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
Show 47 more ▾