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Limb Injuries Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • Infant ≤ 12 months

  • Neurovascular compromise

  • Overt limb deformity

  • Inability to bear weight on limb or walk 3 steps

  • Injury involving shoulder or hip

  • History of workplace injury

  • Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observation Charts

Additional Observations

Conduct a full set of neurovascular observations (as a minimum on arrival and prior to discharge)

Management Principles

  1. Jewellery (rings / watches etc.) must be removed from affected limb (cut jewellery if required)

  2. Commence R.I.C.E treatment

  • Rest: Patient to rest injured limb

  • Ice: Apply cold pack for 20 minutes / 2nd hourly if injury to limb is ≤ 48 hours for analgesia and reduction in swelling

  • Compression: Apply a firm and supportive crepe bandage to injury

  • Elevate limb where possible

  • Apply sling where appropriate

  • Apply splint where appropriate

  1. Avoid H.A.R.M.

  • Heat (hot packs, heat rubs etc)

  • Alcohol

  • Running (or excessive movement of injured limb)

  • Massage

  1. Provide analgesia as required according to pain scale – refer to Pain (any cause) NMG

  2. Provide crutches with appropriate instructions where indicated

  • Instruct the patient and / or carer on R.I.C.E. and H.A.R.M. principles for proceeding 72 hours

  • Document assessment findings, interventions and outcomes
  • References / Further Resources

    1. ECI Patient Factsheet - Ankle Sprain

    2. ECI Patient Factsheet - Knee Injury

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