A 26-year-old woman presented to an urban Detroit emergency department complaining of bilateral foot pain after walking outside in the snow for 30 minutes without shoes or socks. She was unable to ambulate secondary to the pain and swelling. Physical examination revealed bilateral pallor, doughy texture, and coolness to the touch. There was generalized tenderness to palpation throughout the digits. The overlying skin was edematous, although without signs of breakdown.
Distal radius fractures are among the most commonly encountered fractures in the emergency department (ED). They have been reported to account for around 25% of pediatric fractures and up to 18% of fractures in the elderly.1 Reducing minimally displaced distal radius fractures is a procedure that can be greatly facilitated by the presence of finger traps, which help hold traction while you reduce the fracture.2 Often While working in small 5-bed, free-standing emergency department (ED), I found myself needing to perform this vital procedure and finger traps were unavailable.
Application of fluorescein is a vital part of the workup of ocular complaints. Despite some studies showing questionable support, the typical cited clinical concern for stored fluorescein solutions is contimination with Pseudomonas and risk for iatrogenic infection with associated ulcer formation. 1–4 Subsequently, single dose sterile strips have become the standard agent stocked in most EDs. Many patients, especially children, can be apprehensive of the application of the physical strip directly to the eye, and are more comfortable with the concept of eye drops. In this post, we review multiple technique to create fluorescein solutions and additional tips for utilization that may be integrated into your practice, depending on the supplies available to you.
Placing a peripheral IV under ultrasound guidance is often much more challenging than it outwardly appears, especially for novice users. One of the more difficult aspects is in making sure that the target vessel is perfectly in the middle of the screen and then guessing where that corresponds to the middle of the ultrasound probe.
Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex.
A patient comes into the ED and you suspect septic arthritis to the knee. As you consent the patient for arthrocentesis, you can tell s/he has reservations about a needle being inserted into their knee and left in place while you aspirate. You also think in the back of your mind how tricky it is to sometimes change syringes while keeping the needle in the correct location. Is there another way of tapping the knee without a needle?