A better way to get plastered

Like many EDs the Austin had to tackle the problem of messy plaster rooms, junior staff coming up with inventive but not always effective ways of applying plasters,  as well as inappropriate follow up and plaster checks with prolonged (and expensive) waits.

We decided to make a process change approach to plastering in the ED…with templates

We use

• template based plaster slabs
• an organised plaster trolley that can be moved around department
• posters illustrating by step photo-guidelines stating indications, how to and disposition

The key to really create order from plaster chaos…

• the use of Haftan (no financial conflicts of interest to declare) or something similar that allows the slabs to both have a snug fit and to be converted to full casts at fracture clinic. You can see what this does by looking at this video. It costs a few cents per slab.
• convincing your orthopods that it’s just as good as full casts even for manipulated fractures — here’s the evidence in their literature and a 1 year audit at the Austin showed no increased rate of slippage in Colles fractures.
• yearly plaster workshops for the registrars/nurse practitioners and use of educational videos. At present these workshops are led by plaster techs, but in the future the supervision of ED plaster teaching for doctors and nurses will become the domain of specially trained nurse practitioners.

The templates are designed for the ‘average’ 70kg male they fit most people but not everyone. So once the slab is cut out you should try the fit out on the unbroken arm to see if any trimming needs to be done before wetting it and applying it to the injured arm. There is still an element of skill needed but much less than required for a full cast.

Plaster Template Resources (PDF files)

• Charnley slab for Colles
• Thumb spica for scaphoid
• Volar slab
• Cam walker
• Plaster templates

Additional Resources

• Spaso Breaks his silence – Spaso Miljesic reduction and immobilisation techniques
• Plaster, Fibreglass and Splints – Dan Smith plaster tips and tricks
• Simon and Neil get plastered – Backslabs, splints, CAM boots and Darco shoes
• A better way to get plastered – Plaster Template PDF Resources
• Getting a leg over – Lower limb plaster techniques
• Buddy strap no more – Management of dorsal and volar phalangeal fracture

Vimeo showcase

• Paediatric guide to fracture management
• Plaster, Fibreglass and Splints
• Spaso reductions and immobilisation

Further reading

• The therapeutic clunk
• FARES method (shoulder reduction)
• Spaso technique (shoulder reduction)
• Cunningham method (shoulder reduction)
• Abraham Colles and the Colles fracture (1814)
• Robert William Smith and the Smith fracture (1847)

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