This Issue's Rounds Question - What is Staphylococcus aureus (MRSA)?

In the last issue of Body Cast, Rounds asked: “Believe that you apply a superior cast? Tell us why.”

The following responses were received:

From Mary Perkins:

I looked up the word “superior” in the dictionary. It means of high quality or performance, greater rank or station, of higher nature or kind, or of great value or excellence. I have been striving to achieve a superior cast application for the past 16 years, with mixed results. I maintain all the rules of casting as I was taught. Always put the limb in the correct position before casting, 50/50 overlap, not too high, not too low, not too weak, or not too heavy. So why do some of my casts come back looking so bad? I blame the patient for sabotaging my good work. If Dr. Phil asked me, “So, how’s it working for you Mary?” I’d reply, “If the cast comes back in one piece and I don’t have to re-do it, my cast application is SUPERIOR !”

From Val Stockdale:

I believe that I apply a superior cast. I thought this Rounds Response was different and interesting. I am answering this because I really do my very best at cast application. I have been casting for 17 years and I pride myself in casting because I take my time to provide comfort and reassurance to my patient. I use plenty of eye contact and talk while I cast. I am very gentle and never hurt a patient when changing a cast. Besides doing all the correct requirements of a perfect cast such as wrinkle-free padding, correct placement of product, tension, position, amount of product, etc., I do extensive teaching to help the patient understand and accept their injury. I also listen to my patient and any concerns they have are dealt with. Aside from casting techniques, I apply a cast that I would wear and feel comfortable and secure in.

I also get positive feedback from the orthopods when they comment to the patient that I put on an awesome cast. Most of my patients also give me compliments when they tell me that they’ve had a lot of casts, but the one I put on was best. I am also very good at specialty cast application and I feel proud when the orthopods ask me specifically to do the cast they require because they know the patient will not be calling them later with cast problems.

Most of all, I do a superior cast because I really care about my patient and I really enjoy helping patients recover from their injuries, and I love my job.

From Neuville Yao:

I believe anyone who is a registered orthopaedic technologist and a member of the CSOT has the ability, knowledge and experience in the application of a superior cast. A superior cast is one that sufficiently immobilizes a joint or fracture throughout the whole entirety/duration of injury/fracture treatment, without any complications that would result in patient compromise. Factors involved in the application of a proper cast include: type/amount of materials used, amount of tension in the application, proper water temperature (depending on the technologist’s preference and experience), proper cast molding (e.g., three-point mold), proper cast length, proper amount of padding between the skin and casting material, especially where bony prominences are located, proper functionality of mobilized joints (both proximally and distally) just adjacent to the joint immobilized by a cast and, last but not least, the cosmetic appearance of the cast applied, since more often than not, like a piece of clothing, a cast is worn outside/on the body, for everyone to see and judge.