| Trauma
The urgent care is well trained
and equipped to care for non-life threatening, minor
emergencies. Some examples are listed.
Fractures-x-ray is available to establish
the diagnosis of a fracture. Most fractures do not
need immediate reduction. If reduction is necessary,
we usually splint the fracture to immobilize it and
refer to orthopedics in a few days.
Ankle sprains-it
is important to be sure a chip fracture or more is
not present. Usually a good exam will give useful
information, but x-ray may be necessary. The joint
needs to be immobilized to prevent further damage.
We use an Air Cast, a splint that can be applied during
the day.
Skin lacerations-some
wounds need to be sutured while others can be closed
with strong reinforced paper tape. Seniors with thin
skin cannot be sutured well, but it is important to
close the wound to accelerate healing. The wounds
need to be cleaned and closed within the first 24
hours to prevent infection. Clean with water, not
with peroxide, don’t cover with Neosporin/Neomycin,
and come in ASAP.
For children, many of the wounds can be closed with
glue.
Rib fractures-most are very painful,
but it is rare for a broken rib to puncture the lung.
X-rays will show the fracture and lung status. We
treat with pain medication and encourage deep breathing
to prevent lung collapse.
Nose fracture-these
fractures are reduced immediately only if deformity
of the nose is obvious. Reduction can wait for swelling
to recede, usually a week.
Wrist injuries-a
fall on an out stretched hand can cause a fracture
of the main bone at the wrist or one of the small
wrist bones. These injuries need splinting or a cast.
Hip fractures-we
do not see this fracture because these patients cannot
walk. Usually, it you look at the legs, the fractured
one will be shorter and rotated out. Go to the ER.
Whiplash injury-this
occurs in motor vehicle accidents, usually from a
collision from the back. Most have painful muscle
spasm, but rarely have fractures. X-rays are done
on most, because a missed fracture in the neck can
be a disaster. Pain medication, muscle relaxants,
and a cervical collar are used.
Finger fractures-a
fracture at the terminal phalange will not be a problem.
However, fractures in the mid phalange usually need
to see orthopedics/surgery, because they tend to become
displaced fractures.
Toe fractures-usually a hard shoe is all that is necessary.
Head trauma-this
can be difficult because standard x-rays offer very
little. Our interest ismore on the condition inside
the brain and for this we need a CT/MRI scan. We evaluate
the patient with the history to determine the necessity
of further testing.
These are examples of the
types of trauma we see in the urgent care center.
I hope you find this helpful.
Written
& edited by Robert E. Dyer, MD
Read
more about Trauma:
www.surgical-tutor.org.uk
www.physsportsmed.com/issues/1996/09_96/thordar.htm
www.trauma.org
www.aaos.org
ipromiseprogram.com |
