If it continues, the cigarettes are probably not the culprit. Urticarial vasculitis is a possibility if wheals last more than 24 hours or purpura is present. The patient probably requires referral to an allergy specialist for further evaluation. Urticarial reaction following the inhalation of nicotine in tobacco smoke. Many of my elderly patients have taken up walking for exercise, and an unfortunate result is that I have a lot of office visits for ankle sprains.
Ankle sprain is probably the most common acute musculoskeletal injury seen in primary care practice.
Although x-ray evaluation has become almost automatic, it is certainly not needed in all ankle injuries. On the basis of this information, it is evident that clinical methods can be used to determine the usefulness of x-ray films in diagnosis of ankle injury. Ankle fractures that are missed using these criteria tend to be insignificant, and their treatment is similar to that of sprains. I recommend that the OAR be considered along with the mechanism of injury, the medical history, and your own personal experience. These rules are not meant to be inviolably followed but rather to be used as clinical or decision-making guidelines.