EMRad: Can’t Miss Elbow Injuries

lateral elbow fat pads

Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. To begin: “Can’t Miss” adult elbow injuries.

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2019-09-13T09:18:01-07:00

EMRad: Radiologic Approach to the Traumatic Elbow

 elbow lateral xray normal

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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2019-09-13T09:28:50-07:00

SAEM Clinical Image Series: Hip Pain

hip pain anterior inferior iliac spine fracture

[Click for larger view]

Chief complaint: Left hip pain

History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball.

He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation but could not stand after the kick and fell to the ground. He can ambulate but only with significant pain.

He now has 8/10 sharp, non-radiating left hip pain that is worse with movement, weight-bearing and palpation.

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2019-09-09T17:23:16-07:00

SplintER Series: Ankle and Foot Pain in a Child

iselin disease xray

A 10-year-old female dancer presents with sub-acute onset pain located in her lateral ankle and foot without any history of significant trauma. She has had similar pain occasionally over the past 6 months. Pain is worse while dancing and now has difficulty putting on her shoe. You obtain a foot x-ray and see the adjacent image (photo credit).

What is the most likely diagnosis, differential diagnosis, and appropriate management plan?

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SplintER Series: Funny Looking Finger

right 5th digit xray mallet finger

Figure 1: Terminal extensor tendon avulsion at distal interphalangeal joint of 5th digit

A 17-year-old baseball player presents complaining of finger pain and difficulty straightening his finger after a baseball game. You obtain x-rays and see the following fracture (photo credit).

What is your diagnosis and emergency department management?

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Fascia iliaca nerve block: A hip fracture best-practice

fascia iliaca nerve block hip fracture

An 82-year-old woman presents with left hip pain after a mechanical fall while cleaning the kitchen floor. When EMS arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of IV morphine, but she is still writhing in pain on arrival. The AP pelvic x-ray demonstrates a left femoral neck fracture (arrow). You consider performing a fascia iliaca nerve block for better pain control.

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2019-09-09T13:55:18-07:00

SplintER Series: Ankle Dislocation | Leg Day #4

Welcome to Leg Day #4 of the SplintER Series! Ankle dislocations are an emergent condition in the Emergency Department (ED) that requires expert-level examination and management. We review the pertinent and subtle sports medicine examination and management techniques that will help you feel in control from time of presentation to disposition. 

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