Pediatric Trick of the Trade: Finger Immobilization Technique

A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair?

Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.

(more…)

By |2017-11-13T10:18:47-08:00Nov 13, 2017|Orthopedic, PEM Pearls, Trauma, Tricks of the Trade|

Atraumatic Low Back Pain: ACEP E-QUAL Network Podcast

Atraumatic low back pain is a common complaint in the ED. For most patients, a thorough history and physical exam is sufficient to exonerate causes that threaten life or neurological function. For a small subset, however, MRI may be required. ALiEM has partnered with the ACEP E-QUAL Network to promote clinical practice improvements through a series of podcasts. In our first installment, we focus on this common presentation. We review highlights from an interview with Dr. Jonathan Edlow, Vice Chair of Emergency Medicine at Beth Israel Deaconess, about the presentation and evaluation of low back pain. Afterward be sure to check out the podcast in full.
(more…)

By |2019-04-05T17:16:48-07:00Sep 28, 2017|Orthopedic, Radiology|

SplintER: A New Series on Orthopedic Injuries and Splinting

splintingThe purpose of the SplintER series is to teach the fundamentals and introduce advanced concepts of splinting to the Emergency Medicine (EM) professional. Humans have been splinting their injuries since 1300 B.C.1 Although the fundamentals have not changed, splint selection and application require some thoughtful consideration. A 2017 prospective, observational study in the Journal of Pediatric Orthopaedics demonstrated that more than 90% of splints applied in the Emergency Department were inappropriate (30% applied by EM attendings), as evaluated by orthopaedic surgeons.2 While that number may not be representative in your institution, it certainly highlights the inadequacies that many of us feel when approaching a splint!

(more…)

By |2018-03-07T01:13:14-08:00Sep 18, 2017|Incubators, Orthopedic, SplintER|

Extensor Tendon Lacerations to the Foot

A young man is brought into an emergency department after an electric lawn edger cut through his work boot and into the dorsum of his right foot. He has a clearly contaminated 5 cm x 1 cm laceration on the lateral side, and an underlying tendon is exposed. Sensation is diminished around the wound and he is unable to actively extend his 5th toe past a neutral position. How would you diagnose and repair his extensor tendon injury?

(more…)

By |2017-09-11T03:28:42-07:00Sep 11, 2017|Orthopedic, Trauma|

Trick of the Trade: DIY Squirt Bottle Wound Irrigation

wound irrigationWound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative?
(more…)

By |2017-07-30T14:37:24-07:00Jul 31, 2017|Orthopedic, Trauma, Tricks of the Trade|

Management of Major Pelvic Trauma

pelvic trauma fracturePelvic trauma frequently is associated with other injuries from the high force required to break the pelvis. Management is focused on stabilizing the pelvis and stopping the bleeding. Due to other injuries requiring emergent surgical stabilization, pelvic trauma is primarily managed surgically with pre-peritoneal packing and external fixation, followed by angioembolization for continued bleeding. Emergency physicians must quickly resuscitate patients while gathering vital information to direct the correct definitive bleeding control strategy. New endovascular techniques such as REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) may change future emergency department strategies and improve mortality in severe pelvic trauma. 
(more…)

By |2017-07-19T21:58:25-07:00Jul 19, 2017|Orthopedic, Trauma|