Paediatric Fracture Management in the ED - Western Health Emergency Department

July 26, 2021

Overview

Paediatric fractures are a frequent presentation to SHED, with over 200 patients per month presenting with a fracture.

Alignment to Western Health Best Care Framework

Person-centred Care, Co-ordinated Care, Right Care, Safe Care, Best Care Governance, Quality Systems supporting best care

To review the Western Health Best Care Framework, please visit the live Best Care microsite.

Why is this important?

The Emergency Department can be a daunting place for a child and their family, especially when they are injured and in pain.

Prompt delivery of pain relief, placement of a splint and assessment for imaging, has the potential to vastly improve the experience for the child. Some paediatric fractures (for example supracondylar fractures) have a high risk of neurovascular injury and can be limb threatening.

Timely assessment for this type of injury in the Emergency Department can help to prevent significant long-term morbidity.

What does this look like in practice?

Early assessment at triage for pain, deformity and pulse
Appropriate triage category and location in ED. Deformity, significant pain or neurovascular compromise would need ready access to a cubicle for assessment and administration of analgesia
Intra-nasal fentanyl is a great analgesia for paediatric fractures and is well tolerated and very effective
Documenting paediatric weight and allergies directly onto the EMR allows for timely ordering of analgesia
Early clinician review for neurovascular assessment, placement of a splint, prescription of analgesia and ordering of imaging when needed