›Avoid circumferential cast in acute swelling phase
›Two-finger tightness check
›Post-immobilization checks
›Repeat motor and sensory exam
›Repeat perfusion exam
›Reduction pathway
›Indications
›Elbow dislocation
›Neurovascular compromise
›Threatened skin
›Analgesia and anesthesia
›Non-opioid analgesia
›Acetaminophen PO 1000 mg every 6 to 8 hours
›Ibuprofen PO 400 to 600 mg every 6 to 8 hours with food
›Opioid analgesia for severe pain
›Hydromorphone PO 1 to 2 mg every 4 to 6 hours as needed
›Oxycodone PO 5 mg every 6 hours as needed
›Procedural sedation when required
›Monitoring and readiness
›Cardiac monitor
›Continuous pulse oximetry
›Capnography
›Airway equipment at bedside
›Ketamine IV option
›Initiate 1 mg/kg IV
›If inadequate sedation after 2 minutes, additional 0.5 mg/kg IV
›Emergence reactions management
›If agitation, midazolam IV 0.5 to 1 mg
›Propofol IV option
›Initiate 0.5 to 1 mg/kg IV
›Additional 0.25 to 0.5 mg/kg IV every 1 to 3 minutes to effect
›Technique principles
›Traction and countertraction
›Gentle sustained force
›Avoid repeated forceful attempts
›Post-reduction requirements
›Immediate neurovascular re-check
›Post-reduction radiographs
›Immobilization in stable position
›Failed reduction pathway
›Persistent neurovascular deficit triggers immediate specialist escalation
›Irreducible dislocation triggers urgent orthopedics
Open fracture medications and timing
›Open fracture medication pathway
›Antibiotics
›Cefazolin IV 2 g every 8 hours
›If severe beta-lactam allergy, clindamycin IV 900 mg every 8 hours
›Gross contamination or farm injury
›Add gentamicin IV 5 mg/kg once daily
›Tetanus prophylaxis
›Unknown or incomplete immunization
›Tetanus toxoid vaccine
›Tetanus immune globulin
›Up to date immunization
›Booster per schedule and wound risk
DVT prophylaxis when relevant
›Thrombosis prevention
›Not routine for isolated upper extremity immobilization
›Low baseline VTE risk
›Individualized consideration
›Prior VTE history
›Active malignancy
›Prolonged immobility
›Alignment with local protocol
›Documentation of rationale