HITTING BOTTOM ISN'T A WEEKEND RETREAT! IT'S NOT A SEMINAR! ONLY AFTER YOU'VE LOST EVERYTHING ARE YOU FREE TO DO ANYTHING! YOU SEE, YOU LISTEN, BUT YOU DON'T GET IT! YOU HAVE TO FORGET EVERYTHING YOU KNOW, EVERYTHING YOU THINK YOU KNOW!
I heard that we were bombing some little country somewhere, I really haven't paid much attention
My best friend's sister's boyfriend's brother's girlfriend heard from this guy who knows this kid who's going with a girl who saw Ferris pass-out at 31 Flavors last night. I guess it's pretty serious
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Your pocket Bible will stop an assailant's bullet, but not before it passes through four innocent bystanders, a school-bus gas tank, and your genitals.
HITTING BOTTOM ISN'T A WEEKEND RETREAT! IT'S NOT A SEMINAR! ONLY AFTER YOU'VE LOST EVERYTHING ARE YOU FREE TO DO ANYTHING! YOU SEE, YOU LISTEN, BUT YOU DON'T GET IT! YOU HAVE TO FORGET EVERYTHING YOU KNOW, EVERYTHING YOU THINK YOU KNOW!
someone has been saying that alkie has one big ear, but i'm not buying it. that would be to freakish
Edited By Arpikarhu on Jan. 21 2002 at 11:20
I love him. He's like those happy old people who become known for sitting by the side of a busy street and waving to passing cars. People drive by regularly and beep just to see him and get him to wave to them.
That's just like our Arpi... except he doesn't wave or anything. He just says mean things to you.
GonzoStyle Wrote:I pledge my undying love for Arpi, any retraction of this undying love is to be ignored.
Nominated for," 2005 poster of the year", by 4 out of 6 mods!
I heard that if you take Rape's head and bash it across the gutter, she will ask for your hand in marriage.
Then, the fun begins! You take her in the house and just punch the ever loving shit out of the back of her skull until you see the tears of joy streaming down her face, or her head gets as soft as a microwaved melon, which ever comes first. You rip her clothes right off her skin and knee lift her right in the grill to get her to lay down! Then, when the moment is right, you grab her bluddy skull and plant the most passionate, intrusive kiss you can while grinding your elbow into her fuckin rib cage. She will be jumpin........
Presentation
The patient has stubbed, hyperflexed, hyperextended, hyperabducted, or dropped a weight upon a toe. He presents with pain swelling, ecchymosis, decreased range of motion and point tendeness, and there may or may not be any deformity.
What to do:
Examine the toe, particularly for lacerations which could become infected, prolanged capillary filling time in the injured or other toes which could indicate poor circulation, or decreased sensation in the injured or other toes which could indicate peripheral neuropathy, and may interfere with healing.
X rays are not essential but are often necessary to provide patient satisfaction. They have little effect on the initial treatment, but may help predict the duration of pain and disability (e.g., fractures entering the joint space).
Displaced or angulated phalangeal fractures must be reduced with linear traction after a digital block. Angulation can be further corrected by using your finger as a fulcrum to reverse the direction of the distal fragment. The broken toe should fall into its normal position when it is released after reduction.
Splint the broken toe by taping it to an adjacent non- affected toe, padding between toes with gauze or Webril, and using half-inch tape. Give the patient additional padding and tape, so he may revise the splinting, and (if there is a fracture) advise him that he will require such immobilization for approximately one week, by which time there should be good callus formation around the fracture and less pain with motion. Inform the patient that he must keep the padding dry between his toes while they are taped together or the skin will become mace rated and will break down.
Also treat with rest, ice, elevation, and anti-inflammatory medication. A cane, crutches, or hard-soled shoes which minimize toe flexion may all provide comfort. Let the patient know that in many cases a soft slipper or an old sneaker with the toe cut out may be more comfortable.
If the fracture is not of a phalanx, but of the metatarsal, buddy taping is not effective. Instead, construct a pad for the sole with space cut out under the fracture site and the distal metatarsal head, either taped to the foot, or, ideally inside a roomy cast shoe used for walking casts.
Arrange for followup if the toe is not much better within one week.
What not to do:
Do not tape toes together without padding between them. Friction and wetness will macerate the skin between.
Do not let the patient overdo ice, which should not be applied directly to skin, and should not be used for more than 10-20 minutes per hour.
Do not overlook the possibility of acute gouty arthritis, which sometimes follows minor trauma after a delay of a few hours.
Discussion
If there is no toe fracture, the treatment is the same, but the pain, swelling, and ability to walk may improve in 3 days rather than 1-2 weeks. Although patients still come to the ED asking whether the toe is broken, they can usually be handled adequately over the telephone and seen the next day.