Using Casts for Immobilization

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    OBJECTIVESAfter this presentation learners will be able to:

    Explain the basic functions of a cast/splint

    Compare and contrast the use of casts/splints

    Discriminate between injuries that require casts or

    splints

    Integrate knowledge to formulate a complicationprevention plan for patients receiving casts

    Explain the factors leading to development of ischemicinjury in casts

    Organize proper supplies for cast application

    Demonstrate the ability to avoid hypersomnia duringthis presentation

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    What is a Cast?

    An orthopedic cast is a temporary device used

    to immobilize and protect tissue to foster healing Similar to an exoskeleton Historically made of Plaster of Paris

    Also made of fiberglass sheeting with resin

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    A History Lesson Ancient Egyptians used bark and linen splints

    Hippocrates recommended using splints Roman Celsus used bandages hardened withstarch in AD 30

    Arabians used egg whites and ground shells Ambrose Pare (1517-1590) made casts of wax,

    cardboard, cloth, and parchment Antonius Mathijsen (1805-1878) first to used

    bandages soaked in Plaster of Paris

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    Cast or Splint

    Cast Mainstay treatment More effective

    immobilization Most protection

    Splint Splints are faster and

    easier to apply

    Can be static or dynamic Allows for tissue swelling Removed more easily Good for acute phase

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    Which One to Use?

    Casts Splints

    OUCH!!!OUCH!!!

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    Plaster Made from gypsum- calcium sulfate dihydrate

    Mixed with water an exothermic reaction occurs 2 (CaSO 4 H 2O) + 3 H 2O 2 (CaSO 4.2H2O) + Heat Warm H2O speeds up setting, Cool H 2O slows Fast drying (blue & white box) 5- 8 minutes set Extra-fast ( green & white box) 2-4 minutes set

    Up to 24 hours to cure (at least) Warmer =faster cure Air circulation speeds up cure No weight bearing until cure is complete!

    Do Not Burn the Patient !!!!

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    Fiberglass

    Cures rapidly

    Less messy Stronger, lighter, wicks moisture better Less moldable $$ More expensive $$ Much shorter shelf life than plaster Requires less skill to apply Less risk of burns (burns still occur!)

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    General Principles of Application

    Immobilize a joint above and below injury

    Avoid pressure points due to: Excessive molding Cast indentations Use enough padding More at bony prominence Not too much at fracture site Consider skin wounds

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    Warning Signs of Ischemia

    Numbness

    Inability to move Discoloration distally Cold Increased pain Remove, loosen or split promptly ! Get Help Quick!!!

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    Let`s Cook Up a Cast!!

    Supplies Needed

    Patient Traction supplies Stockinette Softroll or Webril Plaster rolls Bucket Scissors Gloves Towels

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    Putting on the Cast

    Let`s see this skill in action!

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    Review

    Casts and splints are used to immobilize

    injured tissues to promote healing Two types of materials Plaster andFiberglass

    Skilled application techniques help preventcomplications

    Ischemic injury and burns are major seriouscomplications

    Proper planning helps prevent injury Still awake?

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    QUESTIONS?

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    ICE!!!!ELEVATION Airway Breathing circulation

    Orthopedic ACLS