2 questions re: fractures

[queenjean]

1. Who typically applies the casts in the ER setting? My book indicates that it is usually the physician; my experience in floating is that it is the ER nurse. Is this considered out of the scope of nursing practice, or does it vary from state to state, or facility to facility?

2. When a pt is in Buck's traction, should the traction be removed for activities like rolling the pt for repositioning and bedpan use, to be reapplied afterwards, or should it be left in place at all times, only removed for skin assessment?

Thanks.

[Daytonite, BSN, RN]

I've never known of anyone other than the doctors to apply casts to a fractured limb. We very seldom removed the weight from patient's in Buck's traction, but it can be done. The patient can be rolled and moved with the traction applied if done carefully. Removing the traction usually is a lot more painful for them since the traction is helping to relieve muscle spasm.

[AnnieOaklyRN, BSN, RN, EMT-P]

hi,

Casts are very rarely applied in an ED to fx because of the swelling that will occur in the extremity. Putting a cast on would chance cutting off the circulation to the extremity with the swelling that occurs. In the rare cases that a cast is applied it is usually done on a pretty unstable fx and the patient is usually admitted into the hopsital since they will require ORIF (open reduction internal fixation). Casts are usually applied by ether an orthopedic tech or an orthopedic physician. A lot of training is needed to apply these since not putting them on correctly can result in a lot of problems.

Normally ortho glass is applied or something similar, this is just a few peices of fiberglass in between a couple layers of cotton. it is moistened with water and applied secured with an ace bandage. It is very flexable and molable until it drys in about 5 minutes, sometimes quicker. This type of splint allows the extremity to expand with the swelling. The person will be reffered to an orthopedic physician and they may have a cast applied about a week later. Depending on the ER a nurse, ED tech, or orthotech may apply this type of splint. Some training is requred to apply these as well, but they are a lot easier than applying a cast and they are a little lest risky, but can still cause serious skin breakdown/infections if not applied correctly.

Hope this helps.

Swtooth

[steelcityrn, RN]

good info swtooth!