The Credit Valley Hospital

Emergency department

Abdominal Pain

You should be seen urgently by your family doctor or in the emergency department if any of the following new problems develop:

Persistent fever above 38.5C (102F) unresponsive to acetaminophen.
Pain which becomes more and more severe, especially if it stays in one area of the abdomen.
Bloody vomiting or blood in the stools.
Burning or blood in the urine or pain in the sides.
Fainting or light headedness.
Chest pain or shortness of breath.
The abdomen becomes hard and tender to the touch or very swollen.
In males, pain or swelling in the testicles.
In females, unusual vaginal bleeding or discharge.
Any type of skin rash.
Dehydration - extreme thirst, dry mouth, no urination for 6 hours.
No rectal gas passed within 12 hours.

Please ask for further explanation if these instructions are not clear.

Laryngotracheobronchitis (Croup)

Croup is caused by a viral infection of the larynx (voice box) and the trachea (air tube) just below the larynx. It often accompanies a cold and causes inflammation and swelling of the larynx and trachea. This causes the common symptoms of croup, namely: hoarseness, a barking type cough and difficulty taking in a breath. The harsh, vibrating noise that a child makes as they take a breath in is called stridor. In more severe cases, children will show pulling in or retraction of the tissues between the ribs or above the breastbone when they take a breath in. Croup can last from 2 to 7 days and usually seems to flare up at night.

Most often, croup resolves without any specific treatment. The use of lots of warm fluids, acetaminophen (Tylenol, Tempra) every 4 hours as needed, and cool, humidified air in the child's bedroom, are usually all that are required. During outbreaks of croup in the spring and fall, your doctor may recommend 48 hours treatment with a cortisone type drug such as Decadron or Prednisone, to decrease the inflammation of the trachea and larynx.

If your child wakes up during the night, in distress, due to cough or stridor, try the following:

Stay calm and try to calm your child.

Turn on the hot water taps in the bathroom and allow it to fill up with warm steam.

Sit with your child on your lap for 10 - 15 minutes in the steamy bathroom.

If this doesn't work try going outside for 5 - 10 minutes or for a short car ride with the windows rolled partially down.

If this does not improve your child's breathing, bring them to the emergency department.

Return to the Emergency Department immediately if:

Your child is having trouble breathing, cannot swallow water and is drooling.
Breathing increases to above 40 breaths per minute.
Bluish colouring of the lips or fingernails (cryanosis).
Your child develops retractions (pulling in) between the ribs which persist longer than 10 minutes in a steamy room.
Your child develops a fever greater than 38.5 degrees C.

Cast Care

Casts should be checked 24 - 48 hours after they have been initially applied. In most cases, this can be carried out by your own family physician. In some cases, an appointment will be made for this to be carried out at our Fracture Clinic in the Ambulatory Care Department of The Credit Valey Hospital.

Following the initial cast check, appointments may be required in order for your physician to evaluate your recovery and eventually to remove your cast. These appointments can be carried out either by your own family physician in his/her office or, in some cases by the staff at The Credit Valley Hospital in our Fracture Clinic.

If you have been given instructions to return to your own family physician for cast check and/or follow-up, please arrange this appointment yourself by calling your family physician's office.

If it has been suggested that you return to the Fracture Clinic in the Ambulatory Clinic Department for consultation with one of our Physicians, please make note of the date and name of the physician who will be seeing you in the Clinic. This information will be given to you before you leave the Emergency Department. You will then be contacted at home, by telephone, within the next 24- 48 hours by the personnel in our Ambulatory Care Department to confirm your specific appointment time and date.

General Instructions regarding cast care:

Please try to keep your cast dry at all times.
Do not allow pressure or weight bearing for 48 hours after the initial application of the cast.

To diminish the chance of swelling, it is best to keep the casted limb elevated above the level of your heart for at least the first 48 hours following application.

Neck Injury

The doctor who examined you has diagnosed a sprain/strain of the muscles and ligaments of your neck. Most people have some pain and stiffness for 1- 3 weeks after such an injury. It is usually the most severe in the first 48 hours. Less than 10% of people have ongoing pain and stiffness longer than 8 - 10 weeks. To improve your chances of rapid recovery, follow the simple principles below:

Rest: For the first 1 - 2 days, a soft neck collar (available at your pharmacy) or a pillow collar (made by wrapping a soft pillow around your neck and fastening it together at the front with safety pins) may provide some pain relief. Beyond 2 days, collars can weaken the neck muscles and actually prolong your recovery. Maintain good neck posture by tucking your chin in when you are upright and by using a small pillow or rolled up towel to fill in the hollow of your neck when lying down.

Ice: Fill a zip-lock bag with crushed ice and some water, or use a bag of frozen peas. Cover this with a wet towel or pillow case. Apply to the painful area of your neck for 10 - 15 minutes at a time. Repeat every 2 - 3 hours while awake for the first 24 - 48 hours. Gently move your neck around after icing to stretch the muscles.

Heat: After 48 hours, begin heat application with hot, wet towels, a heating paid, a hot water bottle, or by using a hot shower, for 10 - 15 minutes while you slowly start moving your neck through all of its motions. Repeat every 3- 4 hours during the day.

Medication: Your doctor may have prescribed medicine to relieve pain and muscle spasm over the next few days. These pills may make you quite drowsy at first. Be careful with any activities where you have to be alert, such as driving, and avoid alcohol while on this medication. Codeine products may upset your stomach or cause constipation. This can usually be relieved by taking the pills after meals and by eating extra fibre such as bran cereals, bran muffins, prunes or by taking a bulk laxative such as Metamucil. If you have not been prescribed a pain-killer, an adult can take acetaminophen (Tylenol), 2 regular or even 2 extra-strength tablets, every 4 hours for pain relief.

Activity: Recovery is faster in those people who start early, active neck movement. Range of motion exercises are very important to decrease neck stiffness and maintain normal movement. Until you see your own doctor for follow-up in 2 - 3 days, you should gently stretch your neck in every direction at least 3 - 4 times daily. If this is too painful sitting up, try doing it while lying down on your back. It may also help to apply heat, as mentioned above, prior to movement. Your own doctor may refer you for early physiotherapy to continue the active rehabilitation process.

See a doctor again immediately if any of the following occur:

You develop pain, tingling or numbness going down your arms or back.
You develop weakness or clumsiness in any part of your arms or legs.
You lose control of your bowels or bladder.
Your pain continues to get worse in spite of rest, ice and acetaminophen.

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