Measures to reduce swelling should be initiated early. Severe swelling not only intensifies the patient's discomfort but may also delay the application of a long-term definitive immobilization dressing and may make the skin more susceptible to pressure sores. Although sometimes regarded as trivial modalities, the application of cold and elevation are both effective in keeping swelling to a minimum or at least preventing its progression. When cold is applied, the skin should be protected from direct contact with ice-cold temperatures.
Parenteral analgesics should be administered as necessary. If the patient is relatively comfortable at rest, medication may not be required. Analgesics have virtually no effect on the pain of movement or manipulation unless combined with hypnotics or other central nervous system active agents. Jewelry, watches, or rings that can cause compression as an extremity swells should be removed if there is suspicion or confirmation of proximal injury.
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