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What is the first step in preparing the plaster as described?
How thick should the plaster slab be when rolled out?
Which step directly follows marking the length on the plaster?
What action should be taken after rolling out the plaster slab?
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What is an essential characteristic of the plaster slab during preparation?
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What technique can help older children adjust to wearing a short arm cast?
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What position should the patient be in to complete the long arm portion of the cast?
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What is the first step after applying the short arm cast according to the technique described?
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Which statement accurately reflects the procedure after applying the short arm cast?
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What is the purpose of encouraging older children to adopt the 'drama queen' pose?
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What are potential consequences of immobilizing fewer joints than necessary?
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Why is it important to immobilize the correct number of joints during casting?
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Which of the following is NOT a consequence of inadequate joint immobilization?
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What can be a direct impact of fracture displacement due to improper immobilization?
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What is a common risk associated with inadequate joint immobilization during casting?
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What is the recommended position for the patient during the casting process?
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Which technique facilitates the padding to be folded over during casting?
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Why is positioning the shoulder girdle off the side important during casting?
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What could happen if the patient is not properly positioned during the casting procedure?
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What is the primary focus when positioning a patient for casting?
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What is crucial to prevent during the casting of a wrist fracture?
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Where should the cast or splint begin when immobilizing a wrist fracture?
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What bone is located above the radius at the site of a wrist fracture?
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What might occur if the cast/splint does not begin above the elbow?
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Why is preventing forearm rotation significant when casting a wrist fracture?
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What is the purpose of applying cast padding before the plaster slab?
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Which of the following describes the sequence of applying plaster in the casting process?
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How does the technique of layering cast padding and plaster benefit the splint?
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What is a potential downside of using only plaster without cast padding?
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Which characteristic is a primary benefit of the described casting technique?
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What is the primary material used in a fiberglass prepadded splint?
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How is a fiberglass prepadded splint adjusted for use?
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What does the structure of a fiberglass prepadded splint consist of?
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Which characteristic of the fiberglass prepadded splint provides effective immobilization?
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What advantage does the fiberglass layering provide in casting?
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What is a key advantage of elastic casting material compared to traditional plaster casts?
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Which characteristic makes elastic casting material preferable for certain patients?
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Why might elastic casting material be considered a better option for children?
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What is a disadvantage of using traditional plaster casts that elastic casting material addresses?
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Which statement about elastic casting material is incorrect?
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What should be done if the splint material extends beyond the required length?
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What is the final step in the process of applying the prepadded splint?
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What size consideration is important when using prepadded splints?
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Which material is suggested for the overwrapping of the prepadded splint?
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What is the primary purpose of applying the prepadded splint to a limb?
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What is the purpose of applying small strips of cast padding over the bony prominences?
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Which areas of the body should the cast padding specifically be applied to?
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What is a possible consequence of neglecting to apply proper padding during the casting process?
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What additional benefit does applying padding provide during the casting procedure?
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When should the strips of cast padding be applied in relation to plaster application?
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Where should the mold for an ankle fracture be positioned?
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Which preparation step involves measuring before applying a splint?
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What is the main benefit of ensuring correct mold placement for an ankle fracture?
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What is the primary purpose of using plaster for molding in an ankle fracture?
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Where should the splint begin when immobilizing an ankle fracture?
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Study Notes
Applying Plaster Casts
- Mark the plaster length by tearing one side
- Roll out the plaster slab 10-12 sheets thick
- Use the measured length to roll out the plaster
- To alleviate difficulty, have older children pretend to be a "drama queen" by placing the dorsal aspect of their hand on their forehead after applying the short arm cast
- Apply long arm cast after short arm cast
- Surgeon should hold the limb, place the foot on the thigh, and apply axial load to ensure the foot is not in equinus
- This positioning naturally places the knee at approximately 30 degrees of flexion
- Span the ankle joint line with cast padding but do not cover the heel
- Leaving the foot in equinus for prolonged periods can lead to Achilles tendon contraction and ankle stiffness
- Roll out the cast padding
Immobilization
- Immobilizing fewer joints than necessary can lead to complications, including fracture displacement, neurovascular injury, and unnecessary pain and suffering.
Casting Techniques
- Thumb spica casts: Begin just distal to the wrist crease and extend to cover the entire thumb.
- Hand-based thumb spica casts: Allow wrist motion.
- Plaster roll application: Twist 360 degrees in the interspace, then pinch to narrow it at the web space.
Patient Positioning
- Shoulder girdle: Patient should be supine on the stretcher with the shoulder girdle entirely off the side.
- Pelvis: Patient is supine with pelvis halfway onto a padded crutch placed beneath the mattress.
Plaster Cast Setup
- Activate the plaster by placing it in tepid water.
- Allow the plaster to soak until it is softened.
- Be prepared to open the cast (bivalve) to prevent compartment syndrome if postreduction swelling occurs.
Cylinder Cast
- Apply a mold if desired.
- For a fracture of both bones of the forearm use a cylinder cast.
Cylinder Cast Indications
- Patellar fractures
- Patellar dislocations
Cylinder Cast Precautions
- Pad the malleoli thickly to avoid pressure sores on the ankle.
- Limit distal migration of the cast.
Plaster Casts
- Use very wet plaster for optimal application.
- Always roll the plaster on the cast.
- Fiberglass casts do not expand to accommodate swelling.
Elastic Casts
- Too much padding can lead to inadequate immobilization and won't accommodate swelling.
- Wrinkled padding can cause pressure necrosis.
- To activate plaster in hot water, the patient should be seated upright with their shoulder off the side of the bed.
- The elbow should be positioned in the desired flexion and pronation/supination.
- Start applying plaster proximal to the palmar flexion crease.
Foot Positioning
- Two techniques to prevent equinus (foot pointing downwards) when a reduction maneuver is not used:
- The patient lies prone with their knee bent at 90 degrees.
Wrist Fracture (Distal Radius) Treatment
- Cast/splint should begin above the elbow to prevent forearm rotation at the wrist
- Cast padding is applied to the limb followed by a layer of plaster
- Cast padding is then rolled over the plaster to create a conforming and versatile splint
- Four layers of cast padding should be rolled out on a flat surface longer and wider than the plaster slab
Clavicle Fracture Treatment
- Figure-of-8 splints are commercially prepared devices that reduce force on the clavicle
- There is no difference in outcome between a figure-of-8 splint and a sling for closed clavicle fracture management
Other splints
- Splints should allow free movement of the thenar eminence (thumb)
- A hematoma block can be performed before measuring a splint to allow the block to become effective while the splint is being measured
Fiberglass Prepadded Splint
- Fiberglass prepadded splint is a strip of fiberglass inside cast padding material
- Can be cut to any desired length
- Fiberglass prepadded splint is applied to the limb
- If the splint material is too long, fold it back or cut it to size
- Overwrap the splint with an elastic or self-adherent bandage
Fiberglass Prepadded Splint Advantages
- Elastic casting material allows some motion
- Elastic casting material is easier to apply than a plaster cast
Posterior Elbow Splint
- Apply small strips of cast padding over the bony prominences of the olecranon and ulnar styloid to provide additional padding
Ankle Fracture Molding Location
- Distal to the lateral malleolus over the calcaneus
- Immediately proximal to the medial malleolus
AO Splint
- Measure the length of the splint using plaster
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Description
This quiz covers essential techniques for applying plaster casts, including the steps for short and long arm casts. It also addresses positioning considerations to prevent complications like Achilles tendon contraction. Test your knowledge on proper cast application procedures and patient positioning.