Emergency Department Clinical Pathway for the Evaluation/Treatment
of Children with Suspected Long Bone Open Fracture

Triage Care
  • Ibuprofen
  • Ice pack
  • Splint/sling
  • Elevation
  • Wound care
  • X-ray protocol
  • NPO
Pain Management
  • When possible, optimize prior to X-ray, wound care, splint removal
  • Ibuprofen
  • IN fentanyl
  • Morphine
Sedation Analgesia
  • Use ED Sedation Order Set
Open Fracture Classification Typing
Orthopaedics to determine fracture type
  • ED Care
    • Sedation
    • Neurovascular assessment
    • Irrigation
    • Reduction (if needed)
    • Splint application
  • Ortho consults with Plastic Surgery
  • Orthopaedic or Trauma Attending
    to Consult:
    • Lower Extremity — Vascular LE Trauma
    • Upper Extremity — Hand Service
To OR with Orthopaedics
Admit to Orthopaedic Service
Consider Admission to Trauma Service If Other Injuries Present
Schedule OR
Posted: April 2018
Reviewed: April 2020
Authors: L. McNeely, CRNP; K. Baldwin, MD; M. Wood RN; J. Lavelle MD, J. Callahan MD; T. Metjian, PharmD; V. Ho Fung, MD; D. Perks, CRNP;
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