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TIMELY FIRST aid for a sprain can help the victim by reducing pain, swelling, and the potential for further injury. A sprain is a stretched or torn ligament connecting bone to bone. (A strain affects tendons or muscles.)

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Remember R-I-C-E-S when treating a sprain: rest, ice, compression, elevation, and stabilization. Have the victim stop bearing weight on her injured body part and help her to a comfortable position. If possible, elevate the injured part and carry out these steps.


Assess the victim


* Assess her for injuries that could pose a greater risk and require more immediate care than a sprain.


* Examine the injured body part, observing for discoloration, deformity, and edema. Gently palpate the area for pain, tenderness, crepitus, and changes in skin temperature. Ask the victim to rate her pain on a scale from 0 (no pain) to 10 (worst pain imaginable).


* Assess the quality of pulses and capillary refill distal to the injury site. Determine whether range of motion and sensation in the injured area are normal compared with the corresponding area on her opposite side.


* Find out how the injury occurred. Did any contributing factors such as a wet floor or a health-related condition impair her balance or cause a fall?


Treat the injury


* Apply a cold or ice pack to the injured area to reduce pain and swelling. A cover or lightweight material such as a thin washcloth placed between the skin and the ice pack helps prevent cold-related injury to the skin.


* Apply an elastic compression bandage to reduce swelling and help stabilize the injury site. Wrap it around the limb in a distal to proximal direction, overlapping the layers. The wrap should be snug but not tight enough to impair circulation. Instruct the victim to loosen it if it feels too tight.


* Apply a splint if the sprain is severe and further stabilization is necessary.


* Perform a neurovascular assessment before and after bandaging and splinting to ensure adequate circulation. If neurovascular status is impaired, remove the splint and bandage to preserve neurovascular function, then reapply them.


* Arrange for the victim's transport to the emergency department. Only an X-ray can differentiate a sprain from a fracture.


Instruct the victim

If time allows:


* Advise her not to bear weight on or use the injured part until she has a diagnostic workup and the health care provider gives the okay. If the injury involves her leg and crutches are available, show her how to use them.


* Teach her how to properly apply an elastic bandage for compression.


* Advise her to apply an ice pack to the sprained area for 20 minutes four to five times a day for several days. Explain the need for rest, elevation above heart level, and compression to reduce swelling and promote healing.


* Teach the patient to follow the manufacturer's guidelines when taking over-the-counter pain medication. A nonsteroidal anti-inflammatory drug such as ibuprofen is usually effective for mild to moderate pain.


* Emphasize that if her pain significantly worsens or if the affected area becomes abnormally cold, pale, discolored, numb, or tingly or she can't move it, she should loosen the compression wrap. If this doesn't resolve the problem, she should immediately contact her health care provider.



Pass on information

Provide the health care provider with the following information:


* how the injury occurred as the victim described it


* what she did to treat herself before you came to her assistance


* your assessment findings, emergency interventions, her response, and any health teaching information you provided.



Items that can help


* cold or ice pack


* elastic bandage


* splint (a padded board, sturdy cardboard, magazines, pillows, or a blanket roll can serve the purpose)


* sling


* crutches




Auerbach PS, et al. Field Guide to Wilderness Medicine, 2nd edition. Philadelphia, Pa., Mosby, 2003.


Rapid Response to Everyday Emergencies: A Nurse's Guide. Philadelphia, Pa., Lippincott Williams & Wilkins, 2006.