Emergency Department Clinical Pathway for the Evaluation/Treatment
of Children with Suspected Long Bone Open Fracture
Transfer from Outside Hospital
Recommend IV antibiotics be given as able
Recommend IV antibiotics be given as able
Triage Care
- Assess neurovascular status, pain
- Ibuprofen, ice
- Consider NPO
- RN Standing Order X-ray as able
- Pain Management
- Optimize prior to X-ray
- IN Fentanyl
- Morphine
- Wound care
- Splint removal
- Sedation Analgesia
- ED Sedation Order Set
- Abuse
- ED Physical Abuse Pathway
- Frontline Ordering Clinical (FLOC) Team
- Rapid Assessment
- IV Access
- Neurovascular Status
- Use ED Open Fracture Order Set
- Pain Control
- Imaging
- Antibiotic Recommendations
- Goal: administer within 1 hour of
ED arrival
- Goal: administer within 1 hour of
Open Fracture Classification Typing
Orthopedics 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
Consider Admission to Trauma Service if other injuries present
Schedule OR
Posted: April 2018
Revised: October 2022
Authors: K. Baldwin, MD; M. Wood, RN; J. Lavelle, MD; J. Callahan, MD; T. Metjian, PharmD; V. Ho Fung, MD;
E. Szydlowski, MD; S. Swami, MD; D. Perks, CRNP; R. Robinson, CRNP
Revised: October 2022
Authors: K. Baldwin, MD; M. Wood, RN; J. Lavelle, MD; J. Callahan, MD; T. Metjian, PharmD; V. Ho Fung, MD;
E. Szydlowski, MD; S. Swami, MD; D. Perks, CRNP; R. Robinson, CRNP
Evidence