Pediatric emergency medicine trisk 1115
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (107.57 KB, 4 trang )
Commercially available splinting materials (e.g., Orthoglass), which incorporate
the padding and fiberglass splinting material into a single preparation, are also a
good option. Although these preparations are designed to provide a sufficient
amount of padding by themselves, many practitioners prefer additional cotton
padding to minimize the risk of pressure ulcers, especially over bony
prominences, such as the malleoli, heel, or elbow, particularly when the splints
may be left in place for longer periods of time before follow-up. The advantages
of these materials are their ease and neatness of application. The fiberglass
products also appear to be more durable than the plaster splints. A relative
disadvantage is that these products are not as moldable as plaster to the bends and
contours of an extremity.
It is important to follow the specific manufacturer’s instructions to ensure
appropriate application. In general, these products are cut to length; moistened
with a small amount of water; stretched, smoothed, and molded to the injured
extremity; and then covered with an elastic bandage. Once the material is applied
and secured, maintain the extremity in the proper position until the splint
becomes sufficiently rigid. This usually occurs more rapidly than with plaster, as
soon as 10 minutes from application. It is helpful to cut the material slightly
longer than necessary and to fold the excess length back on itself to make a
smooth comfortable end to the splint. This technique is especially helpful at
natural flexion areas, such as the palm or toes. Remember also that the cut ends of
the fiberglass material may become sharp when dry and require either taping of
the exposed ends, stretching of the padding material on its application to cover
the exposed end, or filing with a nail file once dry to smooth the end of the splint.
Other Issues
Dispense crutches or slings as appropriate to prevent weight bearing or usage that
may enhance edema, pain, or cause the splint to break. Children are often not
capable of using crutches if they are 6 years of age or younger, and even some
older children may have difficulty using crutches properly. Discharge instructions
should include appropriate recommendations for rest, ice, and elevation. Discuss
signs and symptoms of neurovascular compromise (e.g., compartment syndrome),
and recommend that the patient loosen the splint and return to the ED if
neurovascular insufficiency is suspected. Assist in arrangement of appropriate
referral and follow-up specific to each injury.
Long Arm Posterior Splint
Indications
Immobilization of elbow and forearm injuries
Procedure
Ascertain that the injury will be adequately immobilized by a long arm splint (
Fig. 130.49A ). Prepare the child by carefully exposing the upper arm, elbow, and
forearm. The appropriate position for splinting will have the elbow flexed to 90
degrees, the forearm in neutral position, and slight dorsiflexion at the wrist. When
applying a splint for a supracondylar fracture, position the forearm with slight
pronation.
The length of this splint will extend from the palmar crease of the hand to
approximately two-thirds of the distance up the humerus. It will run along the
ulnar aspect of the forearm and the posterior aspect of the humerus. Take care so
the splint does not impinge upon the axilla. The width should extend
semicircularly halfway around the arm. Prepare and apply the splint material as
described in the “General Splinting” section. This splint requires the use of a
sling.
Posterior Splint—Below the Knee
Indications
Immobilization of ankle sprains and fractures of the foot, ankle, and distal fibula
Procedure
This splint extends from the ball of the foot to the proximal lower leg at the level
of the fibular head ( Fig. 130.49B ). Ensure that it does not impinge upon the
popliteal fossa when the leg is flexed. For metatarsal fractures, the splint is
sometimes extended to include the toes. The material should be wide enough to
support the entire width of the foot. The splint will maintain the foot at 90 degrees
of dorsiflexion at the ankle and may be most easily applied with the child in the
prone position with the leg flexed at the knee. Prepare and apply the splint
materials as described in the “General Splinting” section. Consider additional
padding at the malleoli and calcaneus. Once the splint is applied, it is often
necessary to have someone maintain the foot at 90 degrees while the material
hardens.
Discharge the patient with crutches and warn that this splint does not tolerate
weight bearing well, particularly in school-age children or teens.
Ankle Stirrup (Sugar Tong) Splint
Indications
Immobilization of injuries to the ankle
