By Tedler D. Depaynos, MD
The young lady student was lucky in the sense that although she was hit by an incoming passenger jeep and thrown helplessly on the street while crossing, she just incurred soft tissue injuries. After several views of x-rays she did not incur any fracture or any other major injuries. She had bruises and painful swelling in some parts of her body but the main injury appeared to be on her left upper arm. Swelling was much obvious and hematoma formation with bluish discoloration was apparent when she was rushed into the Hospital Emergency Room.
The ER personnel were very experienced and after listening to the patient’s history they were one in concluding that it was a miracle she suffered no serious injury. They were also adept in treating the patient so that watching them and listening to their advices reminds me of the lectures we had on simple treatments for muscle injuries.
Muscle injuries may come in several forms like contusions, strains, severe soreness and cramps. In treating these injuries one must understand the basic structure of muscles. They come in elongated fibers and very vascularized with very small blood vessels. Any injury therefore of the muscles would cause the rupture of those micro vessels causing bleeding or hemorrhage and hematoma formation. The aim therefore of the initial treatment of these muscle injuries is to control the bleeding. The guideline in treating is referred to as RICES.
R – refers to REST. The left arm should be made to rest by simply putting a sling. In athletes, they have to refrain or stop from their athletic exercises.
I – refers to the application of ICE to the injured area. The ER personnel wrapped the ice with a towel and applied it directly to the injured area for 15 to 20 minutes. After an hour they repeated the same procedure and it was done around four times in the ward where she was eventually admitted. Actually an elastic bandage was first applied over the wound to prevent freezing of the skin. Ice application tends to decrease pain, swelling, spasm and even bleeding by vasoconstriction.
C – refers to COMPRESSION of the injured part to control bleeding together with the ice application. This is also the reason why an elastic bandage was applied first to the injured arm before the ice.
E – refers to ELEVATION which may limit circulation. Hence ideally the injured part should be above the heart specially when lying down. It may also help in the venous return to the heart. This may be done by putting a high pillow below the injured part.
S – refers to the STABILIZATION and SUPPORT of the injured area. Movement may increase blood circulation. Ideally, stabilization should be done on the joints above and below the injury.
The above procedure is routinely lectured to professional athletic coaches because when it is done immediately especially to their athletes, it would reduce the extent of the injury and healing would be much quicker.
Because of no other serious injuries the patient was discharged after a few days with detailed instructions. She was advised that because of the severity of the injury, it would take a little time for the swelling, hematoma and pain to completely subside.**
