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King Saud University

College of Nursing

Splinting in the Emergency Room

Hatem Alsrour
Why Do We Splint?

• To stabilize the extremity


• To decrease pain
• Actually treat the injury
Complications of Splinting

• Abrasions
• Sores
• Neurovascular compromise (tight fitting
splints)
• Contact dermatitis
• Pressure ulcers
• Thermal burns
How to prevent complications
• Apply splint by trained
professional

Apply splint correctly

Monitor neurovascular status.


The 6 P’s of extremity assessment
Pain: Pallor: Pulses:
Palpate the Note color and Palpate
entire extremity temperature and proximal and
for increase pain capillary refill distal pulses
Paresthesia: Paralysis: Pressure:
Assess for Assess motor Palpate for
burning, function (both firmness of
tingling, active and compartment
numbness passive
Equipment need for application
• Cotton bandage( soft roll, cotton roll) Pad
entire area to be splinted
• Plaster slabs or pre padded fiberglass
(Orthoglass), immobilize above and below
injury
• Room temperature water (apply generously)
• Elastic bandage
• Adhesive tape or fastners
Types of Splints
•Yes,its broken and needs
a splint!

•Why sure Doctor, not a


• problem!
Volar Splint
• The Volar short arm
splint is used for:
• Fractures of the wrist
• Fractures of the
second to fifth
metacarpals,
• Carpal tunnel
syndrome
• Soft tissue injuries
Finger Splint
• Finger Splints are used
for phalangeal
fractures
• (A&B) commercial
splints
• © is custom splint
Gutter Splint
• Two types: radial and
ulnar
• Gutter splints are used
for:
• Phalangeal fractures
• Metacarpal fractures
• Two types: radial and
ulnar
Figure Eight Splint
• Used to stabilize a
clavicle fracture
• To be applied properly
the patient must be
erect with hands on his
iliac crest with
shoulders in abduction
(as seen in picture)
Buddy taping of toes
• Secure the fractured
toe to the adjacent toe
with adhesive strips
• Sheet wadding
between toes prevents
maceration
Posterior Leg Splint
• This splint is used for:
• Distal leg fractures
• Ankle fractures
• Tarsal fractures
• Metatarsal fractures
Stirrup Splint
• To prevent inversion
or eversion of the
ankle
• Immobilizes the ankle
for fractures near the
ankle
• Apply from below the
knee and wrap around
the ankle
Thumb Spica Splint
• This splint is used for :
• Scaphoid fractures
• Extraarticular
fractures of the thumb
• Ulnar collateral
ligament injuries
What do you do after you have
applied your splint???

1.Have MD/PA evaluate splint


2.Document what you have done!!!
Documentation
• Which Splint you • Condition of any
applied wound
• Which extremity you • How the patient
applied the splint to tolerated the procedure
• 6 P’s • Which MD/PA
• Time you applied the evaluated splint and
splint time
Application of Splints
• Follow up on the floor • Gutter splint
and perform the • Volar splint
following splints • Thumb Spica
under the observation
• Posterior leg splint
of your preceptor
• Stirrup leg splint
• Clavicle Brace
Cast Care Introduction
• The function of a cast is to rigidly protect an injured bone
or joint. It serves to hold the broken bone in proper
alignment to prevent it from moving while it heals.
• Casts may also be used to help rest a bone or joint to
relieve pain that is caused by moving it (such as when a
severe sprain occurs, but no broken bones).
• Different types of casts and splints are available,
depending on the reason for the immobilization and/or the
type of fracture.
• Casts are usually made of either plaster or fiberglass
material.
Fracture Types and Healing
• A fractured bone is the same as a broken bone. Most fractures happen
because of a single and sudden injury. The diagnosis of a fracture is usually
made with an x-ray film.
– A simple (or closed) fracture has intact skin over the broken bone.
– An open fracture is also called a compound fracture. This means that a cut or
wound exists on the skin near the broken bone. If the cut is very severe, the edges of
the bone may be seen coming out from the wound.
– A stress fracture can result from many repeated small stresses on a bone.
Microscopic fractures form and, if not given time to heal, can join to form a stress
fracture. These types of fractures are usually seen in athletes or soldiers who
perform repetitive vigorous activities.
– A pathologic fracture happens with minimal or no injury to an abnormal bone.
This is usually caused by an underlying weakness or problem with the bone itself,
such as osteoporosis or tumor.
• When a bone is fractured, it may require a reduction or realignment to put
the ends of the fracture back into place. A doctor will do this by moving the
fractured bone into alignment with his or her hands. If a bone has a fracture
but is not out of position or deformed, no reduction is necessary.
• When the ends of the bone are aligned, the injured bone requires support and
protection while it heals. A cast or splint usually provides this support and
protection.
• Many factors affect the rate at which a fracture heals and the amount of time
a person needs to wear a cast. Ask a doctor how much time the specific
fracture will take to heal.
Types of Casts and its Indication

• Airplane Cast
Humerous and shoulder joint with
compound fracture
Basket Cast
Severe leg trauma with open
wound or inflammatin
Body Cast
Lower dorso-lumbar spine
affection
Boot Leg Cast
Hip and femoral fracture
Cast Brace
Fracture of the femur (distal
curve) with flexion and extension
Collar Cast
Cervical affection
Cylindrical Leg Cast
Fractured patella
Double Hip Spica Mold
Cervical affection with callus
formation
Frog Cast
Congenital hip dislocation
Functional Cast
Fractured humerous with
abduction and adduction
Hanging Cast
Fractured shaft of the humerous
Internal Rotator Splint
post hip operation
Long Arm Circular Cast
Fractured radius and ulna
How Casts Are Applied
• Cast application
– Before casting material is applied (plaster or fiberglass), a "stockinette" is usually placed on the skin
where the cast begins and ends (at the hand and near the elbow for a wrist cast). This stockinette protects
the skin from the casting material.
– After the stockinette is placed, soft cotton batting material (also called cast padding or Webril) is rolled
on. This cotton batting layer provides both additional padding to protect the skin and elastic pressure to
the fracture to aid in healing.
– Next, the plaster or fiberglass cast material is rolled on while it is still wet.
– The cast will usually begin to feel hard about 10-15 minutes after it is put on, but it takes much longer to
be fully dry and hard.
– Be especially careful with the cast for the first 1-2 days because it can easily crack or break while it is
drying and hardening. It can take up to 24-48 hours for the cast to completely harden.
• Plaster casts
– A plaster cast is made from rolls or pieces of dry muslin that have starch or dextrose and calcium sulfate
added.
– When the plaster gets wet, a chemical reaction happens (between the water and the calcium sulfate) that
produces heat and eventually causes the plaster to set, or get hard, when it dries.
– A person can usually feel the cast getting warm on the skin from this chemical reaction as it sets.
.
– Plaster casts are usually smooth and white.
• Fiberglass casts
– Fiberglass casts are also applied starting from a roll that gets wet.
– After the roll gets wet, it is rolled on to form the cast. Fiberglass casts also get warm and harden as they
dry.
• Fiberglass casts are rough on the outside and look like a weave when they dry. Some
fiberglass casts may even be colored
Nursing Care
• Handle wet cast with palms of the hands, not the fingers. Doing
so may cause flattering or indentions in the cast that might
cause pressure problems.
• Cast should be allowed to air dry.
• Elevate the cast on one to two pillows during drying.
• Observe ‘hot spot” and musty color. These are signs and
symptoms of infection.
• Maintain skin integrity.
• Do neurovascular checks:
– Skin color
– Skin temperature
– Sensation
– Mobility
– Pulse
• Assess for vascular occlusion
• Adhesive tape petals reduce irritation at cast edges.
Cast Care Instruction
• Keep the cast clean and dry
• Check for cracks or breaks in the cast
• Rough edges can be padded to protect the skin from scratches
• Do not scratch the skin under the cast by inserting objects inside the cast
• Can use a hairdryer placed on a cool setting to blow air under the cast and
cool down the hot, itchy skin. Never blow warm or hot air into the cast
• Do not put powders or lotion inside the cast
• Cover the cast while your child is eating to prevent food spills and crumbs
from entering the cast
• Prevent small toys or objects from being put inside the cast
• Elevate the cast above the level of the heart to decrease swelling
• Encourage your child to move his/her fingers or toes to promote circulation
• Do not use the abduction bar on the cast to lift or carry the child.
Ice and Elevation
• A doctor may want the person to use ice to help decrease
the swelling of the injured body part. (Check with a
physician before using ice.)
• To keep the cast from becoming wet, put ice inside a
sealed plastic bag and place a towel between the cast and
the bag of ice.
• Apply ice to the injury for 15 minutes each hour (while
awake) for the first 24-48 hours.
• Try to keep the cast and injured body part elevated above
the level of the heart, especially for the first 48 hours after
the injury occurs.
• Elevation will help to decrease the swelling and pain at the
site of the injury.
• Propping the cast up on several pillows may be necessary
to help elevate the injured area, especially while asleep.
How a Cast Is Removed
• Do not try to remove the cast.
• When it is time to remove the cast, the doctor will take it off with a cast saw and a
special tool.
– A cast saw is a specialized saw made just for taking off casts. It has a flat and rounded metal
blade that has teeth and vibrates back and forth at a high rate of speed.
– The cast saw is made to vibrate and cut through the cast but not to cut the skin underneath.
– After several cuts are made in the cast (usually along either side), it is then spread and
opened with a special tool to lift the cast off.
– The underlying layers of cast padding and stockinette are then cut off with scissors.
• After a cast is removed, depending on how long the cast has been on, the underlying
body part may look different than the other uninjured side.
– The skin may be pale or a different shade.
– The pattern and length of hair growth may also be different.
– The injured part may even look smaller or thinner than the other side because some of the
muscles have weakened and have not been used since the cast was put on.
• If the cast was over a joint, the joint is likely to be stiff. It will take some time and
patience before the joint regains its full range of motion.
Complications
• Many potential complications are related not only to wearing a cast but also to
the healing of the underlying fracture.
• Immediate complications
• Compartment syndrome
– Compartment syndrome is a very serious complication that can happen because of
a tight cast or a rigid cast that restricts severe swelling.
– Compartment syndrome happens when pressure builds within a closed space that
cannot be released. This elevated pressure can cause damage to the structures
inside that closed space or compartment—in this case, the muscles, nerves, blood
vessels, and other tissues under the cast.
– This syndrome can cause permanent and irreversible damage if it is not discovered
and corrected in time.
– Signs of compartment syndrome
• Severe pain
• Numbness or tingling
• Cold, pale, or blue-colored skin
• Difficulty moving the joint or fingers and toes below the affected area.
– If any of these symptoms occur, call the doctor right away. The cast may need to be loosened
or replaced.

• A pressure sore or cast sore can develop on the skin under the cast from excessive pressure by a
cast that is too tight or poorly fitted.
When to Call Your Doctor
• Check the cast and the skin around the edges of the
cast everyday. Look for any damage to the cast, or
any red or sore areas on the skin.
• Call the doctor immediately if any of the following
happen:
– The cast gets wet, damaged, or breaks.
– Skin or nails on the fingers or toes below the cast become
discolored, such as blue or gray.
– Skin, fingers, or toes below the cast are numb, tingling, or
cold.
– The swelling is more than before the cast was put on.
– Bleeding, drainage, or bad smells come from the cast.
• Severe or new pain occurs
Thank you