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in·ter·nal in·ju·ry(in-tĕr'năl in'jŭr-ē)
Symptoms vary depending on the structures involved. Shock is often present, manifested by hypotension and tachycardia. The patient may be pale, cold, and perspiring freely and have an altered state of consciousness. In some internal injuries, pain may not be expressed.
The patient's vital signs should be monitored carefully and frequently. Changes in level of consciousness should be noted. If the patient is in shock, the shoulders should be lowered and the lower extremities elevated. Intravenous infusions, oxygen, airway management, cardiac monitoring, control of hemorrhage, and bony stabilization are quickly begun pending definitive surgical management.