b'Chapter hapter Ice and Heat Application WHAT NOT TO DO:Do not apply ice or manufactured coldAn injury damages blood vessels,packs directly to the skin.causing bleeding in the injured area. Injury irritates nerve endings andDo not leave ice packs on for anycauses pain. longer than 20 minutes.Do not apply any form of heat inIce or a cold pack constricts bloodthe first 24 hours.vessels, slowing bleeding thatDo not rub or massage the area.causes swelling. Cold deadens nerve endings and relieves pain. How Heat Helps Later OnHeat speeds up the chemical reaction Applying heat dilates bloodneeded to repair tissues. vessels, increasing blood flow toAlways apply ice for at least 24 hours before the injured area. Nerve endingsheat treatment.become more sensitive.DislocationsA dislocation occurs when there is displacement of one or more bones at a joint such as the shoulder, hip, elbow, fingers or toes. Dislocations result in torn ligaments and in some cases can be serious. A severe dislocation of the shoulder, spine or hip may damage underlying major nerves and result in paralysis. There may also be a fracture to the bones involved so it can sometimes be difficult to differentiate between a dislocation and a fracture.How to Recognise Deformity of the joint and intense pain that is increased by any movement. Tenderness, bruising, swelling, discolouration over and around the site.Loss of power - patient may be unable to move the limb.Sometimes numbness and tingling sensations in the affected limb.How to Manage Gently support the injured limb in the most comfortable and least painful position (chosen by the patient). Support the limb and the patient with additional soft padding such as towels or a blanket and bandages.Check for any possible signs of impaired circulation (there may be discolouration and numbnessor tingling sensations). Sometimes the dislocation may be restricting circulation. Never try to manipulate a dislocated joint back into place because this may cause further injury.(refer to page 110).Apply the R.I.C.E.R. Technique Call Ambulance 000. Reassure and keep the patient warm.If you are unsure if the injury is a dislocation, manage as a fractureand gently immobilise in the position foundMuscle, Joint and Bone Injury 111'