Circular Above Elbow Cast

7/29/2019 Circular Above Elbow Cast

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CASE REPORT

A boy, 10 years old, came to emergency installation with chief

complain pain on his left forearm after fall accidentally

PRIMARY SURVEY

Airway & C spine control

Snorring (-)Gurgling (-)

Speak clearly airway patent


2/10

Breathing & Venti lation

RR: 24 x per minute regular , trachea on mid line, JVP not

increase

Thorax : no injury markSat O2 98 % Breathing adequate

Circulation & haemorrhage controle

PR: 90 x / minutes adequate tone and volume

BP : 110/70 mmHg

No external bleeding

stable circulation

DisabilityGCS : E4M6V5 = 15

Equal pupil 3 / 3 mm

Light reflex + / +


3/10

Exposure

Active bleeding (-)

Injury mark (-)

Left forearm: deformity (+) dorsal angulation, oedem (+), warm,radius artery pulsation (+), ulnaris artery pulsation (+),

dorsoflexy/plantarflexy of wirst (+), sensory wnl

Dx :

Uncomplicated closed fracture of left antebrachii


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SECONDARY SURVEY

HOI:

30 minutes before admission, he was falled accidentaly while

he was playing with his friends. His left forearm was strucked down

by his friend. Mecanism of injury unknown. He felt pain on his left

forearm then he was sent to Kariadi General Hospital by the helper.

PHYSICAL EXAM INATIONGeneral condition : Conscious

Vital sign :

BP : 110/70 mmHg

RR : 24 x/ minPR : 90 x/min, tone & volume was enough

t : 37 oC (A)


5/10

Head and neck: Conj palp was pink, equal pupil 3mm

Light reflex +/+

Ottorhea -/-, rhinorhea -/-

JVP not increased, trachea on the mid line.

Chest : No injury mark

Heart : I : IC not seen, injury mark (-)P : IC palpated 5th ICS 2 cm medially LMCS

P : Configuration wnl

A : Pure heart sound I / II

Lung : I : SSD, injury mark (-)

P : Tactile Fremitus left = right

P : Sonor on all of lungs area.

A : Basic sound vesicular +/+


6/10

Abdomen

I : Flat, no injury mark

P : Smooth, muscle rigidity (-) , tenderness (-)

P : Tympanic, LD (+), FD (+), SD( -)A : Bowel sound (+)

Pelvis : Deformity (-), no injury mark stable

Genitalia ext : Male, no perineal hematom


7/10

Extremities : Upper Lower

Cyanosis -/- -/-

Cold acral -/- -/-

Capp refill < 2/< 2 < 2/


8/10

WDx :

Uncomplicated closed fracture of 3rd distal of left radius transverse

undisplaced

Uncomplicated closed fracture of 3rd distal of left ulna transverse

displaced

Management :

Informed consent

Prepare for above elbow circular cast reported to senior onsite &orthopaedic surgeon approved


9/10

Cast application :

Prepare cast application equipment :

gypsona 4 : 3 rolls, softband : 1 rolls

Patient laid on supine position Perform local anestatic with ethyl cloride spray on fraktur site

Applicated softband along the left forearm circulary, frommetacarpophalangeal jointabove elbow

Dipped gypsona into water, squeezed, applied to left forearm with

moulding on fracture site Applicated gypsona along the left upper extremity, from

metacarpophalangeal jointabove elbow with assistant maintainedleft forearm on slightly flexion (900) of elbow joint.

Evaluated the fingers: pain (-), cyanotic (-), pale (-), cappilary refill

Documents

Circular Above Elbow Cast