Immediate life-saving interventions
›Limb threat mitigation
›If pulseless or poorly perfused limb, immediate reduction of suspected dislocation and vascular escalation
›If perfusion not restored, emergent vascular imaging and consultation
›If compartment syndrome concern, emergent orthopedic escalation
›Open fracture immediate pathway
›Sterile dressing coverage
›Antibiotics timing target within 60 minutes when feasible
›Tetanus prophylaxis logic
Immobilization and Splinting
›Lower extremity immobilization options
›Knee immobilizer
›Use for stable, minimally displaced injuries and comfort
›Posterior long-leg splint
›Use for pain control and swelling phase
›Ankle neutral positioning
›Immobilization principles
›Swelling-phase avoidance of circumferential casting
›Neurovascular reassessment after immobilization
›Elevation and ice guidance
›Weight-bearing status
›Non-weight-bearing until orthopedic plan clarified
›Reduction considerations for displaced tibial spine fracture
›Indications for ED reduction attempt
›Neurovascular compromise with suspected concomitant dislocation
›Severe deformity suggesting alternate injury pattern
›Typical tibial spine fracture reduction approach
›Gentle knee extension to reduce fragment elevation
›Avoid forceful repeated attempts
›Mechanical block to extension pathway
›Meniscal or ligament entrapment concern
›If persistent block, urgent orthopedic consultation
›Analgesia and anesthesia for acute knee injury
›Multimodal analgesia
›Acetaminophen oral 1000 mg every 6 hours as needed
›Ibuprofen oral 400 mg every 6 to 8 hours as needed
›Naproxen oral 500 mg then 250 mg every 8 to 12 hours as needed
›Opioid for severe pain
›Hydromorphone oral 1 to 2 mg every 4 to 6 hours as needed
›Morphine oral 5 to 10 mg every 4 hours as needed
›Procedural sedation if urgent manipulation required
›Sedation safety framework
›ACEP procedural sedation guideline alignment
›Continuous pulse oximetry and capnography when available
›Airway rescue capability immediately available
›Ketamine IV 0.5 to 1 mg/kg for dissociation
›Additional 0.25 to 0.5 mg/kg as needed
›Hypersalivation mitigation with suction readiness
›Propofol IV 0.5 to 1 mg/kg bolus
›Additional 0.25 to 0.5 mg/kg boluses as needed
›Hypotension risk monitoring
›Post-manipulation requirements
›Immediate neurovascular re-check
›Post-procedure radiographs
Open fracture medications and timing
›Antibiotic options for open fracture concern
›Cefazolin IV 2 g
›Repeat every 8 hours until operative management per local protocol
›Severe cephalosporin allergy
›Clindamycin IV 900 mg every 8 hours
›Farm contamination or gross soil contamination concern
›Add gentamicin dosing per weight and renal function per local protocol
›Tetanus prophylaxis
›If unknown or incomplete immunization
›Tetanus toxoid containing vaccine
›Tetanus immune globulin for dirty wound per immunization status
DVT prophylaxis when relevant
›Immobilization-associated thrombosis risk assessment
›Lower limb immobilization
›Prior venous thromboembolism
›Active malignancy
›Estrogen therapy
›Major trauma or surgery planned
›Prophylaxis planning
›Align with local orthopedic protocol
›If high risk and prolonged non-weight-bearing, prophylaxis discussion and documentation