Useful Handouts in the Emergency Department:
1. Pain Management Protocol for Orthopedic/Hand Injuries
Sling for Hand Elevation: Place patient in a standard sling around the elbow. Wrap with 3″ ACE around arm/elbow/forearm to ensure it does not slide off. Hook sling straps over an IV pole (adjust bed height to control level of arm). Upper arm should be parallel to the shoulder, and hand should be at or above the patient’s head.
Supplies for ED Hand Procedures (finger tip injuries):
Digital block: 0.25% Marcaine + Epi, 10cc syringe, 18g, 25g, alcohol swab
Prep: Tournicot/Penrose per digit, 4×4 box x 2, iodine bottle, chux x 2, 2 packs sterile blue towels
Irrigation: large basin, 500cc Saline, screw-on irrigation cap
Laceration kit: toothed pickup, iris scissors, hemostat, needle driver (preferably from OR)
For nail/tuft injuries: freer elevator, small rongeur (from OR)
Closure: 5-0 chromic suture, xeroform, 4×4 gauze, 2″ kling, alumifoam splint, 2″ ACE wrap, tape
Best way to stabilize nail-plate:
Use a chromic suture passed first through the tip of the finger then passed through the skin proximal to the nail fold. This forms a “figure 8” stitch that is tied down over the nail. It holds the nail in place and avoids having to force a needle through the nail plate.
Distal Radius Reduction Technique:
Patient positioned supine at edge of bed, provider stands next to patient’s shoulder, facing their feet
Place your leg closest to the patient over their arm, so your thigh is holding down their brachium
Your hand closest to the patient is holding traction, while your “away” hand is gripping the forearm (fingers) and using your thumb directly over the distal fragment to provider a palmarly directed force.
Once reduced, hold in flexion as you pull your leg out from the patient to obtain images and splint
How to Remove a Ring from a Swollen Finger:
Make a Finger Tourniquet from a Glove: