Guidelines for Ordering X-Rays by o64e0bx

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									   Extremity X-ray
Ordering Guidelines for
RN’s in SPH Emergency
            CRNBC Guidelines
Ordering the Application of energy:
6 (1) (j.1) in the course of assessment, issue an instruction
   or authorization for another person to apply, to a named
   individual,

  (i) ultrasound for diagnostic or imaging purposes,
  including any application of ultrasound to a fetus, or

  (ii) X-rays for diagnostic or imaging purposes, except
  X-rays for the purpose of computerized axial
  tomography.
  CRNBC Limits and Conditions:
Registered nurses order X-ray or ultrasound
 only under the following circumstances:

• Registered nurses who order X-ray or ultrasound must
  follow established decision support tools.

• Registered nurses who order X-ray or ultrasound for the
  purpose of screening or triage or treating a condition
  must successfully complete additional education.

• Registered nurses order X-ray or ultrasound for the
  purpose of routine management only when
  organizational processes are in place to direct test
  results to the appropriate health professional for follow
  up.
     SPH Emergency Nursing Protocols
Extremity X-ray
Any patient with fracture/suspected dislocation may have these
     orders:
1.   assess limb for: appearance, deformity, CWMS, ROM, and skin
     injury. See Neurovascular Assessment (CWMS): Procedure for,
     in Nursing Practice Standards Manual.
Refer to EXTREMITY INJURY protocol and follow interventions
     listed.
2. Suspect fracture/dislocation? Order appropriate x-ray under EP (Eric
     Grafstein).
3. Notify EP if 2 hr. target approaching.
4. Document on ED Nursing Record:
     - time/type of x-ray(s) ordered
     - reason for order (tick appropriate box)
     - signature of RN recording
“RN's should order extremity x-ray's when it
      looks apparent (ie swelling and/or
    deformity) or that there is something
                   wrong.”
Chris Dewitt
How do we know what the
 appropriate X-ray is???

    Use the following tips
                    Foot
Foot x-ray series is required if there is:

• any pain in midfoot zone
• Inability to bear weight both immediately
  and in the emergency department.
                   Ankle

Ankle x-ray series is required if there is:

• Deformity
• Inability to bear weight both immediately
  and in the emergency department.
• Pain in the malleolar zone
                   Knee
Knee x-ray series is required if:

• Tenderness of patella or head of fibula
• Inability to flex to 90 degrees
• Inability to bear weight both immediately
  and in the emergency department
                   Hand
Hand x-ray series is indicated for
• Pain
• Deformity
• Immobility
• Mechanism (crush injury)
                   Wrist
Wrist x-ray series is required if there is:
• deformity
• pain
• Immobility of joint.
• Scaphoid views are required if there is
  tenderness in the anatomic snuffbox.
              Extra Tips!

• Always assess the joint above and below
  the injury for pain and immobility.

• When in doubt, consult a physician, they
  are happy to advise.

• Always ask about pregnancy in women of
  childbearing age.

								
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