SPRAINS, STRAIN, FRACTURE, AND DISLOCATIONSTraumatic injuries cause damage to tissues. The incidental rupturing of ancillary and primary blood vessels supplying these tissues internally bleed at the site of trauma. The blood supplies normally bring nutrients, oxygen, and remove waste materials and metabolic by-products from tissues. With damage, the delicate piping systems of blood vessels rupture at smaller capillary, aterioli, venule, and even in larger blood vessels yielding profuse bleeding. This bleeding is what causes the swelling at the site of the injury. The injury is enclosed within the skin creating increased fluid/blood pressure inside the body. When the traumatic site fills and expands with bleeding, it tamponades the traumatic site. This occurs by increasing he site’s inner body pressure at or above the person’s normal blood pressure. This pressure is what finally stops the bleeding naturally.
The heart pumps blood out to the tissues in the arteries. About 99% of all blood pumped out of the heart is returned by the venous return system. Being an enclosed plumbing system, the arterial pressure via the capillary bed drives the blood back to the heart by the pressure in the enclosed venous system. The generally low negative right-sided heart, allows natural decreased pressures to direct blood from the venous systems back into the heart. This allows the blood to be re-circulated and be pumped again and again by the heart.
LYMPHATICS: In addition to the heart, artery, and venous systems, there is a passive lymphatic pip system form the tissue sites back to the heart. This lymphatic system acts as a cleaning sewage system allowing extra fluid not removed by the veins to drain from the capillary beds and trauma site, via the venous system, and finally to the heart. Lymphatic vessels have one-way valves and pumps. These passive pumps called lymph nodes are located behind joints or at sites of pressure from physical movement. They are much like a hose with a bulb and a valve attached to another hose. When the bulb is squeezed, the system pumps fluid in one direction only-towards the heart. When a joint is flexed and extended, the bulb is naturally compressed and it pumps moving fluids from the distal extremity towards the heart. This naturally removes blood, fluid, and potential infections fluid from the site or injury. This reduces the on-site pressure after bleeding is stopped to allow new circulation and healing.
THE DEFINITION OF ELEVATION: The definition of elevation of a traumatic point is applied by measuring from the floor directly vertical to the heart. Then measure from the floor directly vertical to the site of injury. This means that the point of injury should be elevated approximately 12-16 inches higher that the position of the heart at any time and from any position, i.e. sitting in the chair with your foot on an ottoman if the foot is the site of injury IS NOT ELEVATION. The distance to the floor from the foot must be less than the heart to the floor. However, laying flat on a couch with your foot up high on the back of the couch at the head level IS elevation of a traumatic site decreasing pain and removing the fluids.
Therapy:
ELEVATION: All traumatic injuries should be elevated 12-16 inches immediately from the time of injury to decrease bleeding and capillary pressure. This is most critical the first 3-5 days after the injury. If you do not have elevation, this is the cause of the thumping and pounding of your heart in the new injury site causing swelling.
ICE decreases circulation at an injury site. Ice should be placed gently against the wound of 5-20 minutes per hour as tolerated for at least the first 5-7 days and depending on the injury 10-12 after the injury. Ice in an ice bag or blue ice pack should have at least 1-2 layer of a thick towel. You don’t want to burn or freeze health superficial tissues and cause other substantial secondary damage.
HEAT is good only after 7-12 days. This time allows the ripped blood vessels to heal by increasing the circulation. Early heat to a new acute injury will definitively increase bleeding, swelling, and pain and will lengthen the recovery time. Heat should only be on low, not hot, with gentle warming. I.e. a heating pad on low heat with at least 1-2 layer of a thick terrycloth towel.
MOVEMENT of joints closer toward the heart occasionally with elevation, pumps traumatic fluids away from the injury. After several days, movement and pumping of lymphatics reverses swelling at the site and promotes healing and circulation.
ACE: An external ace bandage gently and lightly applied may compress a new injury, stopping or slowing the bleeding and controlling the injury. Light compression with an ace bandage stops the bleeding by compressing the wound and should NEVER be place on tight.
IMMOBILIZATION: A fracture, tendinous strain/pull-partial or complete rip must be initially immobilized with a splint. Splints decrease movement so further bleeding or damage doesn’t occur. The most distal site beyond the injury, i.e. the finger and toes, should always be exposed (splinting permitted) to check to see that there is good distal capillary refill.
DISTAL CAPILLARY REFILL: Squeezing a finger or a toe between the thumb and index finger for 2-3 seconds and getting a whitish blanching under the nail tests for distal capillary refill.
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