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Neurovascular assessment is essential and performed Q hour fo the first 24 hours and Q1-4 hours thereafter. Assess pain level using a 0-10 pain rating scale, location and frequency. Administer analgesics as needed per order. Assess for numbness or tingling. Assess skin temp which should be warm. Assess pulses which should be palpable and strong. Maintain body alignment. Avoid lifting or removing weights, ensure weights are hanging freely and not resting on the floor. Ensure pulley ropes are free of knots, fraying, loosening and improper positioning at least q 8-12 hours, Routinely monitor skin integrity and document. Pin site care is done frequently throughout immobilization to prevent and to monitor for manifestations of infection such as drainage and redness, Monitor for loosening of pins and tenting of skin at pin site. Pin care protocols are based on provider preference and facility policy. A primary concept of pin care is that one cotton swab is designated for each pin to avoid cross-contamination. Pin care is provided usually once a shift, 1-2 times daily, or per facility protocol. Monitor vital signs. Educate and demonstrate proper care of equipment at incision site. Don't touch it!

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The pelvic binder is placed in the ED by the trauma team on patients who have suspected or
documented pelvic injuries potentially associated with major hemorrhage. Patients with mechanically unstable (disruption of pelvic ring
continuity) fractures are the most likely to benefit from pelvic binding. (ucsf.edu)

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Skin traction is far less invasive than skeletal traction. It involves applying splints, bandages, or adhesive tapes to the skin directly below the fracture. Once the material has been applied, weights are fastened to it. The affected body part is then pulled into the right position using a pulley system attached to the hospital bed.

Skin traction is used when the soft tissues, such as the muscles and tendons, need to be repaired. Less force is applied during skin traction to avoid irritating or damaging the skin and other soft tissues. Skin traction is rarely the only treatment needed. Instead, it’s usually used as a temporary way to stabilize a broken bone until the definitive surgery is performed.

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In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system. There are two types of traction: skin traction and skeletal traction.

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Skeletal traction involves placing a pin, wire, or screw in the fractured bone. After one of these devices has been inserted, weights are attached to it so the bone can be pulled into the correct position. This type of surgery may be done using a general, spinal, or local anesthetic to keep you from feeling pain during the procedure.

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The shoulder immobilizer is designed to support your arm, but also to protect you from doing certain motions. It is also to protect your arm from other people pulling on or against the arm and to protect the arm at night, so you do not sleep on it wrong or move it in the wrong position. (johns hopkins medicine)

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Sling and swathe is used to support your arm and hold it closely against your body after an injury. It is used for injuries where moving the shoulder joint could cause harm. For example, it would be used after a shoulder dislocation or shoulder fracture.

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The extended use of motorized cold therapy modalities, such
as Polar Care Cold Therapy, have been shown to have many beneficial effects following surgery. Motorized cold therapy has repeatedly been shown to decrease postoperative pain, swelling, inflammation, and
narcotic use following a variety of surgical procedures, such as surgery to the shoulder, knee, and back.

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An assistive device for transfers and re-positioning

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A hip abduction pillow helps prevent your hip from turning in or away from your body. It will also keep your hip straight while you are in bed, even while you are asleep. The abduction pillow will hold your hip in one position and help it heal. You may need to wear a hip abduction pillow if your hip moved out of the joint or you have a hip fracture. It may also be used after surgery such as an open reduction and internal fixation  or a hip arthroplasty. You may need to use a hip abduction pillow for several weeks. (dru gs.com)

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A halo, also known as a "halo ring" or "halo crown," is a piece of equipment that encircles and is fixed to the head of a patient. This device is crucial for the management of a variety of conditions that destabilize the cervical spine.
Fixation of the halo to a patient's head relies on a series of four titanium "pins" which are equally spaced around the ring. After injection of a local anesthetic, the pins are placed in tight connection with the head at two locations on each side (generally over the ridge of the orbit and just behind the ear). The vast majority of patients do not experience significant pain from the pins being too tight; in fact, loosening of the pins is by far the most common cause of pain at the pin sites. Once the halo is in place, the physician may want to keep the patient in bed-based traction for a few days before connecting the vest and getting the patient up and around.

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A surgical procedure that stabilizes and joins the ends of fractured (broken) bones by mechanical devices such as metal plates, pins, rods, wires or screws.

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A cervical collar, also known as a neck brace, is a medical device used to support a person's neck. It is also used by emergency personnel for those who have had traumatic head or neck injuries, and can be used to treat chronic medical conditions.

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FIGURE 19-5   •   Types of surgical drains: A. Penrose. B. Jackson-Pratt. C. Hemovac.

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JP Drain Example:

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A Hemovac drain is used to remove fluids that build up in an area of the body after surgery. The Hemovac drain is a circular device connected to a tube. One end of the tube is placed inside the body during surgery. The other end comes out through a small cut in the skin, called the drain site. The device is connected to this end. There may be one or more stitches to hold the tube in place.

The Hemovac drain removes fluid by creating suction in the tube. The circular device is squeezed flat. The device expands as it fills with fluid.

A hemovac drain can hold up to 500ml of drainage.

Caring for the drain: Empty the drain when it is half full or every 4 to 8 hours:
To empty: Wash your hands with soap and water, Remove the plug from the top of the drain, Pour the fluid into a measuring cup, Clean the plug with an alcohol swab or a cotton ball dipped in rubbing alcohol, Squeeze the drain flat and put the plug back in. The drain should stay flat until it starts to fill with fluid again, Make sure the tubing is not kinked or twisted. Refasten to your clothes below your surgery site so it does not pull at your skin, Measure the amount of fluid you pour out documenting characteristics, dispose of and wash hands.

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External fixation is done by placing pins or screws into the bone on both sides of the fracture. The pins are secured together outside of the skin using a series of clamps and rods known as the external frame.

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A Jackson-Pratt (JP) drain is used to remove fluids that build up in an area of the body after surgery. The JP drain is a bulb-shaped device connected to a tube. One end of the tube is placed inside the body during surgery. The other end comes out through a small cut in the skin. The bulb is connected to this end. There may be a stitch to hold the tube in place.

The JP drain removes fluids by creating suction in the tube. The bulb is squeezed flat and connected to the tube that sticks out of the body. The bulb expands as it fills with fluid.

JP drain cold hold 20-30ml of fluid.

Caring for JP drains:

Empty the bulb when it is 1/2 full or every 8-12 hours. Document: quantity, color, odor.

To empty: Wash your hands with soap and water, Remove the plug from the bulb, Pour the fluid into a measuring cup, Clean the plug with an alcohol swab or a cotton ball dipped in rubbing alcohol, Squeeze the bulb flat and put the plug back in. The bulb should stay flat until it starts to fill with fluid again. Measure the amount of fluid you pour out. Write down how much fluid you empty from the JP drain and the date and time you collected it. Flush the fluid down the toilet. Wash your hands

If there is a dressing around the drain, change it daily.

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A Penrose drain is a soft, flat, flexible tube made of latex. Part of the drain will be inside the surgical incision, and part of it will come out of the skin. A safety pin or a small tab is usually left at the end of the Penrose drain to keep it from slipping into the wound.The Penrose drain lets blood and other fluids move out of the area after surgery. The blood and fluids are released outside of the body onto a dressing (gauze bandage). This keeps fluids from collecting under the incision and causing infection.The length of time that a pt will have a drain depends on the surgery and the amount of fluid that’s draining from the incision. As the incision heals, there will be less fluid. When no fluid drains from the Penrose drain for 24 hours, pt's should contact the doctor to make an appointment to remove it.

Caring for drain: Change dressing at least BID documenting:

How much drainage is on the gauze? (Is it the size of a dime, a quarter, a lime, an orange?)

What color is the drainage? (Is it bright red, dark red, pink, brown, yellow?)

Does the drainage have any odor? (Does it smell foul, sweet, musty?)

Whats needed to change the drains dressing:

Wash cloth and soap (clean the area each time dressing is changed)

2 sterile 4 inch X 4 inch gauze (if slit is not already present, will need to cut a slit)

Paper tape

1 pair of nonsterile gloves