ACEP procedural sedation clinical policy Level B and Level C recommendations for monitoring and preparedness
Patient Discharge Instructions
copy discharge instructions
Discharge guidance set
Splint care
Keep splint clean and dry
Do not insert objects inside splint
Check toes for color and warmth several times daily
Swelling control
Elevation above heart as much as possible for first 48 to 72 hours
Ice over splint at intervals if tolerated
Activity
Non-weight-bearing on injured leg unless explicitly cleared
Crutches or walker use until follow-up
Pain plan
Acetaminophen as first-line per label and clinician plan
Ibuprofen if safe per clinician plan
Opioid only if prescribed
Return to ED now
Increasing pain not controlled with medication
New numbness or tingling in foot or toes
Inability to move toes
Toes becoming pale, blue, or cold
Increasing tightness or severe pain with toe movement
Splint feels too tight or causes new pressure pain
Fever or wound drainage
Bleeding through dressing
Follow-up
Orthopedics appointment within instructed timeframe
Return earlier if symptoms worsen
References
Clinical guidelines and evidence sources
Core sources
BOAST guideline on open fractures of the lower limb
Early antibiotics emphasis
Multidisciplinary open fracture care standards
AAOS and orthopedic society guidance on tibial shaft fracture management principles
Operative fixation indications
Alignment and follow-up principles
ATLS principles for long bone trauma and polytrauma triage
Hemorrhage and shock prioritization
Secondary survey and associated injury detection
ACEP clinical policy on procedural sedation and analgesia in the emergency department
Monitoring and preparedness recommendations
Evidence levels Level B and Level C statements
Evidence and outcomes themes
Open fracture infection prevention evidence
Time to antibiotics associated with infection risk reduction
Compartment syndrome diagnostic principles
Clinical diagnosis priority over laboratory markers
Intracompartmental pressure measurement adjunct in equivocal cases
Source file citation
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