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What now?

So I’ll just have a quick check of this arm again before we get moving. Yes. Ok so, no, I can’t feel a radial pulse now in this arm. Alright. I think we’re going to have to straighten his arm. Ok, let’s just take this off you for a second. Ok, big deep breaths on that. That’s it, well done.
So are you able to just get the vac sling in for me? Yes, of course. Then we’ll straighten this arm. So, Luther I just need to straighten this arm. Ok. That’s it. Well done. Straighten that… OUCH! Perfect, thank you.

It is important to ensure vascular and neurological adequacy. Evidence of poor perfusion or reduced sensation may require prompt transfer to an appropriate hospital setting to enable re-alignment of the injury. However, arterial spasms and altered sensation may occur even if there isn’t ongoing compromise.

A cold, pulseless limb with no or altered sensation is a very unusual situation in a child but can result from significant trauma or from a arterial rupture (in which case swelling at the site of injury may be present).

An open injury, i.e protrusion of bone through the skin, requires operative intervention and there is a increased risk on infection.

Take a note of the surrounding scene. It is important to check the immunisation status of children with open wounds particularly for those that have occurred in a farmyard or other settings where there is a risk of contaminated soil.

Would you have managed this case any differently up until now?

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Emergency and Urgent Care for Children: a Survival Guide

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