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I'm always interested in additional opinions, especially from Nurse Red. Here's the deal on a sprained ankle, which will happen to you sometime in your career. If this happens it pays to have a professional take a peek and a film, as much as I don't like unnecessary x-rays. I had a sprain I convinced myself was a sprain which ended up as broken metatarsal bones. First and foremost you want to PREVENT SWELLING BEFORE IT STARTS. This mis hard because the ballooning will take place very swiftly. Have an ACE bandage handy in the cab and wrap IMMEDIATELY, starting at the BOTTOM, overlapping wraps and working UP, NOT the other way around. Cold is appropriate if available. Submerge the entire foot in iced water without removing the bandage is best. It will probably be impossible to do this on the road. Elevation of the leg at your rest period and that night will help also. Take an anti-inflammatory medication immediately, such as two aspirin or two Motrin (not ONE). Motrin used to be a prescription drug. When it went over the counter to prevent overdoses they halved the amount in one pill. Repeat four hours later. Try to stay of it, NO ALCOHOL. Don't take the bandage off to examine the injury. If you have cortisone ointment IMMEDIATELY available in your first aid kit, rub it on quickly before putting on the ACE bandage. The studies suggest that if initial swelling is PREVENTED by a quick application of a circumferential wrap, ice and an anti-inflammatory the heal time and time back togo back to normal goes down big-time.
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One of the things I didn't emphasis was to NEVER EVER use hot or warm compresses. They cause SWELLING, which is not what you want. Think Santa Claus and the North Pole. COLD! COLD! COLD! This is important because the first aid recommendations changed one hundred and eighty degrees from the 1950's. If you are over forty five and had a class in high school they probably told you HEAT. Forget about a warm bath at the end of the day right after the injury. You can start using heat after two or three days. Elevate the foot when you sleep that night with a couple of pillows.
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Hi all,
Thought I would help newyorktwo. I agree totally about the xrays as you, but as you say...you never no Working in an ER you see a lot of unnecessary xrays being done to make the lawyers happy, but when it comes to acute bone injury there is nothing better. One note. There is a type of fracture that does not show up for24-48 hours after the injury. While not usually a "true" fracture, it can lead to trouble if not splinted right. This type of fracture is called an avulsion fracture. Basically, your ankle is connected with ligaments (big rubber bands). What happens is that during the injury the ligament gets stretched beyond its limits and tears away from the bone. Initial xrays will be negative for this injury because it's not a bone. What happens is the end that was torn from the bone starts to calcify around 6-12 hours later and is able to show up on xray around 2 days later.
Ice is best applied as soon as possible and for the next 48 hours after initial injury. After that, the initial swelling from the injury subsides. At that point heat is actually better. It aids in blood flow to the injured area to help give the nutrients that the injured tissue needs to heal quickly. Ice will constrict the blood flow and thereby increase healing time after 48 hours.
Asprin is ok if you can take it. Be wary if you are on blood thinners or anti-platelet medications, asprin also thins the blood a little making it even harder to stop any bleeding.
Tylenol is a good substitute for people that either don't like asprin or cannot take it. You can also take it with one of the two listed drugs below. Make sure to stagger the doses, for example you take tylenol now, then in 2 hours take some motrin, then another 2 hours you can take the tylenol again. In the acute phase of pain, this is a great way to gain pain control by going to the root of the problem-swelling. If you need to keep up with the medications, as I just described, for longer than 2 days seek medical attention for there very well may be more damage than first thought.
Motrin comes in 200mg pills at the drug store. For an acute injury the usual dose is 400-600mg (2-3 pills)every4-6 hours. Never take more than 800mg at a time, it does no good and you start to get into dangerous amounts of the drug. Also, you may want to take this medication with food or milk. It can be tough on the stomach.
Aleve, naproxen, is another anti-inflamatory medication that you can buy at the store. It works like motrin but not quite as hard on the stomach. You take 1-2 pills every 6 hours.
Be safe,
Jim
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Very good info from both of you.
I too, feel that many xrays are done unnecessarily. Not just for attorney;s but to generate revenue for the facility.
And very often a fracture does not show initially, but will appear 24-48 hours later.
So, if xray is not availalbe, always treat the area as if it is fractured. Immobilize it for the first 48 hours while icing the area. When using ice or heat, do it in 1/2 hour intervals. Icing an area constantly may result in tissue damage so take 1/2 hour breaks. Elevation is key in the treatment and the best rule of thumb is to elevate the affected area above the level of the heart whenever possible. Using anti-inflammmatory medications is also very important. Those of you with allergies ,ulcers or other stomach problems must use these with caution. Whenever possible use the enteric coated forms. I prefer Aleve, myself.
Once a fracture has been ruled out, be sure to keep the affected extremity mobile. Very often, the area is painful and motion will be limited by the patient due to pain. It is very important to put the area through all forms of (non-weight bearing) movement several times a day. Once the discofort has started to subside, bear as much weight as tolerable and keep it moving. Many persons create more problems down the road by limiting movement so severely that the muscles and other connective tissues tighten and atrophy to the point where a pronounced limp is present for a long time. Keep the area as mobile as possible while healing.
Thanks for the input y'all.
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Keeping you safe, healthy, and on the road.
Nurse Red
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Very nice additional posts, which proves three heads are better than one. The part about immediate immobilization, to the extent possible, I forgot to mention. I must have been taking dumb pills. There is slight controversey regarding the TIME you should immobile BEFORE beginning and continueing mild regular exercise. Many years ago long term immobilization was recommended (if you are a trucker over 45 this is what you were taught bin first aid) but this was found not to be best. Probably immobilization until the initial danger of inflammation is over and you have some anti-inflammatory medication on board would be the best course. Some people recommend 24 hours. Others 72 hours. Certainly I would immobilize until someone with a proper medical background had a look. If you are like most of us who work, however, we really can't afforrd to lose a day's pay or time to head for an emergency room every time we get a bump or bruise. Incidentally, if you decide to go to an emergency room you may find the triage nurse has you UNWRAP the ACE bandage, discard it, and then you will sit for two hours waiting to be seen because you have a non-life threatening emergency. Meanwhile your ankle will swell like a balloon. Back to square one. The wrap should stay on, or at least only be removed to permit a quick examination. Ecercise of an injured member is now viewed as an essential part of the healing process. After two days you will probably find warm ginger soaks to be helpful. Buy the ginger plant in the store, slice it, and boil it in hot water to use for the soak.