Treatment and Management : General Knee Injury

So I've got loads of information from this website which I think is adequate for this week's PCL. But no matter, will post them up, part by part. The references are at the last post okay? Will definitely be simplifying things for Friday. This could just take up 30 minutes of our time. HAHA. :

Prehospital Care

Stabilizing the lower extremity and monitoring the neurovascular status of the limb.
Should be realigned only if associated neurovascular structures are compromised.
Always recheck and document pulses after splinting or manipulation of the limb.
If initial efforts meet with resistance, prehospital personnel should not force realignment.
Cover open wounds with saline-soaked sterile gauze.

Emergency Department Care

Always determine the mechanism of injury and verify hemodynamic stability.
Assess vascular perfusion and control any bleeding.
Hard signs of vascular injury include absent or diminished pulses, active hemorrhage, and expanding or pulsatile hematoma.
Signs of distal ischemia include pain out of proportion to the injury, pallor, paralysis, and paresthesias.
For knee dislocations or grossly malaligned fractures with potential vascular compromise, attempt immediate reduction or realignment of the knee if an orthopedic specialist is not immediately available.
Observe for signs and symptoms of compartment syndrome. Measurement of compartment pressures is often needed to exclude the possibility of compartment syndrome.
Remove any constricting clothes and bandages.
Consider splinting the injured knee to provide support and to prevent further injury.
Serviceable devices include commercially available immobilizers and handcrafted compressive dressings, such as the Robert Jones dressing, which incorporates coaptation plaster.
Detrimental effects of immobilization include joint stiffness, degenerative changes in articular cartilage, muscle atrophy and weakness, and decreased vascularity.
Therapy for specific injuries
For first-degree sprains :RICE regimen. Normal function usually returns quickly.
Second-degree sprains : require protection by using a cast, cast brace, or a restrictive movement brace. Arrange for timely follow-up care.
Third-degree sprains : depends on the severity and type of instability; some third-degree sprains of ligaments necessitate surgical repair. Factoring into the deliberation for surgery is the patient's age, relative health, associated injuries, activity demands, and individual desires.

Pharmacological treatment

Nonnarcotic analgesics
acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)
Most commonly ingested pain reliever; marketed in combination with other drugs to provide analgesia.
Acetylsalicylic acid (Bayer Aspirin, Bufferin, Anacin, Ecotrin)
Prototype NSAID; used in combination with many other drugs; available OTC. Offers anti-inflammatory benefits, unlike acetaminophen. Effective in PO, suppository, and topical preparations.
Ketorolac (Toradol)
Frequently overlooked fact is that this medication is an NSAID, with all of the group's attendant risks and that it costs almost 20 times more than morphine (and 140 times more than ibuprofen). Data supporting superiority over other analgesics scarce.
Ibuprofen (Motrin, Advil, Nuprin)
Widely used NSAID, also available OTC, derivative of propionic class of NSAIDs and considered safest of NSAIDs. Advise taking with food or milk if possible; caution in children with flulike illnesses.
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy

Narcotic analgesics

Patients reporting inadequate pain relief from NSAIDs may benefit from short-term supplementation with an opioid compound. A wide array of products is available. Common adverse effects include constipation, nausea, respiratory depression, sedation, and urinary retention.

Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Anexsia)
Drug combination indicated for relief of moderately severe to severe pain.
Oxycodone and acetaminophen (Percocet, Tylox, Roxicet)
Drug combination indicated for relief of moderately severe to severe pain.
Acetaminophen and codeine (Tylenol #3)
Drug combination indicated for treatment of mild to moderately severe pain.
Morphine sulfate (Oramorph, MS Contin, Duramorph)
Criterion standard for relief of acute severe pain; may be administered in a number of ways; commonly titrated until desired effect obtained. IV morphine demonstrates half-life of 2-3 h; however, half-life may be 50% longer in the elderly.
Meperidine (Demerol)Narcotic analgesic with multiple actions similar to morphine; however, may cause less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine