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Old 11-25-2012, 09:55 PM   #1
storiesinmyhead
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Broken Arm

My MC is going to break her arm skateboarding and seeing as the last time I broke a bone I was three I don't remember what the procedure is once she gets to the hospital. I assume the first thing that would happen is that she would be taken for an x-ray. Once they found out her arm was broken what would happen? Do they get her a cast right then and there? Would she get a room or just be stuck in the ER until her arm is set and she gets to go home?

Also, how many people are allowed various places with her? She is a minor, so I figure at the very least her mom, but I wasn't sure if anyone else would be allowed and at what points.

Thanks!
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Old 11-25-2012, 11:10 PM   #2
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I was 13 when I broke my arm roller skating. I was taken to the emergency room by my friends grandparents (that is who had taken us) I was taken right away into a bed in the emergency room (my arm was very clearly broken there was no question) They gave me a few shots and my two friends and both of the grandparents were allowed to stay with me. When my friends started crying (because they felt they had caused me to fall) they were sent out to wait in the waiting area. I got very very groggy and I think fell asleep for a little bit. I remember waking up when I was on my way to be x-rayed and the only one there with me was a nurse. Then in the x-ray room there was a doctor and a couple of nurses but that also I was in and out for I remember very little of it. The entire time I was rolled arond in my ER bed. Then I woke up in the bed in the emergency room my mom was there and one of my friends because she wanted to see that I was alright before they left. I was still really groggy from the pain meds but I remember them wheeling me out to the car in a wheel chair and then I woke up when my mom had to get me out of the car and into the house. I had on a plaster cast with a slit down the side and ace bandages wrapped around it. They left that on for the first week or so because I had a lot of swelling and they couldn't put the regular cast on until the swelling had gone down. I think I slept most of the first 3 days as I was on pain medication and that is what pain meds do to me. I have no idea if this is all standard procedure but that is my experience hope it helps.
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Old 11-25-2012, 11:28 PM   #3
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I'm not a medical professional, so take this with a grain of salt, but I've had a handful of run-ins with emergency rooms...

Something to consider is the severity of the break and/or any other injuries. For example - and I'm totally using hyperbole but I think you'll get the idea - if a patient comes into the ER after a car accident, and there's some broken arms/legs but also a broken neck, the broken neck is going take priority. Of course it sounds like this isn't the case with your character. I'm guessing her only injuries will be the broken arm and some cuts and bruises?

As far as the break - the severity of the break will definitely affect treatment. If the bone has pierced the skin or the arm is clearly at an unnatural angle, the patient will definitely be moved up in the ER "queue". They may start getting pain meds ASAP. On the other hand, if someone comes in with a painful ankle that may be sprained or may be a tiny fracture, they might get sent to the waiting room until a bed opens up. (Depends on how busy the ER is.)

If it's a bad break, I would guess that the first thing they'd do is give her pain meds, then an x-ray, then splint or cast the injury. Just guessing, though, and it may vary from ER to ER and even dr to dr.

ETA: Just a thought, if the bone has broken the skin she will almost certainly get antibiotics to prevent infections.

Last edited by melindamusil; 11-26-2012 at 02:52 AM.
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Old 11-26-2012, 02:05 AM   #4
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I'm not a medical professional, either, but my understanding is that nowadays most hospitals are so leery of lawsuits they will not administer painkillers beyond OTC-strength Tylenol without a parent's permission.

I know a broken bone which has not broken the skin is a pretty low priority if they're busy. They'll get you a cold pack, a sling for support, and have you wait, perhaps for hours. (I waited six hours on a Sunday afternoon, the bone through the skin, many years ago. Want to see the scar?)

The doctor will take a fast look, or a more extensive one, depending on how obvious it is that the bone is broken, then get X-rays. The bone is set and a rigid cast or whatever they're using is applied right there. Unless surgery was required for shattered bones, they don't seem to check you in as an inpatient, just deal with it entirely in the ER.

Hospitals will set their own policy, but in my ER experience as an adult, the nuclear family is allowed to be there without question unless they're in the way or disturbing the patient or others. Young kids usually get so restless they have to be taken out eventually. Both of the two hospitals with which I have any experience were pretty laid-back about people staying around. Family or friends often distract the patient from his/her distress and can handle simple tasks like finding kleenex or helping the patient to the rest room, leaving the staff free-er to do their jobs.

Maryn, glad not to have been in an ER in a while
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Old 11-26-2012, 06:15 AM   #5
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In the ER where I work broken bones are not cast - the patient gets x-rays and a splint, then is referred to an orthopedist, who will do the casting after the initial swelling has gone down some, in a few days. I think that's SOP in most places now.

Few fractures get sent to surgery immediately. Only really bad ones.

Our ER has an informal limit of two visitors in the patient's room at a time, but that's flexible depending on circumstances. If the visitors are quiet and nice, more leniency. If they're a pain, the "no visitors" rule goes into effect. For a minor, a custodial parent will have access, unless he/she is a problem, then is escorted out.
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Old 11-26-2012, 06:15 PM   #6
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both my boys have broken numerous bones playing sports etc and we are no sranger to the er.

basically we check in , then triage nurse takes a look, then we go back and wait in a room, then we go for xrays, then a dr comes in and tells you yup its broken then a nurses or a tech will wrap it and put it in a sling and hand you your discharge instructions, which include the phone number to the to the orthopedic dr who will cast it.

when we've gone to the er, the whole family will go back, me , my younger son (under 12) or my older son (16) , my husband. when we have gone to the er for a fellow icehockey teammate of one of my kids who may have broken something or been injured in a game, we all wait in the waiting room, since its immediate family only in the back for the er.
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Old 11-26-2012, 07:12 PM   #7
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You don't necessarily have to go to the ER for a broken bone. When I broke my tailbone, my mother took me to a non-emergency walk-in clinic, which is much cheaper than an ER visit. They're equipped for all manner of injuries and illnesses, but they can't handle surgeries or life-and-death situations. When I had pleurisy and pneumonia, they sent me on to the ER, because my heart wasn't handling the stress very well. For my tailbone, they took x-rays, confirmed my tailbone was now L-shaped instead of straight, gave me pain meds, and referred me to an orthopedic specialist. He, in turn, opted to do nothing whatsoever, so I'm stuck with a fused L-shaped tailbone for the rest of my life. (Unless I get pregnant, in which case they'll have to re-break and straighten my tailbone so I can give birth.)
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Old 11-27-2012, 01:17 AM   #8
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My broken-bone experience was what juniper and I_love_coffee said.

I broke my ankle, and my sister drove me to a nearby ER. It was a full-service ER, but it wasn't attached to a hospital... like a walk-in clinic, but they treat heart attacks...

Anyway, I filled out paperwork, they took me back.My sister came with me. I sat on an exam table while the doc examined my ankle. They took me to get the x-ray, said yup, it's broken. Then they put a splint on it--not a cast. The splint was some kind of hard stuff that they got wet and then held on my ankle to shape. When that dried, they wrapped it on with an Ace bandage.

Cost around a $100. I left with a prescription for 10 Tylenol 3s and a list of several orthopedists in the area.
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Old 11-28-2012, 04:33 AM   #9
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Thanks so much guys! That is all really helpful.

That is really interesting that they don't seem to cast it and only splint it until you go to the orthopedic doctor later, I would have thought they just did it all at the hospital. I guess I'll just have to hold off the cast signing a few days!
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Old 11-28-2012, 11:38 PM   #10
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Quote:
Originally Posted by storiesinmyhead View Post
That is really interesting that they don't seem to cast it and only splint it until you go to the orthopedic doctor later...
You can't really do a cast in the first couple days because of swelling. But it depends on the break. Many simple breaks today aren't even given a cast anymore. Most breaks don't really hurt, so no pain killers are given. Compound fractures are, naturally, treated differently.

Jeff
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Old 11-29-2012, 08:26 PM   #11
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Quote:
Quote:
Originally Posted by storiesinmyhead
That is really interesting that they don't seem to cast it and only splint it until you go to the orthopedic doctor later...

You can't really do a cast in the first couple days because of swelling. But it depends on the break. Many simple breaks today aren't even given a cast anymore. Most breaks don't really hurt, so no pain killers are given. Compound fractures are, naturally, treated differently.
Very true. My youngest broke his arm when we were on vacation, actually my middle one broke it for him because boys have to jump on hotel beds it's in their genetic makeup. We were out of the country, the arm didn't swell much so we waited two days until we were home to go to the doctor. Not the emergency room. We really didn't think it was broken either did the doctor but he took an ex ray, came back totally shocked that the kid wasn't crying because both bone were broke all the way through. He sent us to an orthopedic doctor who sent us to the 'cast lab'.

My husband fell off a ladder and his hand swelled up pretty good. Went to the emergency room, I stayed with him until they took him for an ex ray. The emergency room said it wasn't broken but suggested going to an orthopedic doctor. They called us the next day and told us another doctor looked at the ex ray and said there was a break in his hand.
The orthopedic doctor told us to wait a day for an appointment to give it a chance for the swelling to go down. We went the next day and we were sent to the 'cast lab' again.
So the emergency room will only splint a fracture, the orthopedic doctor will tell you it's broken and send you away for a cast and ask you to come back in however many weeks he thinks it will take to heal, but you don't see him until you have another ex ray.
You probably get approximately 5 different bills. Your MC's mother will have to take some days off work with all the hoops they make you jump through.

Sorry for being so long winded.
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