Common Emergency Procedures



Common Emergency Procedures


Angelo Mikrogianakis

Christina Ricks



Procedures



  • Orthopedic splints


  • Laceration repair: suturing and glueing


  • Lumbar puncture


  • Chest tube insertion


Orthopedic Splints


Materials



  • Stockingette, webril, plaster, kling wrap, flannel, water (cast setup)


Instructions for All Splints



  • Position patient


  • Place stockingette over extremity (measurements should be taken on unaffected side)


  • Wrap extremity in webril: extra padding is needed over bony prominences


  • Dip measured plaster (10 layers) in water and squeeze out excess


  • Place plaster over affected extremity, wrap with kling and mold into proper position. If second layer of plaster (tong or stirrup) needed for reinforcement around joints, mold first layer, then apply stirrup, wrap in kling, and mold second layer.


  • Finally, wrap completed splint in flannel. Secure with tape for a nice-looking cast.









Table 62.1 Orthopedic Splints






























TYPE OF SPLINT


INDICATION


Volar (short arm)


Nondisplaced distal forearm and wrist fractures


Sugar tong, forearm


Nondisplaced distal radio-ulnar fractures


Sugar tong, humerus


Stable distal humeral fractures (e.g. supracondylar)


Thumb spica


Stable fracture of metacarpal/proximal phalanx of thumb and scaphoid fractures


Ulnar gutter


4th and 5th metacarpal and proximal phalangeal fractures


Long arm


Stable fractures around elbow joint


Short leg


Stable distal tibia/fibular fractures, and ankle injuries


Long leg


Stable fractures of proximal tibia/fibula, distal femur fractures, and knee injuries



Instructions for Specific Splints


Volar Splint



  • Begins at MCP joints and courses along volar surface of forearm to mid forearm, covering ulna and radius


  • Position child supine on bed with elbow at 90° or child may sit with fingers pointing up and elbow flexed 90°


  • Mold plaster with wrist in neutral position and fingers flexed at all joints






Figure 62.1 Volar Splint



Sugar Tong, Forearm Splint



  • Should cover ulnar and radial edges of forearm and course along dorsal surface from MCP around elbow to palmar crease


  • Place child prone with affected arm hanging toward floor and elbow flexed 90°, or sitting with elbow flexed 90°


Sugar Tong, Humeral Splint



  • First place long arm splint


  • Sugar tong: splint from acromioclavicular joint around elbow, ending just distal to axilla


  • Place child in sitting position, elbow flexed 90°, and humerus internally rotated


Thumb Spica Splint



  • Position arm with elbow resting on bed


  • Splint should wrap around thumb and extend along radial side of arm to mid forearm


  • Wrist should be in neutral position with thumb abducted and MCP and PIP in slight flexion as if holding a cup






Figure 62.2 Thumb Spica Splint


Ulnar Gutter Splint



  • Position arm with elbow resting on bed at 90°


  • Splint wraps around ulnar surface from DIP of 5th digit to mid forearm.

    Cotton padding should wrap around 4th and 5th digits. Place additional cotton padding between digits for comfort.



  • Splint should be molded with wrist in neutral position and MCP and PIP in 70° and 30° of flexion, respectively






Figure 62.3 Ulnar Gutter Splint


Long Arm Splint



  • Should extend from dorsal surface of upper arm, down around elbow, along ulnar surface of forearm to palmar crease


  • Child may lie prone with arm hanging over bed and elbow at 90°, or sitting on bed with elbow at 90°


  • Mold plaster with elbow at 90° and wrist in neutral position


  • To reinforce splint, place humeral sugar tong splint over long arm splint


Short Leg Splint



  • Should extend from fibular neck to proximal toes, covering dorsum of lower leg


  • Position child prone on bed with knee flexed and foot extended toward ceiling


  • Mold splint with ankle at 90°. May strengthen splint by applying a stirrup (sugar tong) splint. Stirrup should wrap around heel of foot and extend up to mid lower leg, bilaterally


  • Give crutches to those 6 years and older, with instruction


Long Leg Splint



  • Consider orthopedic consult as growth disturbances are common around knee



  • Should cover posterior aspect of upper and lower leg extending from proximal thigh to heel distally


  • Place child prone on bed with leg in position of comfort, or supine with someone supporting leg


  • Mold plaster with knee in slight flexion and ankle in neutral. May need reinforcement around knee to prevent cast from cracking


  • Give crutches to those 6 years and older, with instruction


Laceration Repair: Suturing

Superficial: a superficial laceration is restricted to the epidermis

Deep: a deep wound extends beyond epidermis into dermis


Sutures

Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Common Emergency Procedures

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