History

Presentation context

Cast or splint details

Symptom trajectory

Baseline function

OPQRST

Onset

Provocation and palliation

Quality

Region and radiation

Severity

Timing

Associated symptoms

Neurovascular symptoms

Local skin symptoms

Systemic symptoms

Thromboembolic symptoms

Alarm Features

Immediate limb threat triggers

Compartment syndrome concern

Acute neurovascular compromise

Infection with systemic toxicity

Vital sign danger thresholds

Physiologic instability

High risk historical triggers

High risk mechanism or condition

Medications

Current and recent medications

Analgesics and antiinflammatories

Anticoagulants and antiplatelets

Antibiotics

Steroids and immunosuppressants

Medication risk modifiers

Bleeding and hematoma risk

Infection risk

Diet

Hydration and nutrition considerations

Hydration status

Nutrition impacting healing

Review of Systems

Neurovascular and limb symptoms

Neurologic

Vascular

Skin

Systemic and thromboembolic symptoms

Infectious and inflammatory

Cardiopulmonary

Collateral History and Family History

Collateral sources and reliability

Collateral details

Reliability factors

Family history relevant to complications

Thrombosis history

Bleeding disorders

Risk Factors

Cast and immobilization related risks

Mechanical risks

Skin integrity risks

Thrombosis and bleeding risks

VTE risk

Bleeding risk

Differential Diagnosis

Life threatening

Limb and life threats

Common

Frequent complications

Less common

Other considerations

Past Medical History

Relevant comorbidities

Conditions increasing complication risk

Prior procedures and baseline status

Prior limb history

Prior thromboembolism

Physical Exam

Initial and repeat neurovascular exam

Perfusion and pulses

Sensation and motor

Cast and limb inspection

External cast findings

Limb findings after removal if performed

System exam for systemic complications

Cardiopulmonary

General appearance

Lab Studies

Infection and systemic illness labs

Inflammatory markers and infection

Metabolic and end organ assessment

Rhabdomyolysis and compartment related labs

Muscle injury assessment

Thrombosis evaluation

VTE testing logic

Imaging

Scoring Systems

VTE pretest probability tools

Compartment syndrome criteria framework

MRI

Indications

Constraints and timing

CT

Indications

Contrast cautions

Ultrasound

DVT evaluation

Soft tissue evaluation

POCUS vascular

Special Tests

Bedside maneuvers and measurements

Compartment syndrome bedside findings

Neurovascular adjuncts

Cast related evaluation

Invasive diagnostics when indicated

Intracompartmental pressure measurement

ECG

Indications in cast or splint complications

Cardiopulmonary concern

Systemic illness concern

High risk patterns to recognize

PE related patterns

Hyperkalemia related patterns

Assessment

Problem representation

Working problem list

Severity and risk stratification

Limb threat stratification

Infection stratification

VTE stratification

Plan

First 5 minutes workflow

Immediate actions for suspected limb threat

Monitoring and access

Analgesia and symptom control

Pain control approach

Medication cautions

Diagnostic plan and sequencing

Decision sequence

Testing by scenario

Reassessment loop

Scheduled reassessment

Escalation triggers

Disposition

Level of care criteria

ICU or monitored setting

Inpatient admission

Observation pathway

Discharge criteria

Follow up timing

Orthopedics or fracture clinic

Primary care

Discharge Instructions

Copy discharge instructions

Your cast or splint was checked for problems and adjusted as needed

Keep the cast or splint clean and dry

Elevation and swelling control

Pain medicines

Follow up

References

Guidelines and key sources

American Academy of Orthopaedic Surgeons cast care patient guidance

British Orthopaedic Association Standards for Trauma compartment syndrome guidance

NICE venous thromboembolic diseases guideline NG158 2020

CHEST antithrombotic therapy for VTE disease guideline update 2021

International guideline on pressure injury prevention and treatment 2019