Self cast removal?

[LadyMonteCarlo]

We had an elderly dementia patient in an assisted living facility with a wrist fracture that slipped his cast off of his arm. Obviously the swelling had subsided enough to allow this self removal. Slipped off as easily as a glove.

What would be the best immediate action to take?

[Marie_LPN, RN, LPN, RN]

Alert the on-call doc. Chances are they'll recommend a trip to the ER for an X-ray, since it's not determined if the fracture is healed or not.

One of our ortho docs has told nurses to try and put the cast back on (for stabilization) and wrap a gauze roll around it, weaving through the fingers, around the cast, and then around the arm, past the elbow, and tape the end (to attempt to keep the cast on), to try and prevent re-fracture, until a new cast can get applied.

[meownsmile, BSN, RN]

I would think anything to splint the arm, wrap with kerlix and send to ER for xray and new cast application if needed would be the best thing to do. I dont necissarily agree with slipping the cast back on because of the bacteria inside the cast could cause infection if you were to scrape the skin with any jagged edges of the old cast.

But why wasnt this cast being monitored in the first place. Was anyone checking the pressure points at the top and hand opening of the cast? They should have seen that it was getting to loose and not really doing any good and maybe should have been replace several days earlier? Just wondering.