Medical Intake Concern Chart

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9/16/2010 16:42

Rehabilitation

It may take from several weeks to several months for the injuredarm to heal completely. Rehabilitation

involves gradually increasing activities to restore muscle strength, joint motion and flexibility.

The patient's cooperation is essential to therehabilitation process. The patient must completerange of motion, strengthening and otherexercises prescribed by thedoctor. Rehabilitationcontinues until the muscles, ligaments, and othersoft tissues perform theirfunctions normally.

Oncerehabilitation is completed, thedoctormay want to examine the arm and its function to

make surehealing is complete.

One common cause of arm pain that affects the upperarm directly,however, is bicipitaltendinitis, in which a tendonnearthe shoulder is frayed ortorn, triggering a flare-up of pain in

the biceps of the upperarm.

If pain sneaks up gradually andhangs on like an annoyingrelative, there may be a brokenbonein the forearm orupperarm. You might think that broken bones are always obvious, but it is

possible to experience a fracture without realizing it. You might hit yourarm orfall, forexample, andnot feel the pain until you increase yourlevel of activity orput stress on the broken

area.


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Nursemaid's elbow is a partial dislocation of the elbow, which occurs when the

lower part of the arm (forearm) slips out of its normal position at the elbowjoint.

The injury is also called radial head dislocation.

Nursemaid's elbow is a common condition in young children and generally affects children

under age 5. The injury occurs when a child is pulled up too hard by the hand or wrist. It is often

seen after someone lifts a child up by one arm up. (For example, when trying to lift the child

over a curb or high step.) Swinging a young child from the arms while playing can also cause this

injury.

When the injury occurs, the child usually begins crying immediately and refuses to use the arm.

The child may hold the arm so that is slightly bent (flexed) at the elbow and pressed up against

the belly (abdominal) area. The child will move the shoulder, but not the elbow. Some children

stop crying as the immediate pain goes away, but continue to refuse to move the elbow.

Once the elbow dislocates, it is likely to do so again, especially in the 3 or 4 weeks following the

injury.

Nursemaid's elbow does not usually occur after age 5. By this time, a child's joints and surroundstructures are stronger, and the child is less likely to be in a situation where this injury might

occur. However, in some cases, the injury can occur in older children or adults, usually from a

fracture of the forearm.

Symptoms

y Immediate cryingy Complaints ofelbow painy

efusing to use the arm that is injuredy Holding elbow slightly bent at the elbowy Holding the lower part of the arm against the belly area (abdomen)y Moving arm at shoulder but not elbowy If you think your child has nursemaid's elbow again:y DO NOT move the child without first splinting the arm.y DO NOT try to straighten the arm or change its position.Apply an ice pack to the elbow. Splint

the injured arm in the position in which you found it. Keep the area both above and below theinjured elbow from moving, including the shoulder and the wrist, if possible.If the injury isnot improving after 3-5 days please return immediately.


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Valley Medical Urgent Care

Accident / Injury Report Form

Name: ______Idon Hilton____D.O.B____/___/____/___ Sex: _x__Male ___ FemaleAge:_3yrs___Ht___Wt___28.2

Address: _______________________________________________________________________________

Street City State Zip Code

Telephone: ___(805)210-2338______________ E-Mail: _______________ Social Security #__________________Parent/Guardian _____Sara Hilton ___________________ Other: (specify ) Linda Brown _________________

Date ofThis Report: ________9/16/2010__________________Date ofAccident: ___________9/16/2010_________________

Time ofAccident: ________2-3 p.m.

Place ofAccident: _caregiverresidence/ outdoors

NATURE OF INJURYAbrasion _x____ Fracture _____Aspxiation _____ Laceration __x___

Bite _____ Poisoning _____Bruise _____ Puncture _____

Burn _____ Scalds _____Concussion _____ Scratches _x____

Cut _____ Shock (el.) _____

Dislocation __x___ Sprain _x____

Other(specify) __Nursemaid Elbow/ Radial Head Dislocation/Subluxation_________________

DESCRIPTION OF ACCIDENT

PART OF BODY INJUREDAbdomen _____Ankle ( ____R / ____L )

Back _____Arm ( _x___R / ____L )

Chest _____ Ear( ____R / ____L )

Face ______ Elbow ( ____R / ____L )

Finger______ Eye ( ____R / ____L )Head ______ Foot ( ____R / ____L )

Mouth ______ Hand ( ____R / ____L )Nose ___x___ Knee ( ____R / ____L )Scalp ______ Leg ( ____R / ____L )

Tooth ______ Wrist ( ____R / __x__L )Other( specify ) ___Mild abrasions and lacerations from accident. Primary concern is theradial head subluxation of

the arm and complaint of pain in the left wrist. Goggles had pressed into sides of childs nose small abrasion.

How did accident happen? What was the childdoing? Where was the child? List any specifically unsafe acts and

unsafe conditions existing? Specify any objects involved?Additional space available on back.

, Child was riding on motorscooteron the back of olderchildren and they had fallen. Child was not wearing shoes

possibly only swim trunks ordiaper.Unknown ifhelmet was on,goggles were being worn andhaddug into childs

nose.

Was First AidTreatment Given: _x_ YES __NO ByName: Linda___ Phone #: (805)210-2338 Email:

List First Aid Rendered: arms were wrapped to prevent movement and furtherinjury.

Topical Ointment rendered.___________________________________________________________________

Called Parent/Guardian__YES _x_NO ByName: ____________________ Phone #:__________ Email: ___

Referred to Rehabilitation Services? ___YES ___NO Sent to Hospital? ___YES _x__NO


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Transported to hospital for furtherexamination/treatment ? ___YES _x__NO

____Ambulance _____ Parent/Guardian Vehicle ____________________________________

9/16/2010 16:57

Notes:

Child is underthe care of caregiver. The parent is not caring for the childdue to pre-term labor .

Caregiverprovided a release from parent forconsent to medical treatment.

Caregiveradministered wrap to child for first aid. Counsel was given as to propercare forinjury.

Childhas special needs which may require splinting to prevent the child from re-injury.

Caution to not remove the wrap fornext 3-5 days.

Ibuprofengiven. Continue as needed. Caregiverreports minorcold symptoms being treated with Motrin.

AlternateTylenol and Motrin as needed.

Wei-Chi HuangNP 9/16/2010 16:10

TREATMENT GIVEN

Your child required reduction for radial head dislocation. Please follow instructions and

return in 3-5 days for follow-up.

Additional Documents on Procedure and Follow-up Instructions Given.


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Accident Prevention Education was provided to care-giverregarding theneed to adequately supervise child and

provide protectivegearand propergarments while outdoors.

Caregiverwas advised against leaving the child in the care of an untrained individual orunattended/improperly

supervised.

FOLLOWUP

Return child in one week to review the progress of the injuries.

If the child complains of pain orthere is worsening of the condition pleasereturn immediately.

HOME CARE INSTRUCTIONS

Yourchildhadreduction. Please fill all prescribed medications anddispense as directed.

You may also alternateTylenol/Motrin forpain. Keep the child still so the injuries canheal and limit recurrence or

furtherinjury. Do not allow the child to play outdoors orsubmerge in bathtub.

Do not allow child to remove the bandages. The splint must remain intact.

Apply the topical cream as directed 3 times daily on the abrasions.

Keep the wounds clean anddry.


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- Patient Presentation:- child presents w/ injured elbow pronated, partially flexed and held by side;- forearm is pronated and the elbow is partially flexed;- there is anterolateral tenderness over the radial head;- this child may not cooperate with keeping the arm immobile; additional support may be necessitated.- the child presents with a flexed and pronated forearm supported closely to the trunk of the body;- the patient complains of pain around the radial head;

- Reduction of nurse maid elbow:- interposed annular ligament was repositioned in its normal site by simple supination of forearrm w/ the elbow inslight flexion;- elbow is gently flexed to 90 degrees by gripping childs forearm above wrist w/ one hand while, w/ other hand, lowerend of humerus and elbow are held to prevent rotation at shoulder;- thumb was placed in region of of the radial head for palpation & application of posteriorly directed pressure on thehead of the radius, while firmly, supinating and extending the forearm;- childs forearm is firmly rotated into full supination;- immediately following reduction, a click heard and child appeared to have immediate pain relief.-

- Post Reduction Treatment:

- immobilization may be necessary for this episode of subluxation.

- Following reduction, upper limb is immobilized for 10 days in long arm posterior splint w/ elbow

in 90 deg of flexion & forearm in full supination;

- if pt has 3 recurrent episodes of subluxation, then apply cast for 3 weeks;

-Pain Relief Instructions

-Tylenol and Motrin alternating as necessary.

-E

ncounter Signoff

- Encounter reviewed and signed off by W.K Shimabukuro,N.P Valley Urgent Care


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