Discharge Instructions

Continuous elevation of the injured part usually helps minimize swelling and pain. However, most individuals do not share the physician's knowledge that, to be effective, elevation must be above the level of the heart. Patients with an injured lower extremity often sit at home or at work with the leg resting on a chair, thinking they are complying with instructions. The patient should understand that the benefits of elevating a lower extremity can only be achieved in a recumbent or near-recumbent position, with the leg supported higher than the rest of the body.

Patients discharged in a lower-extremity plaster dressing should be cautioned not to rest the heel on the floor or any other hard surface. Plaster takes about 24 h to fully set. During this time, prolonged pressure on the heel can gradually create an indentation that may cause significant discomfort or even a pressure sore. This is not a consideration with fiberglass, which sets immediately.

If an upper-extremity sugar-tong dressing has been applied, the patient should be instructed to work the fingers (wiggle or wave) as much as possible to minimize stiffness and swelling. The sugar-tong splint should allow full flexion of the metacarpophalangeal joints.

Patients should be advised to watch the fingers or toes for excessive swelling, decreased sensation, or cyanosis, and to be alert for a significant increase in pain. Any of these signs or symptoms warrant a return to the emergency department or prompt evaluation by the follow-up physician.

When crutches, a cane, or a walker is supplied, instruction for use should be provided, and the patient's ability to navigate with such aids should be verified. FOLLOW-UP

There is no universally prescribed follow-up interval for specific injuries. Physicians differ as to how soon patients should be seen. Generally, patients with unreduced fractures or injuries that require future surgical intervention should be seen within a few days.

Sometimes the situation may be discussed with the follow-up physician and an appointment arranged while the patient is still in the emergency department. Alternatively, the emergency physician may instruct the patient to contact the follow-up physician or clinic as soon as possible. If the name of the injury is written on the discharge instruction sheet, the patient can convey it at the time of the call. Based on this information, the follow-up physician can decide when the patient should be seen.

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