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R.I.C.E. is an acronym (a word coined from first letters) for the most important elements--rest, ice, compression and elevation--in first aid of many injuries. This acronym appears repeatedly throughout this book--and in medical literature in general--in reference to athletic injuries. Use the word R.I.C.E. to jog your memory when your child is faced with such injuries as contusions, sprains, strains, dislocations, or uncomplicated fractures.

Your child should stop using the injured part and rest it as soon as an injury has taken place. Continued exercise or other activity could cause further injury, delay healing, increase pain, and stimulate bleeding. The child can use crutches to avoid bearing weight on injuries of the foot, ankle, knee, or leg and splints for injuries of the hand, wrist, elbow, or arm. After medical treatment, the injured part may require immobilization with splints or a cast to keep the area at rest until it heals.

Ice helps stop internal bleeding from injured blood vessels and capillaries. Sudden cold causes small blood vessels to contract. This contraction of blood vessels decreases the amount of blood that can collect around the child's wound. The more blood that collects, the longer the healing time. Ice can be safely applied in several ways using the following instructions:

  • For injuries to small areas, such as a finger, toe, foot, or wrist, immerse the injured area in a bucket of ice water. Use ice cubes to keep the water cold as ice dissolves.

  • For injuries to larger areas, use ice packs. Avoid placing ice directly on the skin. Before applying the ice, place a towel, cloth, or one or two layers of an elasticized compression bandage on the skin to be iced. To make the ice pack, put ice chips or ice cubes in a plastic bag or wrap them in a thin towel. Place the ice pack over the cloth. The pack may sit directly on the injured part, or it may be wrapped in place.

  • Ice the injured area for about 30 minutes (no matter what form of ice treatment you are using).

  • Remove the ice to allow the skin to warm for 15 minutes.

  • Reapply the ice.

  • Repeat the icing and warming cycles for 3 hours, as well as following the instructions below for compression and elevation.

    If pain and swelling persist after 3 hours, consult your doctor (if you have not already done so). Your doctor may change the icing schedule after the first 3 hours. Regular ice treatment is often discontinued after 24 to 48 hours. At that point, heat is often more comfortable.

    Compression decreases swelling by slowing bleeding and limiting the accumulation of blood and plasma near the injured site. Without compression, fluid from adjacent normal tissue seeps into the injury area. The more blood and fluid that accumulates around an injury, the slower the healing. Following are instructions for applying compression safely to an injury.

    Use an elasticized bandage (Ace bandage) on the child for compression, if possible. If you do not have one available, any kind of cloth will suffice for a short time. Wrap the injured part firmly, wrapping over the ice also. Begin wrapping below the injury site and extend above the injury site. Be careful not to compress the area so tightly that the blood supply is impaired. Signs of blood-supply deprivation include pain, numbness, cramping, and blue or dusky-colored nails. Remove the compression bandage immediately if any of these symptoms appear. Leave the bandage off the child until all signs of impaired circulation disappear. Then rewrap the area -- less tightly this time.

    Elevating the injured part above the level of the child's heart is another way to decrease swelling and pain at the injury site. Elevate the iced, compressed area in whatever way is most convenient. Prop an injured leg on solid objects or pillows. Elevate an injured arm by having the child lie down and placing pillows under the arm, or placing them on the chest with the arm folded across. The whole upper part of the child's body may be elevated gently with pillows by having the child sit in a reclining chair or by raising the top of the child's bed on blocks.

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