Trick of the Trade: Got a shoulder dislocation? Park it

ShoulderDLxray

Myriad techniques exist to reduce shoulder dislocations, which includes scapular rotation, Hennepin, Snowbird, Cunningham, and Legg maneuvers. They are nicely reviewed at ShoulderDoc.co.uk. You can also supplement any technique with ultrasound-guided intraarticular lidocaine for improved pain control.

Recently, Dr. Jay Park (Beth Israel Medical Center in New York) contacted me about his novel approach to shoulder reduction which anatomically makes sense. If his animation video doesn’t convince you, check out the video of an actual reduction.

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By Michelle Lin, MD|2019-01-28T21:59:02-08:00Jun 25, 2013|Orthopedic, Tricks of the Trade|

Anterior Shoulder Dislocation: Are Prereduction Films Needed?

A patient comes into your department with an obvious shoulder dislocation. You know you can easily reduce the shoulder and have the patient discharged before the orthopedic consultant calls back. But what if there is a fracture? Do you need to get that plain film before popping it back into place?

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By Matt Astin, MD|2018-02-06T17:49:09-08:00Jun 24, 2013|Orthopedic, Radiology|

Patwari Academy video: Torsades de Pointes

Torsades de pointes is a polymorphic form of ventricular tachycardia. Why does this occur? What does it characteristically look like? Why is this an important form of ventricular tachycardia to differentiate from the more classic monomorphic ventricular tachycardia? View this short 9 minute video on QT intervals and Torsades de Pointes.

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By Michelle Lin, MD|2019-01-28T21:59:21-08:00Jun 23, 2013|Cardiovascular, ECG, Patwari Videos|

Lead aVR: The Forgotten 12th Lead

Augmented leads (aVR, aVF, and aVL) were developed to derive more localized information looking at the right, lower, and left part of the heart respectively. Specifically, lead aVR obtains information from the right upper side of the heart. It also gives reciprocal information on the left lateral side of the heart, which is already covered by leads aVL, I, II, V5, and V6. This is the main reason lead aVR has become forgotten.

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By Salim Rezaie, MD|2019-09-10T13:39:11-07:00Jun 20, 2013|Cardiovascular, ECG|

Wellens’ Syndrome: Is it on your radar?

Wellen’s Syndrome was first described in 1982 in which 75% of patients with t wave inversions in V2-V4 went on to have an acute myocardial infarction (MI). This was again repeated in 1989, and showed that all patients with this morphology had >50% LAD stenosis. The incidence in the United States is about 10-15%.

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By Salim Rezaie, MD|2019-09-10T13:39:05-07:00Jun 18, 2013|Cardiovascular, ECG|

Must We Avoid Nitrofurantoin with Impaired Renal Function?

Acute uncomplicated cystitis is becoming more difficult to treat in the setting of increasing antimicrobial resistance. In the 2010 IDSA Guideline, as summarized in a PV Card on Cystitis and Pyelonephritis in Women, nitrofurantoin is now listed as the first-line choice, surpassing ciprofloxacin and sulfamethoxazole/trimethoprim from the previous iteration.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2021-03-09T12:31:20-08:00Jun 17, 2013|Tox & Medications|

RUSH protocol: Rapid Ultrasound for Shock and Hypotension

Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for the evaluation of critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states.

The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (<2 minutes) by most emergency physicians.

How do you perform the RUSH protocol?

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By Salim Rezaie, MD|2019-09-10T13:38:55-07:00Jun 1, 2013|Cardiovascular, Ultrasound|