Critical patient first 5 minutes
›Immediate actions if unstable or limb threatened
›Monitoring and access
›Cardiac monitor for systemic illness or ischemia concern
›Two large bore IV if sepsis or shock concern
›Perfusion threats
›If pulseless limb then emergent vascular and ortho consult
›If compartment syndrome concern then emergent ortho consult
›Sepsis threats
›If sepsis physiology then lactate and blood cultures
›Antibiotics within 1 hour if septic shock concern
Analgesia and immobilization
›Pain control options
›Acetaminophen
›Adult dose 1000 mg PO every 6 hours as needed
›Maximum 3000 mg per day typical outpatient
›Ibuprofen
›Adult dose 400 mg PO every 6 hours as needed
›Avoid in CKD or GI bleed risk
›Naproxen
›Adult dose 500 mg PO once then 250 mg PO every 12 hours as needed
›Avoid in CKD or GI bleed risk
›Topical diclofenac
›1 percent gel to affected area up to 4 times daily
›Avoid on broken skin
›Opioid limited rescue
›Hydromorphone 1 mg PO every 6 hours as needed
›Avoid with sedation risk and combine with bowel regimen
›Immobilization and support
›Sling for comfort
›Short term use to avoid stiffness
›Early gentle range of motion when safe
›Posterior long arm splint indications
›Suspected fracture
›After dislocation reduction
Infection and inflammatory treatment
›Suspected septic arthritis management
›Consult orthopedics
›Urgent source control planning
›Aspiration coordination
›Empiric antibiotics after cultures when possible
›Vancomycin IV local protocol dependent
›Add ceftriaxone IV if gram negative risk local protocol dependent
›Suspected septic olecranon bursitis management
›Aspiration if feasible
›Gram stain and culture
›Cell count and crystals
›Oral antibiotics if mild and no systemic illness local protocol dependent
›Cephalexin 500 mg PO four times daily
›TMP SMX DS 1 tab PO twice daily if MRSA risk
›Suspected gout flare management
›NSAID option if no contraindications
›Naproxen regimen as above
›Avoid in CKD or GI bleed risk
›Colchicine option early in flare
›Adult dose 1.2 mg PO once then 0.6 mg PO 1 hour later
›Then 0.6 mg PO daily or twice daily as tolerated
›Oral corticosteroid option if NSAID and colchicine not suitable
›Prednisone 30 mg to 40 mg PO daily for 5 days
›Caution with diabetes and active infection concern
›Interval reassessment targets
›Pain score and function
›Recheck 30 to 60 minutes after analgesia
›Ability to flex extend pronate supinate
›Neurovascular status
›Repeat after splinting
›Repeat after reduction
›Infection trajectory
›Recheck vitals
›Recheck erythema borders if cellulitis