The LSUHSC New Orleans Emergency Medicine Interest Group Presents The Student Procedure Manual

General Extremity Splinting

by Jude Reed

Indications
Prerequisites
Contraindications and Cautions
Equipment
Procedure
Follow-Up
Education Issues

Indications

• Fractures, dislocations, sprains, major lacerations, bites, stings, etc.
  
• The purpose of splinting is to immobilize the injured area to minimize further damage to tissue from unwanted motion.
  
• Splinting also helps reduce swelling and pain.
  
• The immobilization supplied by splinting prevents further soft tissue or bony damage, and speeds the healing process.

Prerequisites

• Test neurologic and blood supply to areas distal to injury.

Contraindications and Cautions

• Handle the damaged area with care to minimize movement to reduce risk of complications.
  
• Pad bony prominences and any area where splinting materials might rub and damage skin.
  
• If injury is to a bone immobilize joint above and below the site.
  
• If injury is to a joint immobilize the bone distal and proximal to the injury.
  If injury involves a joint, splint in position found.
  
• If injury involves a long bone, gentle longitudinal traction may be exerted during application.
  
• If circulatory compromise is found gently straighten to restore distal pulse.
  
• Make the splint fit the injury; do not force the injury to fit the splint.
  
• Keep attachment devices of splint from being placed directly over the site of injury.
  
• Assess and document neurovascular status before and after splinting.
  If deterioration occurs, the splint must be adjusted or reapplied.

Equipment

• Supplies needed varies greatly with the type of splint and area of injury
  
• Cast padding
  
• Ace wraps
  
• 2 inch tape
  
• Splint/plaster' material

Procedure

• Remove or cut away clothing over the injured site.
  
• Remove any object of clothing or objects in pockets that may cause irritation to-skin once splint is applied.
  
• Assess neurovascular function
  
• Measure area to be sprinted on the noninjured side to determine correct length.
  
• Pad bony prominences very well
  
• Remove jewelry
  
• Remove shoes and any tight fitting clothing proximal to the inj ury
  
• Dress open site of wound with sterile gauze

Follow-Up

• Care needs to be taken to insure that the patient properly maintains the sprinted area.
  
• The patient should be educated in the signs and symptoms of complications and asked to report or return for any such complications.

Education Issues

• Keep splint clean and dry
  
• Watch for color change in distal areas
  
• Report numbness or tingling in distal area
  
• Report any intensification of pain or pain not responding to pain meds
  
• Proper elevation of limb
  
• Proper use of ice and cooling,
  
• Avoid scratching
  
• Time that immobilization devices is to be used
  
• If patient's ability to ambulate is impaired, then instruct them in alternatives
  
• Asses patients need for help with task for daily living.

*Watch for 5 P's- pain, pallor, pulseless, parasthesias and paralysis consistent with a compartment syndromes vascular emergency.