Separation of the acromioclavicular (AC) joint is a common injury encountered in the emergency department. Keys to optimal outcome and return of function in these patients include knowledge of injury mechanism, diagnosis and classification, and initial treatment.
Cauda equina syndrome (CES), which occurs due to compression of the distal lumbar and sacral nerve roots, is a potentially devastating cause of back pain. CES is often missed on the patient’s initial visit which can lead to significant neurologic compromise in a matter of hours [1]. To improve patient outcomes and minimize medicolegal risk, providers need to understand the limitations of the history and physical and carefully consider the diagnosis of CES in any patient with back pain.
To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.
Metacarpal fractures are commonly present to the Emergency Department for care. The plain film shown here shows metacarpal neck fractures of the middle and ring finger shown. There are specific criteria requiring closed reduction in the ED (PV Card). Generally ANY rotational angulation requires reduction. Detection of such angulation depends on the clinical exam rather than the plain film. How does one diagnose it?
Injuries to the hand are fraught with multiple, concurrent injuries. Many injuries may have chronic debilitating complications, if not detected early. One such example is a finger laceration with a concurrent extensor tendon injury, causing delayed boutonniere deformity formation and limited function. Review the anatomy of the extensor tendon. View the video on how to perform the Elson’s test to detect a central slip tendon injury.
A common thumb injury is the “gamekeeper’s thumb or “skier’s thumb”, which involves an injury to the ulnar collateral ligament (UCL) of the first MCP joint. It is caused by forced abduction and hyperextension of the thumb, such as from a ski pole. But did you know that there are two branches of the ligament that you should test?
A patient presents with an anterior shoulder dislocation on x-ray. Your ED just received 5 new patients via ambulance and you are trying to prioritize your patients as they come in the door. What can you do for your patient with the shoulder dislocation in the meantime? (more…)