Paucis Verbis: Distracting injuries in c-spine injuries

CervicalCollar

“Distracting injury” is a frequent cited reason for imaging the cervical spine in blunt trauma patients, per the NEXUS study. In the Journal of Trauma in 2005 and 2011, studies aimed to narrow the definition of “distracting injury”. Although both are studies at different sites, both conclude the same:

  • Chest injuries may be considered “distracting injuries” because of their proximity to the cervical spine.

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By |2019-02-19T18:42:18-08:00Sep 9, 2011|ALiEM Cards, Orthopedic, Trauma|

Trick of the Trade: Crossed straight leg raise test

SLRA 35 year old man presents with low back pain which radiates down his right leg to the level of the knee. Is this sciatica?

Low back pain is one of the most common chief complaints that we see in the Emergency Department. In addition to the examination of the back and distal neurovascular function, we also need to test for evidence of a radiculopathy (compression or inflammation of a nerve root typically from a herniated disk). Because most disk herniations occur at the L4-L5 and L5-S1 level, you should test for irritation of the L4-S1 nerve roots. This is the sciatic nerve.

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By |2016-11-11T18:52:17-08:00Aug 23, 2011|Orthopedic, Tricks of the Trade|

Trick of the Trade: Cunningham maneuver for shoulder dislocation

ShoulderDLxray

We commonly see patients with shoulder dislocations in the Emergency Department. There are a myriad of approaches in relocating the joint, which includes scapular rotation, Snowbird, and Kocher maneuvers.

I recently stumbled upon the Cunningham technique after hearing about it from Dr. Graham Walker (of MDCalc fame) on TheCentralLine.org.

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By |2019-01-28T22:43:28-08:00Jun 22, 2011|Orthopedic, Tricks of the Trade|

Trick of the Trade: Fingertip injuries

FignernailGone2sm fingertip injuriesFingertips can get injured in a variety of ways such as machetes, meat grinders, and broken glass. You name it, and we’ve probably seen it. Some don’t actually need anything invasive done because the skin is basically just torn off. The wound just needs to be irrigated, explored, and then bandaged to allow for secondary wound closure.

What do you do if the finger injury keeps oozing and the finger tip is too painful for the patient to apply firm pressure? Poking the finger with 2 needles to perform a digital block seems a bit overkill.

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By |2020-02-12T20:41:43-08:00Jun 8, 2011|Orthopedic, Trauma, Tricks of the Trade|

Tricks of the Trade: Nursemaid elbow reduction

We’ve all seen it before while working in the ED. A parent brings in their child because they pulled on their arm, and now the child is not using it. Parents are thoroughly convinced that the child’s arm is either broken or dislocated. We all recognize this as radial head subluxation or “nursemaid’s elbow” and immediately attempt to reduce it. The provider takes the injured arm, supinates at the wrist and flexes at the elbow. Does the child scream? What if nothing happens?

Is there an alternative technique to reducing a nursemaid elbow?

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By |2016-11-15T22:02:31-08:00Jan 19, 2011|Orthopedic, Pediatrics, Tricks of the Trade|