Find the fracture in this patient with blunt knee trauma.As a general rule, plain films are insensitive in ruling out orthopedic injuries. One particularly tricky area is the knee. This 2-view knee series above is normal.
Did you know that the sensitivity of picking up knee fractures is as low as 79% with a 2-view series and 85% with a 4-view series? With the advent of CT imaging, more and more subtle fractures are being found.
In this installment of the Paucis Verbis (In a Few Words) e-card series, the topic is Pediatric Blunt Head Trauma.
This a particularly relevant topic given the recent press and discussions about CT irradiation and the cancer risk especially in pediatric patients. It’s also relevant since Dr. Nate Kuppermann (UC Davis) just gave Grand Rounds at our UCSF-SFGH EM residency program. He first-authored a landmark 2009 Lancet article on minor head injury in kids.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
We collaborated with PECARN and CanadiEM to create visual PECARN’s official decision tool.
As bedside ultrasonography is becoming a staple in central line placement (especially of internal jugular lines), emergency physicians now can minimize complications, such as carotid artery puncture and a pneumothorax. Traditionally, the US probe is positioned along the short-axis of the IJ during the procedure (see right).
Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of The Red Eye from EM Clinics of North America, Here are some sample images:
Epidemic keratoconjunctivitis (note subtle white precipitates over pupil)
Bacterial conjunctivitis (note injection along inferior fornix)
Episcleritis
Scleritis (note bluish hue of deep scleral vessels)
Acute angle closure glaucoma (note corneal edema)
Go to ALiEM (PV) Cards for more resources.
I got a nice email from Dr. John Fowler from Turkey who recently published a modified version of the Hair Apposition Technique (HAT) trick in the American Journal of Emergency Medicine in 2009.
Read more about the traditional HAT trick.
The HAT trick allows for scalp laceration closure by using scalp hair and tissue adhesive glue. Contraindications to this technique for wound closure include hair strands less than 3 cm, because it is difficult to manually manipulate short hair.
Updated on 6/1/13: Old PV card revised to reflect the 2012 ACCP guidelines
Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of Transient Ischemic Attacks (TIA) from EM Clinics of North America. I use this card a lot specifically for the ABCD2 risk-stratification score.
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.