OCC OCC Cast Removal & Bivalving 1 — Questions and Answers
Question 1: Which instrument is the standard tool for cast removal?
- Oscillating cast saw (Correct answer)
- Bandage scissors
- Plaster knife
- Electric drill
Correct answer: Oscillating cast saw
The oscillating cast saw vibrates rather than rotates, cutting hard cast material while minimizing risk of skin laceration.
Question 2: How does an oscillating cast saw avoid cutting the patient's skin?
- It vibrates rapidly but does not rotate, cutting rigid material but bouncing off soft tissue (Correct answer)
- Its blade is coated with a protective plastic layer
- The blade automatically stops when it contacts skin
- It uses suction to pull the cast away from the skin
Correct answer: It vibrates rapidly but does not rotate, cutting rigid material but bouncing off soft tissue
The oscillating motion cuts through hard fiberglass or plaster but does not slice soft, pliable skin when proper technique is used.
Question 3: When removing a cast, the saw should be moved in which pattern?
- In and out (plunging motion) along the cast surface, not dragged (Correct answer)
- In a continuous drag along the length
- In circular motions around the extremity
- In a single long cut straight down the center
Correct answer: In and out (plunging motion) along the cast surface, not dragged
A plunging in-and-out motion prevents overheating and reduces the risk of skin burns and lacerations.
Question 4: What is the purpose of bivalving a cast?
- To split the cast into two halves to relieve pressure or allow for swelling (Correct answer)
- To remove the cast entirely
- To reinforce the cast with additional layers
- To apply a new synthetic cast over the existing one
Correct answer: To split the cast into two halves to relieve pressure or allow for swelling
Bivalving cuts both sides of the cast and releases the underlying padding, reducing circumferential pressure while maintaining some immobilization.
Question 5: After bivalving, what is the NEXT step to fully relieve circumferential pressure?
- Cut and spread the underlying cast padding (Correct answer)
- Apply an elastic bandage over the bivalved cast
- Remove one shell and discard it
- Soak the cast in warm water
Correct answer: Cut and spread the underlying cast padding
The inner padding layer also contributes to circumferential pressure and must be cut along the same bivalve lines to fully decompress.
Question 6: Which complication is most directly prevented by prompt bivalving of a tight cast?
- Acute compartment syndrome (Correct answer)
- Wound dehiscence
- Bone non-union
- Skin maceration
Correct answer: Acute compartment syndrome
Bivalving relieves circumferential pressure that, if left unaddressed, can progress to compartment syndrome and ischemia.
OCC OCC Cast Removal & Bivalving 1
Which instrument is the standard tool for cast removal?