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
Jewellery (rings / watches etc.) must be removed from affected limb (cut jewellery if required)
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
Avoid H.A.R.M.
Heat (hot packs, heat rubs etc)
Alcohol
Running (or excessive movement of injured limb)
Massage
Provide analgesia as required according to pain scale – refer to Pain (any cause) NMG
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
References / Further Resources
ECI Patient Factsheet - Ankle Sprain
ECI Patient Factsheet - Knee Injury