Mrs. X was getting out of her car, when she slammed the car door on her knee, hurting it quite badly, even though there was no broken skin or bleeding. The knee became very swollen and painful within the first couple of hours, making it difficult to walk, so Mrs. X went to an emergency room to check her knee.

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Explanation:

1. After a cellular lesion, a complex cascade of biochemical and cellular interactions begins, mediated by the activity of multiple chemical agents, which cause changes in the microvasculature, as well as an increase in leukocytes in the area of the lesion, and finally the Signs of acute inflammatory response.

Together with the vascular changes secondary to an injury, the coagulation cascade is also activated, as a consequence of the endothelial lesion and the exposure of the tissue factor, and its interaction with the coagulation factor VII (proconvertin) . At present, factor VII next to its cofactor (the tissue factor) is considered the cornerstone of the activation of coagulatory processes.

2. Effects of ice: decreases circulation, metabolic activity and inflammation and numbs the skin. Benefits of ice: decreases pain, inflammation, swelling and muscle cramps.

Initially vasoconstriction occurs, both direct cooling of the smooth muscles of the vessels and by reflex excitation of adrenergic terminations. The

blood flow, blood viscosity is increased, fluid extravasation to the interstitium is reduced. By maintaining the cooling for more than 10 min. or in the event that the temperature reaches 10 ° C, vasodilation occurs followed by another vasoconstriction ("oscillating response" of Clarke and Lewis) as an effort by the body to maintain body temperature.

3. Ibuprofen inhibits the action of COX-1 and COX-2 enzymes. The anti-inflammatory effects of ibuprofen are the result of peripheral inhibition of prostaglandin synthesis subsequent to the inhibition of cyclooxygenase. Ibuprofen inhibits leukocyte migration to inflamed areas, preventing the release by cytokine leukocytes and other molecules that act on nociceptive receptors.

Ibuprofen, does not alter the pain threshold or modify brain prostaglandin levels, concluding that its effects are peripheral. Antipiresis is a consequence of peripheral vasodilation due to a central action on the temperature regulating center of the hypothalamus.

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