluated thoroughly. Splints allow people to apply ice and to move more than a cast does. A splint is a long, narrow slab of plaster, fiberglass, or aluminum applied with elastic wrap or tape. Because the slab does not completely encircle the limb, there is room for some expansion due to swelling. Thus, a splint does not increase the risk of developing compartment syndrome. Some injuries that eventually require a cast are first immobilized with a splint until most of the swelling resolves. Aslingby itself can provide some support. Slings can be useful when complete immobilization has undesirable effects. For example, if a shoulder is completely immobilized, the tissues around the joint may become stiff, sometimes within days, preventing the shoulder from moving (called frozen shoulder). Slings limit movement of the shoulder and elbow but allow movement of the hand. Aswathe,which is a piece of cloth or a strap, may be used with a sling to prevent the arm from swinging outward, especially at night. The swathe is wrapped around the back and over the injured part. Occasionally, dislocations cannot be reduced using closed reduction, and surgery is required to realign the joint in its normal position. Once the joint has be realigned, additional surgery is often not necessary. Sometimes surgery is required to treat fractures that accompany dislocations, to stabilize the joint, or to remove debris from the joint. 