Immediate life-saving interventions
›Immediate threats
›If respiratory distress or chest injury concern then chest imaging priority
›Chest radiograph
›POCUS pleural evaluation when available
›If tension pneumothorax concern then immediate decompression
›Needle decompression per local protocol
›Tube thoracostomy preparation
›If hard signs of vascular injury then immediate surgical escalation
›Vascular surgery notification
›CTA when not delaying operative control
›If open fracture then antibiotics and tetanus pathway without delay
›Sterile coverage
›Hemorrhage control with direct pressure
Immobilization and Splinting
›Immobilization selection
›Upper extremity options list
›Sling
›Shoulder immobilizer
›Figure of eight brace
›Posterior long arm splint
›Coaptation splint
›Typical selection for clavicle fracture
›Sling
›Shoulder immobilizer when additional comfort needed
›Principles
›Hand and wrist free for motion
›Elbow supported for comfort
›Swelling phase avoidance of tight straps
›Reassessment after immobilization
›Pain trend
›Neurovascular exam repeat
›Reduction considerations
›Routine closed reduction not performed for isolated clavicle fractures
›Outcomes not improved with manipulation in most patterns
›Pain and swelling limitation
›If threatened skin from sharp fragment then urgent orthopedics management
›Class I recommendation for emergent specialist evaluation for impending open fracture
›Avoid repeated manipulation attempts in ED
›If SC posterior dislocation suspected then specialist reduction pathway
›Reduction in monitored setting
›Surgical backup available
Open fracture medications and timing
›Antibiotics and tetanus
›Antibiotic timing
›First dose as early as feasible
›Documentation of administration time
›Antibiotic selection
›Cefazolin IV for type I and II open fracture patterns
›Adult dose 2 g IV
›If weight 120 kg or greater then 3 g IV
›If severe cephalosporin allergy then clindamycin IV
›Adult dose 900 mg IV
›If gross contamination or farm injury concern then add gram negative coverage per local protocol
›Gentamicin IV dosing per weight and renal function
›Therapeutic drug monitoring when continued
›Tetanus prophylaxis
›If unknown or fewer than 3 doses then tetanus vaccine
›If dirty wound and unknown or fewer than 3 doses then tetanus immune globulin
DVT prophylaxis when relevant
›VTE prophylaxis
›Routine pharmacologic prophylaxis not indicated for isolated upper extremity sling
›Low baseline VTE risk
›Early ambulation typical
›Consider prophylaxis when high risk and immobilized or admitted
›Active malignancy
›Prior VTE history
›Prolonged hospitalization
›Agent selection aligned with institutional protocol
›Enoxaparin prophylaxis dosing
›Mechanical prophylaxis when anticoagulation contraindicated