Diagnosing the central slip injury

Figure 1. Laceration overlying proximal interphalangeal (PIP) joint of right second digit. (Photograph by Daniel Ting and Jared Baylis)

A 34-year-old cabinet maker presents to your Emergency Department after accidentally getting his finger caught in a drawer. On examination, he has a superficial, clean laceration over the dorsal surface of the right second digit (Figure 1).

In a previous post, we discussed the approach to identifying, treating, and managing extensor tendon injuries of the hand. In it, we advocate for a high index of suspicion for extensor tendon injuries whenever a patient suffers a laceration to the dorsal aspect of the hand. However, lacerations over the PIP joint deserve special mention. In this article, we focus on the diagnosis of a specific type of extensor tendon laceration: the central slip injury.

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2017-03-11T00:19:16-08:00

Jul 25, 2016 | CME, Expert Peer Reviewed (Clinical), Orthopedic

By: Daniel Ting, MD and Jared Baylis, MD

You are working in the treatment area with a medical student and she is ready to review a “straightforward” case with you. She presents a young, healthy 27-year-old man with a laceration over the dorsal surface of the left hand after a kitchen mishap. It appears clean, and she doesn’t suspect a foreign body. The neurovascular status seems okay with the intact ability to extend the fingers. Her plan is to repair the wound and send the patient for follow up in 7 to 10 days with his family physician for suture removal. The wound appears superficial, but you are an astute clinician and wonder if the skin laceration might not be the only injury. Is there an associated extensor tendon injury?

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2017-11-06T18:58:19-08:00

Jul 18, 2016 | CME, Expert Peer Reviewed (Clinical), Orthopedic

By: Daniel Ting, MD, Jared Baylis, MD and Jordan Haythornthwaite, MD FRCSC

Trick of the Trade: Pre-Charge the Defibrillator

In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome.¹ There has also been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why? Because we know interruptions are bad.^2,3 One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival.^4,5 Can we do better to shock sooner and minimize these pauses?

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2016-12-16T16:05:59-08:00

May 16, 2016 | CME, Critical Care/ Resus, Expert Peer Reviewed (Clinical), Tricks of the Trade

By: Sam Ghali, MD

Trick of Trade: Build-it-yourself IV Fluid and Drug Administration Trainer

Simulation equipment can be rather expensive and wanting to practice fluid and drug administration does not always warrant the purchase of specialized equipment. Luckily, a simple administration trainer can be made in less than 10 minutes and only costs a few dollars (or even nothing). This is an ideal option for resuscitation training if you are already using a manikin without IV arms or an IO option. Learners can practice preparing infusions and administering fluid or preparing an injection and administering it via the syringe port. This trainer can have multiple IV cannulas in one lid and can even include an intraosseous cannula, such as an EZ-IO.

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2016-10-26T17:04:20-08:00

Apr 14, 2016 | Expert Peer Reviewed (Clinical), Tox & Medications, Tricks of the Trade

By: Christoph Schroth

Calcium channel blockers for stable SVT: A first line agent over adenosine?

A 52-year old man presents via EMS with a chief complaint of “racing heartbeat” for one hour. He is placed on a cardiac monitor which shows a heart rate of 185, an ECG reveals supraventricular tachycardia (SVT), and his blood pressure is 143/95 mmHg. As you ask the nurse to procure 6 mg of adenosine, the patient’s eyes grow wide.

“Please doc…” he pleads, “anything but that! Last time they gave that to me I thought I was gonna die!”

You recently read about using calcium channel blockers (CCBs) for paroxysmal SVT (PSVT), but can’t recall the last time you actually considered using them. After all, it’s been over 20 years since we switched to using adenosine first-line.

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2019-11-02T21:18:48-08:00

Mar 23, 2016 | Cardiovascular, Expert Peer Reviewed (Clinical), Tox & Medications

By: Stephen Rappaport, PharmD, BCPS and Meghan Groth, PharmD, BCPS

Zika Virus: What emergency department providers need to know

The Zika virus outbreak has recently been put on “Level 1” activation status by the Emergency Operations Center at the U.S. Centers for Disease Control and Prevention (CDC). If you haven’t already thought about this affecting your emergency department, you should starting now. A Level 1 status has been triggered only 3 times in the recent years: Ebola (2014), H1N1 (2009), Hurricane Katrina (2005). The following are some key facts and resources.

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2018-10-28T21:27:16-08:00

Feb 15, 2016 | Expert Peer Reviewed (Clinical), Infectious Disease

By: Lauren Pike, MD and Julian Villar, MD MPH

Trick of the Trade: Isopropyl Alcohol Vapor Inhalation for Nausea and Vomiting

Your triage nurse complains of numerous patients in the waiting room complaining of nausea, retching, and emesis. They ask you “why can’t we have an antiemetic on hand in triage?” Turns out they might have had an effective antiemetic on hand, or rather in their scrub pocket the entire time. They just didn’t know about it yet.
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