›Avoid circumferential cast in first 5 to 7 days if swelling expected
›Two-finger tightness check
›Post-application checks
›Pain trend after splinting
›Distal perfusion and sensation reassessment
›Weight-bearing status
›Suspected syndesmotic injury
›Non-weight-bearing initially if moderate to severe pain
›Crutches instruction and safety
›Confirmed stable low-grade injury
›Protected weight-bearing in boot as tolerated
›Avoid pivot and external rotation
›Reduction scenarios
›Fracture-dislocation reduction pathway
›Traction and countertraction
›Recreate deformity to disengage if needed
›Gentle sustained traction
›Analgesia and sedation options
›Acetaminophen PO 1000 mg
›Maximum daily dose per patient factors
›Lower maximum in liver disease
›Ibuprofen PO 400 to 600 mg
›Every 6 to 8 hours as needed
›Avoid in significant renal disease or GI bleed risk
›Fentanyl IV 0.5 to 1 microgram/kg
›Repeat every 5 minutes to effect
›Respiratory monitoring and readiness
›Procedural sedation when required
›Ketamine IV 1 to 2 mg/kg
›Additional 0.5 mg/kg every 5 to 10 minutes as needed
›Airway equipment at bedside
›Propofol IV 0.5 to 1 mg/kg
›Additional 0.25 to 0.5 mg/kg every 2 to 3 minutes as needed
›Continuous capnography
›Post-reduction requirements
›Immediate neurovascular reassessment
›Post-reduction ankle radiographs
›Syndesmotic sprain without dislocation
›No reduction typically required
›Avoid forceful manipulation
Open fracture medications and timing
›Antibiotic timing targets
›As early as possible after identification
›First dose ideally within 60 minutes of presentation
›Do not delay for imaging if clinically obvious
›Contamination-based adjustments
›Freshwater exposure, add gram-negative coverage per local protocol
›Soil contamination, broaden anaerobic coverage per local protocol
›Tetanus prophylaxis logic
›Clean minor wound
›Booster if more than 10 years since last dose
›No immune globulin if completed series
›Dirty or major wound
›Booster if more than 5 years since last dose
›Immune globulin if unknown or incomplete series
DVT prophylaxis when relevant
›Risk assessment for lower limb immobilization
›High-risk features
›Prior venous thromboembolism
›Active cancer
›Major trauma or surgery planned
›Contraindications
›Active bleeding
›High bleeding risk
›Prophylaxis options per local protocol
›Low molecular weight heparin example
›Enoxaparin 40 mg subcut daily
›Renal dosing adjustment if eGFR low
›Documentation of decision and rationale
›Risk tier
›Planned duration linked to immobilization