Treatments for Injury
Treatments for Injury
The list of treatments mentioned in various sources
for Injury
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
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Hospital statistics for Injury:
These medical statistics relate to hospitals, hospitalization and Injury:
- 1,007,025 patient days spent in private hospitals for injuries and poisoning in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 1,407,612 patient days spent in public hospitals for injuries and poisoning in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 32.6% of hospitalisations for injuries and poisoning in public hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 87.0% of hospitalisations for injuries and poisoning in private hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
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Medical news summaries about treatments for Injury:
The following medical news items
are relevant to treatment of Injury:
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Book Excerpts: Treatment of Injury
Treatments of Injury: Online Medical Books
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for more information about the treatments of Injury.
Rape trauma syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment consists of supportive measures and protection against venereal disease, human immunodeficiency virus (HIV) testing and, if the patient wishes, testing for pregnancy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Open trauma wounds:
Treatment
(Professional Guide to Diseases (Eighth Edition))
If hemorrhage occurs, stop bleeding by applying direct pressure on the wound and, if necessary, on arterial pressure points. If the wound is on an extremity, elevate it if possible. Don’t apply a tourniquet except in a life-threatening hemorrhage. If you must do so, be aware that resulting lack of perfusion to tissue could require limb amputation. (For a description of types of wounds and specific management, see Managing open trauma wounds.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Abdominal trauma:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
I.V. fluid replacement, surgical repair, analgesics, antibiotics
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Blunt and penetrating abdominal injuries:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Emergency treatment of abdominal injuries controls hemorrhage and prevents hypovolemic shock through the infusion of I.V. fluids and blood components. After stabilization, most abdominal injuries require surgical repair; some patients, however, require immediate surgery. Analgesics and antibiotics increase patient comfort and prevent infection. Most patients require hospitalization; if they’re asymptomatic, they may require observation for only 6 to 24 hours.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Blunt chest injuries:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Blunt chest injuries call for immediate physical assessment, control of bleeding, patent airway maintenance, adequate ventilation, and fluid and electrolyte balance.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Spinal injuries:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The primary treatment after a spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other measures are supportive. Cervical injuries require immobilization, using a type of cervical immobilization device (CID) on both sides of the patient’s head, a hard cervical collar, or skeletal traction with skull tongs or a halo device.
Treatment of stable lumbar and dorsal fractures consists of bed rest on firm support (such as a bed board), analgesics, and muscle relaxants until the fracture stabilizes (usually in 10 to 12 weeks). Later measures include exercises to strengthen the back muscles and use of a back brace or other device to provide support while walking.
An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, a laminectomy and spinal fusion.
When the spinal injury results in compression of the spinal column, neurosurgery may relieve the pressure. If the cause of compression is a metastatic lesion, chemotherapy and radiation may relieve it. Surface wounds accompanying the spinal injury require tetanus prophylaxis unless the patient has been immunized recently.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Acceleration-deceleration cervical injuries:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment aims to control symptoms and includes:
❑ a mild analgesic — such as aspirin with codeine or ibuprofen — and possibly a muscle relaxant — such as diazepam, cyclobenzaprine, or chlorzoxazone with acetaminophen
❑ ice or cool compresses to the neck to relieve pain
❑ immobilization with a soft, padded cervical collar for several days or weeks
❑ in severe muscle spasms, short-term cervical traction.
Most whiplash patients are discharged immediately.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cold injuries:
Treatment
(Professional Guide to Diseases (Eighth Edition))
In a localized cold injury, treatment consists of rewarming the injured part, supportive measures and, sometimes, a fasciotomy to increase circulation by lowering edematous tissue pressure. However, if gangrene occurs, amputation may be necessary. In hypothermia, therapy consists of immediate resuscitative measures, careful monitoring, and gradual rewarming of the body. If cold injuries in children suggest neglect or abuse, a thorough history should be performed.
Treat localized cold injuries as follows:
❑ Remove constrictive clothing and jewelry and slowly rewarm the affected part in tepid water (1007 to 1087 F [37.87 to 42.27 C]). Give the patient warm fluids to drink. Never rub the injured area — this aggravates tissue damage.
❑ When the affected part begins to rewarm, the patient will feel pain, so give analgesics as ordered. Check for a pulse. Be careful not to rupture any blebs. If the injury is on the foot, place cotton or gauze sponges between the toes to prevent maceration. Instruct the patient not to walk.
❑ If the injury has caused an open skin wound, give antibiotics and tetanus prophylaxis as ordered.
❑ If a pulse fails to return, the patient may develop compartment syndrome and need a fasciotomy to restore circulation. (See Recognizing compartment syndrome, page 304.) If gangrene occurs, prepare the patient for amputation.
❑ Before discharge, teach the patient about possible long-term effects: increased sensitivity to cold, burning and tingling, and increased sweating. Warn him against smoking, which causes vasoconstriction and slows healing.
Systemic hypothermia is treated as follows:
❑ If you detect no pulse or respiration, begin cardiopulmonary resuscitation (CPR) immediately and, if necessary, continue it for 2 to 3 hours. (Remember that hypothermia helps protect the brain from anoxia, which normally accompanies prolonged cardiopulmonary arrest. Therefore, even after the patient has been unresponsive for a long time, resuscitation may be possible, especially after cold-water near drownings.) Perform CPR until the patient is adequately rewarmed.
❑ Move the patient to a warm area, remove wet clothing, and keep him dry. If he’s conscious, give warm fluids with a high sugar content such as tea with sugar. If the patient’s core temperature is above 89.67 F (327 C), use external warming techniques. Bathe him in water that is 1047 F (407 C), cover him with a heating blanket set at 97.97 to 99.97 F (36.67 to 37.77 C), and cautiously apply hot water bottles at 1047 F to the groin and axillae, guarding against burns.
❑ If the patient’s core temperature is below 89.67 F (327 C), use internal and external warming methods. Rewarm his body core and surface 17 to 27 F (–0.57 to –1.17 C) per hour concurrently. (If you rewarm the surface first, rewarming shock could cause potentially fatal ventricular fibrillation.) To warm inhalations, provide oxygen heated to 107.67 to 114.87 F (427 to 467 C). Infuse I.V. solutions that have been warmed to 98.67 F (377 C) and perform nasogastric lavage with normal saline solution that has been warmed to the same temperature. Assist with peritoneal lavage, using normal saline solution (full or half-strength) warmed to 1047 to 1137 F (407 to 457 C); in severe hypothermia, assist with heart and lung bypass at controlled temperatures and thoracotomy with direct cardiac warm saline bath.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rape trauma syndrome:
Treatment
(Handbook of Diseases)
The rape victim should receive supportive care and protection against venereal disease and, if she wishes, against pregnancy.
Antibiotics are given to prevent venereal disease. To prevent pregnancy as a result of the rape, the patient may be given the “morning-after pill” (norqestrel/ethinyl estradiol) within 72 hours of the assault. If a pregnancy test is negative, two pills are given and the dose is repeated in 12 hours. Menses follows in 3 to 4 days. Or she may wait 3 to 4 weeks and undergo a dilatation and curettage or a vacuum aspiration to abort a pregnancy.
If the patient has vulvar lacerations and minor cuts, the area will be cleaned and the lacerations repaired after all the evidence is obtained. Topical use of ice packs may reduce vulvar swelling.
All victims of rape should be offered testing for human immunodeficiency virus infection and receive medical counseling and follow-up. Testing for hepatitis B and C should be considered and prophylaxis given.
Recovery from rape, which may be prolonged, consists of the acute phase (immediate reaction) and the reorganization phase. During the acute phase, physical aspects include pain, loss of appetite, and wound healing; emotional reactions typically include shaking, crying, and mood swings. Feelings of grief, anger, fear, or revenge may color the victim’s social interactions.
Counseling helps the victim identify her coping mechanisms. She may relate more easily to a counselor of the same sex.
During the reorganization phase, which usually begins a week after the rape and may last months or years, the victim is concerned with restructuring her life. Initially, she may have nightmares in which she’s powerless; later dreams should show her gradually gaining more control. When she’s alone, she may also suffer from “daymares” — frightening thoughts about the rape. She may have reduced sexual desire or may develop fear of intercourse or mistrust of men.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Wounds, open trauma:
Treatment
(Handbook of Diseases)
❑ If hemorrhage occurs, stop bleeding by applying direct pressure on the wound and, if necessary, on arterial pressure points. If the wound is on an extremity, elevate it if possible. Don’t apply a tourniquet except in a life-threatening hemorrhage. If you must do so, be aware that resulting lack of perfusion to tissue could require limb amputation. (For a description of types of wounds and specific management, see Managing open trauma wounds, pages 911 to 914.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chest injuries, blunt:
Treatment
(Handbook of Diseases)
Clinical tip Blunt chest injuries call for immediate physical assessment, control of bleeding, maintenance of a patent airway, adequate ventilation, and fluid and electrolyte balance.
❑ Check all pulses and level of consciousness. Also, evaluate color and temperature of skin, depth of respiration, use of accessory muscles, and length of inhalation compared with exhalation.
❑ Check pulse oximetry values for adequate oxygenation.
❑ Observe tracheal position. Look for jugular vein distention and paradoxical chest motion. Listen to heart and breath sounds carefully; palpate for subcutaneous emphysema (crepitation) and a lack of structural integrity in the ribs.
❑ Obtain a history of the injury. Unless severe dyspnea is present, ask the patient to locate the pain, and ask if he’s having trouble breathing. Obtain an order for laboratory studies (arterial blood gas analysis, cardiac enzyme levels, complete blood count, and typing and crossmatching).
❑ For simple rib fractures, give a mild analgesic, encourage bed rest, and apply heat. To prevent atelectasis, instruct the patient on incentive spirometry and deep breathing, coughing, and splinting. Don’t strap or tape his chest.
❑ For more severe fractures, intercostal nerve blocks may be needed. Obtain X-rays before and after the nerve blocks to rule out pneumothorax.
❑ If the patient has excessive bleeding or hemopneumothorax, intubate him. Chest tubes may be inserted to treat hemothorax and to assess the need for thoracotomy. To prevent atelectasis, turn the patient frequently and encourage coughing and deep breathing.
❑ If the patient has pneumothorax, he may need a chest tube placed anteriorly to the midaxillary line at the fifth intercostal space, to aspirate as much air as possible from the pleural cavity and to reexpand the lungs. Insert chest tubes attached to water-seal drainage and suction.
❑ If the patient has flail chest, place him in semi-Fowler’s position. Reexpansion of the lung is the first definitive care measure. Administer oxygen at a high flow rate under positive pressure. Suction the patient frequently, as completely as possible. Carefully observe the patient for signs of tension pneumothorax.
❑ The patient with flail chest will also need I.V. therapy started. Use lactated Ringer’s solution or normal saline solution. Beware of both excessive and insufficient fluid resuscitation.
❑ For hemothorax, treat shock with I.V. infusions of lactated Ringer’s solution or normal saline solution. Administer packed red blood cells for blood losses greater than 1,500 ml or circulating blood volume losses exceeding 30%. Autotransfusion is an option. Administer oxygen.
❑ The patient with hemothorax will also need insertion of chest tubes in the fifth or sixth intercostal space anterior to the midaxillary line to remove blood. Monitor and document vital signs and blood loss. Watch for falling blood pressure, rising pulse rate, and hemorrhage —all require thoracotomy to stop bleeding.
❑ For pulmonary contusions, give limited amounts of colloids (for example, salt-poor albumin, whole blood, or plasma) to replace volume and maintain oncotic pressure. Administer an analgesic, a diuretic and, if necessary, a corticosteroid, as needed. Monitor arterial blood gas values to ensure adequate ventilation; provide oxygen therapy, mechanical ventilation, and chest tube care.
❑ For suspected cardiac damage, close intensive care or telemetry may detect arrhythmias and prevent cardiogenic shock. Impose bed rest in semi-Fowler’s position (unless the patient requires shock position); as needed, administer oxygen, an analgesic, and other supportive drugs to control heart failure or supraventricular arrhythmia.
❑ Watch for cardiac tamponade, which calls for pericardiocentesis. Essentially, provide the same care as for a patient who has suffered myocardial infarction.
❑ If the patient has myocardial rupture, septal perforation, or another cardiac laceration, immediate surgical repair is mandatory; less severe ventricular wounds require use of a digital or balloon catheter; atrial wounds require a clamp or balloon catheter.
❑ For the few patients with aortic rupture or laceration who reach the facility alive, immediate surgery is mandatory, using synthetic grafts or anastomosis to repair the damage. Give large volumes of I.V. fluids (lactated Ringer’s or normal saline solution) and whole blood, along with oxygen at very high flow rates; then transport the patient promptly to the operating room.
❑ If the patient has tension pneumothorax, insertion of a spinal or 14G to 16G needle into the second intercostal space at the midclavicular line is necessary to release pressure in the chest. After that, insert a chest tube to normalize pressure and reexpand the lung. Administer oxygen under positive pressure, along with I.V. fluids.
❑ For a diaphragmatic rupture, insert a nasogastric tube to temporarily decompress the stomach, and prepare the patient for surgical repair.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Spinal injuries:
Treatment
(Handbook of Diseases)
The primary treatment after spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other treatment is supportive. Cervical injuries require immobilization, using sandbags on both sides of the patient’s head, a hard cervical collar, or skeletal traction with skull tongs or a halo device. When patients show clinical evidence of cord injury, high doses of methylprednisone are started.
Supportive treatment
Treatment of stable lumbar and dorsal fractures consists of bed rest on firm support (such as a bed board), analgesics, and muscle relaxants until the fracture stabilizes (usually 10 to 12 weeks). Later treatment includes exercises to strengthen the back muscles and a back brace or corset to provide support while walking.
An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, laminectomy and spinal fusion.
Other treatment
When the damage results in compression of the spinal column, neurosurgery may relieve the pressure. If the cause of compression is a metastatic lesion, chemotherapy and radiation may relieve it. Surface wounds accompanying the spinal injury require tetanus prophylaxis unless the patient has had recent immunization.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Abdominal injuries:
Treatment
(Handbook of Diseases)
Abdominal injuries require emergency treatment to control hemorrhage and prevent hypovolemic shock, by infusion of I.V. fluids and blood components. Some abdominal injuries require surgical repair after stabilization, whereas others require immediate surgery. Blunt trauma to the spleen or liver may be treated with nonoperative management and close monitoring. Analgesics and antibiotics increase patient comfort and prevent infection. Most patients require hospitalization; if they’re asymptomatic, they may require observation for only 6 to 24 hours.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cold injuries:
Treatment
(Handbook of Diseases)
With a localized cold injury, treatment consists of rewarming the injured part, supportive measures and, in severe cases, a fasciotomy to increase circulation by lowering edematous tissue pressure. However, if gangrene occurs, amputation may be necessary.
With hypothermia, therapy consists of immediate resuscitative measures, careful monitoring, and gradual rewarming of the body.
Frostbite
❑ Remove constrictive clothing and jewelry. Slowly rewarm the affected part in tepid water (about 100° to 108° F [37.8° to 42.2° C]). Give the patient warm fluids to drink.
❑ When the affected part begins to rewarm, the patient will feel pain, so administer an analgesic. Check for a pulse. If the injury is on the foot, place cotton or gauze sponges between the toes to prevent maceration. Instruct the patient not to walk.
Clinical tip When treating a patient with frostbite, never rub the injured area. This aggravates tissue damage. Also, be careful not to rupture any blebs.
❑ If the injury has caused an open skin wound, give an antibiotic and tetanus prophylaxis.
❑ Early surgical intervention isn’t indicated unless wet gangrene or severe infection of the eschar develops.
Clinical tip Prevent refreezing of thawed tissues because significant tissue damage may occur. Also, it’s impossible to assess the depth of frostbite injury in the early stages.
Hypothermia
❑ If the patient has no pulse or respirations, begin cardiopulmonary resuscitation (CPR) immediately and, if necessary, continue it for 2 to 3 hours. (Remember: Hypothermia helps protect the brain from anoxia, which normally accompanies prolonged cardiopulmonary arrest. Therefore, even after the patient has been unresponsive for a long time, resuscitation may be possible, especially after cold-water near-drownings.) Perform CPR until the patient is adequately rewarmed.
❑ Move the patient to a warm area, remove wet clothing, and keep him dry. If he’s conscious, give warm fluids with high sugar content, such as tea with sugar. If the patient’s core temperature is above 89.6° F (32° C), use external warming techniques. Bathe him in water that’s 104° F (40° C), cover him with a heating blanket set at 97.9° to 99.9° F (36.6° to 37.7° C), and cautiously apply hot water bottles at 104° F (40° C) to groin and axillae, guarding against burns.
❑ If the patient’s core temperature is below 89.6° F (32° C), use internal and external warming methods. Rewarm his body core and surface 1° to 2° F (0.5° to 1.1° C) per hour concurrently. (If you rewarm the surface first, rewarming shock could cause potentially fatal ventricular fibrillation.)
❑ To warm inhalations, provide oxygen heated to 107.6° to 114.8° F (42° to 46° C). Infuse I.V. solutions that have been warmed to 98.6° F (37° C), and perform nasogastric lavage with normal saline solution that has been warmed to the same temperature.
❑ The patient may need peritoneal lavage, using normal saline solution (full or half strength) warmed to 104° to 113° F (40° to 45° C). If the patient has severe hypothermia, he may need heart and lung bypass at controlled temperatures and thoracotomy with a direct cardiac warm-saline bath. Avoid using central venous catheters in patients with severe hypothermia to prevent arrhythmias.
Clinical tip Consider administering antibodies if sepsis is the suspected cause of the hypothermia. Consider giving a steroid only if adrenal suppression or insufficiency is suspected to be the precipitating cause of the hypothermia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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