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Extremity X-ray Ordering Guidelines for RN’s in SPH Emergency.

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Presentation on theme: "Extremity X-ray Ordering Guidelines for RN’s in SPH Emergency."— Presentation transcript:

1 Extremity X-ray Ordering Guidelines for RN’s in SPH Emergency

2 CRNBC Guidelines Ordering the Application of energy: 6 (1) (j.1) in the course of assessment, issue an instruction or authorization for another person to apply, to a named individual, (i) ultrasound for diagnostic or imaging purposes, including any application of ultrasound to a fetus, or (ii) X-rays for diagnostic or imaging purposes, except X-rays for the purpose of computerized axial tomography.

3 CRNBC Limits and Conditions: Registered nurses order X-ray or ultrasound only under the following circumstances : Registered nurses who order X-ray or ultrasound must follow established decision support tools. Registered nurses who order X-ray or ultrasound for the purpose of screening or triage or treating a condition must successfully complete additional education. Registered nurses order X-ray or ultrasound for the purpose of routine management only when organizational processes are in place to direct test results to the appropriate health professional for follow up.

4 SPH Emergency Nursing Protocols Extremity X-ray Any patient with fracture/suspected dislocation may have these orders: 1.assess limb for: appearance, deformity, CWMS, ROM, and skin injury. See Neurovascular Assessment (CWMS): Procedure for, in Nursing Practice Standards Manual. Refer to EXTREMITY INJURY protocol and follow interventions listed. 2. Suspect fracture/dislocation? Order appropriate x-ray under EP (Dan Kalla). 3. Notify EP if 2 hr. target approaching. 4. Document on ED Nursing Record: - time/type of x-ray(s) ordered - reason for order (tick appropriate box) - signature of RN recording

5 “RN's should order extremity x-ray's when it looks apparent (ie swelling and/or deformity) or [it appears] that there is something wrong.” Chris Dewitt

6 How do we know what the appropriate X-ray is??? Use the following tips

7 Foot Foot x-ray series is required if there is: any pain in midfoot zone Inability to bear weight both immediately and in the emergency department.

8 Ankle Ankle x-ray series is required if there is: Deformity Inability to bear weight both immediately and in the emergency department. Pain in the malleolar zone

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10 Knee Knee x-ray series is required if: Tenderness of patella or head of fibula Inability to flex to 90 degrees Inability to bear weight both immediately and in the emergency department

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12 Hand Hand x-ray series is indicated for Pain Deformity Immobility Mechanism (crush injury)

13 Wrist Wrist x-ray series is required if there is: deformity pain Immobility of joint. Scaphoid views are required if there is tenderness in the anatomic snuffbox.

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16 Extra Tips! Always assess the joint above and below the injury for pain and immobility. When in doubt, consult a physician, they are happy to advise. All extremity x-rays should be ordered “URGENT” The fracture rate amongst HIV+ patients is 5x that of normal!


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