Immediate life-saving interventions
›Threatened limb or severe injury pathway
›If fracture-dislocation with neurovascular compromise, immediate reduction then splint
›If open fracture suspected, initiate antibiotics and tetanus pathway then urgent orthopedics
›If compartment syndrome concern, emergent orthopedics
Immobilization and Splinting
›Immobilization choices
›Posterior short leg splint
›Severe pain or inability to bear weight
›Stirrup splint
›Moderate sprain with lateral instability symptoms
›Posterior short leg plus stirrup
›Significant swelling with need for added stability
›Walking boot
›Functional support with early weight-bearing as tolerated
›Lace-up ankle brace
›Mild to moderate sprain with early mobilization plan
›Immobilization principles
›Swelling-phase avoidance of circumferential casting
›Neutral ankle position
›Recheck neurovascular status after application
›Crutches or cane plan aligned with weight-bearing status
›Reduction pathway when deformity present
›Indications
›Fracture-dislocation
›Threatened skin
›Neurovascular compromise
›Analgesia and anesthesia options
›Oral and parenteral analgesia
›Acetaminophen PO 1000 mg once
›Maximum 4000 mg per 24 hours
›Ibuprofen PO 400 mg once
›Repeat every 6 to 8 hours as needed
›Maximum 2400 mg per 24 hours
›Naproxen PO 500 mg once
›Repeat 250 to 500 mg every 12 hours as needed
›Maximum 1000 mg per 24 hours
›Procedural sedation when required
›Continuous monitoring
›Cardiac monitor
›Rhythm and rate targets per local protocol
›Pulse oximetry
›Oxygen saturation trend
›Capnography
›Ventilation trend
›Airway readiness
›Suction setup
›Bag-valve-mask
›Rescue airway devices
›Technique principles
›Traction and countertraction
›Deformity exaggeration then reverse mechanism as appropriate
›Gentle sustained force
›Avoid repeated forceful attempts
›Post-reduction requirements
›Immediate neurovascular re-check
›Post-reduction radiographs
›Immobilization in stable position
›Failed reduction pathway
›If persistent neurovascular deficit, immediate orthopedics and vascular
›If irreducible, urgent orthopedics
Open fracture medications and timing
›Open injury pathway when suspected
›Antibiotics
›Cefazolin IV 2 g once
›Repeat every 8 hours if ongoing inpatient care
›If severe beta-lactam allergy, clindamycin IV 900 mg once
›Repeat every 8 hours if ongoing inpatient care
›Tetanus prophylaxis
›If unknown or incomplete immunization and dirty wound, tetanus immune globulin plus vaccine per local protocol
›If immunization up to date, booster timing per local protocol
›Wound management basics
›Sterile dressing
›Gross contamination removal without aggressive probing
›Urgent orthopedics
DVT prophylaxis when relevant
›Lower limb immobilization risk assessment
›Prior venous thromboembolism
›Active cancer
›Major immobility
›Hormonal therapy
›Pregnancy or postpartum
›Local protocol alignment
›Pharmacologic prophylaxis per institutional guideline if high risk
›Mechanical prophylaxis and mobilization encouragement when appropriate
Symptom control and rehab start
›Early functional rehabilitation emphasis
›Range of motion progression as pain allows
›Strengthening progression
›Proprioception and balance training
›Acute care options
›Protection and optimal loading approach
›Ice for short-term analgesia
›Compression wrap
›Elevation above heart level