EMRad: Radiologic Approach to the Traumatic Elbow
Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships.1 Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EMRad, a series aimed at providing approaches and improving interpretation of commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. To begin: the elbow.
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A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.
Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.
Welcome to Leg Day #2 of the