Ortho Hors D'oeuvres (Answer)

To review, this is a 25 year-old male presenting with impressive right hand cellulitis requiring elevation and IV antibiotics.

Question and Answer:

What is the best way to elevate this gentleman's arm?

Try the DIY skyhook.

This technique allows the patient to fully relax the offending extremity, keeps it elevated far above the head, and does not run the risk of causing limb ischemia with finger traps or other constrictive dressings.

Step 1: Get stockinette appropriately sized for the patient's arm.

Step 2: Cut the stockinette off hamburger style (that is, perpendicular to its longest axis) at a length of approximately fingertip (right arm)-to-fingertip (left arm), with the arms spread wide.

Step 3: Cut the stockinette in half hotdog style (that is, parallel to its longest axis) for about the length of one arm, more if the patient is obese. This might be about 1/3 of your total stockinette.

Step 4: Open the uncut segment of the stockinette and put the patient's arm in the uncut stockinette as if you were about to splint the patient (start at the junction of the uncut stockinette and the cut stockinette so that when finished the fingers are at one end and the shoulder is at the middle, with the hotdog-style flaps hanging anteriorly and posteriorly to the shoulder along the patient's torso).

Step 5: The cut segment of the stockinette should be at the shoulder with the two hotdog-style flaps hanging anteriorly and posteriorly to the shoulder. Tie these flaps around the patient's torso and under the contralateral arm like a Miss America Sash.

Step 6: The uncut end of the stockinette should be distal to the fingertips. Tie this end to an IV pole to elevate the arm.

Step 7: (optional, depending on how much you like the patient): If the patient has a particularly painful bit (like a tenosynovitis or an associated laceration, for example), you can cut strategically placed holes in the stockinette so that part isn't being actively rubbed.

References:

Thanks go to CJ Vaughn, who taught me this trick (along with many other orthopedic nuggets of knowledge).