Immediate life-saving interventions
›Critical injury exclusions
›If knee dislocation concern, reduction and vascular assessment pathway
›If open injury, antibiotics and tetanus pathway
›If compartment syndrome concern, emergent surgical consult
›Pain control escalation
›If severe pain, parenteral opioid titration with monitoring
›If sedation required for reduction of dislocation, procedural sedation pathway
Immobilization and Splinting
›Immobilization choice
›Knee immobilizer in full extension
›Hinged knee brace locked in extension if available
›Immobilization principles
›Extension to approximate tendon ends
›Avoid flexion positioning
›Neurovascular recheck after immobilization
›Adjuncts
›Elevation
›Ice
›Compression wrap if tolerated and no vascular compromise
›Reduction indications
›If concurrent patellar dislocation, reduction when safe
›If knee dislocation, emergent reduction with vascular precautions
›Analgesia and anesthesia options
›Non opioid analgesia
›Acetaminophen PO 1000 mg once
›Ibuprofen PO 400 mg once if no contraindication
›Naproxen PO 500 mg once if no contraindication
›Opioid titration
›Fentanyl IV 0.5 to 1 microgram per kg
›Repeat 0.25 to 0.5 microgram per kg every 5 minutes to effect
›Hydromorphone IV 0.2 to 0.5 mg
›Repeat 0.2 mg every 10 to 15 minutes to effect
›Regional anesthesia
›Femoral nerve block ultrasound guided
›Ropivacaine 0.5% 15 to 20 mL
›Maximum total ropivacaine 3 mg per kg
›Adductor canal block ultrasound guided
›Ropivacaine 0.5% 15 to 20 mL
›Sensory predominant option for anterior knee
›Procedural sedation if required
›Sedation setup
›Airway equipment at bedside
›Suction ready
›Continuous monitoring including capnography
›Ketamine IV
›Initial 1 mg per kg IV
›If inadequate, additional 0.5 mg per kg IV
›Repeat every 5 to 10 minutes to effect
›Propofol IV
›Initial 0.5 to 1 mg per kg IV
›If inadequate, 0.25 to 0.5 mg per kg IV boluses
›Repeat every 1 to 3 minutes to effect
›Post reduction requirements
›Neurovascular recheck
›Post reduction radiographs when dislocation reduced
›Immobilization in extension
Open fracture medications and timing
›Open injury antibiotics
›Cefazolin IV 2 g once
›If severe beta lactam allergy, clindamycin IV 900 mg once
›If gross contamination, add gentamicin IV 5 mg per kg once per local protocol
›Tetanus prophylaxis
›If unknown or incomplete immunization, tetanus toxoid vaccine
›If dirty wound and immunization incomplete or unknown, tetanus immune globulin per local protocol
›Wound care
›Sterile saline soaked dressing
›Avoid probing in ED
›Urgent orthopedics
DVT prophylaxis when relevant
›Risk assessment
›Lower limb immobilization
›Prior VTE
›Active malignancy
›Significant mobility limitation
›Prophylaxis decisions
›If high risk and prolonged immobilization anticipated, align with local protocol and orthopedics plan
›If imminent surgery planned, coordinate timing with orthopedics