›Indications for urgent realignment
›Threatened skin over olecranon
›Fracture dislocation component
›Neurovascular compromise
›Analgesia and anesthesia options
›Non opioid analgesia
›Acetaminophen PO 1000 mg
›Maximum 4000 mg per 24 hours
›Ibuprofen PO 400 mg
›Typical maximum 2400 mg per 24 hours
›Opioid options
›Hydromorphone IV 0.2 mg to 0.5 mg
›Titration every 10 minutes to comfort
›Respiratory depression monitoring
›Regional anesthesia options
›Brachial plexus block support by trained clinician
›Ultrasound guidance when available
›Local anesthetic systemic toxicity monitoring
›If neurologic symptoms or arrhythmia, initiate lipid emulsion rescue per protocol
›Procedural sedation pathway when needed
›Monitoring and readiness
›Continuous pulse oximetry
›Continuous ECG
›Capnography when available
›Suction ready
›Sedation options
›Ketamine IV 1 mg/kg
›Additional 0.5 mg/kg as needed
›Emergence reaction mitigation plan
›Propofol IV 0.5 mg/kg
›Additional 0.25 mg/kg to 0.5 mg/kg as needed
›Hypotension monitoring
›Technique principles
›Gentle sustained traction and countertraction
›Avoid repeated forceful attempts
›Alignment to reduce skin tension when tenting present
›Post reduction requirements
›Immediate neurovascular recheck
›Post reduction radiographs
›Posterior long arm splint reapplication and molding
›Failed reduction pathway
›Persistent deformity with instability concern triggers urgent orthopedics
›Persistent neurovascular deficit triggers immediate escalation
Open fracture medications and timing
›Antibiotics
›Cefazolin IV 2 g
›Repeat dosing per operative timing and local protocol
›Severe cephalosporin allergy
›Clindamycin IV 900 mg
›Gross contamination or farm injury concern
›Add gentamicin IV 5 mg/kg per protocol
›Tetanus prophylaxis
›Unknown or incomplete immunization
›Tdap
›Tetanus immune globulin per protocol
›Up to date immunization
›Tdap if due by schedule
›Wound care
›Sterile moist dressing
›No aggressive ED debridement
›Irrigation when heavily contaminated if it does not delay antibiotics and transfer
DVT prophylaxis when relevant
›Upper extremity immobilization
›Routine pharmacologic prophylaxis not typical for isolated ambulatory upper extremity injuries
›Elevated risk scenarios
›Prolonged immobility
›Active malignancy
›Prior VTE
›Concurrent lower limb immobilization
›Anticoagulation decisions aligned with local protocol and surgical plan