> For the complete documentation index, see [llms.txt](https://handbook.teddwa.xyz/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://handbook.teddwa.xyz/broken-limbs/broken-arms-wrists-and-hands.md). # Broken arms, wrists, and hands Control bleeding, assess distal function, and immobilize the upper limb. ### Immediate actions 1. Complete the primary assessment (ABCs). 2. Expose the limb and identify deformity, swelling, wounds, and tenderness. 3. Control bleeding and cover any open fracture with a sterile dressing. Remove rings, watches, and other constricting items before swelling increases. Do not remove an item if it is embedded or trapped by the injury. ### Check distal function Assess and document pulse, skin color, warmth, capillary refill, sensation, and movement below the injury. Repeat the assessment after every intervention. ### Immobilize Support the limb manually in the position found. Splint the injury while immobilizing the joint above and below it. Use padding around bony areas. Secure the splint without constricting circulation. Use a sling and swathe for shoulder, upper arm, elbow, or forearm injuries when appropriate. Do not attempt to straighten a deformed limb. Immobilize it in the position found. ### BLS and ALS care Apply a cold pack over a barrier if appropriate. Keep the patient warm and provide reassurance. ALS should treat severe pain with fentanyl, morphine, or ketamine when appropriate. Establish IV or IO access for severe pain, open fracture, or suspected shock. Urgently escalate care for absent distal pulse, worsening neurological deficit, severe deformity, or uncontrolled bleeding. Watch for compartment syndrome: pain out of proportion, pain with passive movement, tense swelling, numbness, weakness, or reduced distal perfusion. ### Transport Continue to reassess distal function, pain, and vital signs throughout transport. --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com. ## Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation dynamically by asking a question. Perform an HTTP GET request on the current page URL with the `ask` query parameter, and the optional `goal` query parameter: ``` GET https://handbook.teddwa.xyz/broken-limbs/broken-arms-wrists-and-hands.md?ask=&goal= ``` `ask` is the immediate question: it should be specific, self-contained, and written in natural language. `goal` is optional and describes the broader end goal you are ultimately trying to accomplish on behalf of the user. GitBook uses it to tailor the answer towards what is most useful for that goal. The response will contain a direct answer to the question and relevant excerpts and sources from the documentation. Use this mechanism when the answer is not explicitly present in the current page, you need clarification or additional context, or you want to retrieve related documentation sections.