EMRad: Radiologic Approach to the Traumatic Elbow

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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By Stephen Villa, MD|2020-05-14T22:36:46-07:00Sep 16, 2019|EMRad, Orthopedic, Radiology, Trauma|

SAEM Clinical Image Series: Hip Pain

$hip pain anterior inferior iliac spine fracture$

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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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By Louis Yu, MD MA|2019-09-09T17:23:16-07:00Sep 9, 2019|Emergency Medicine, Orthopedic, SAEM Clinical Images, Ultrasound|

SplintER Series: Ankle and Foot Pain in a Child

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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By William Denq, MD CAQ-SM|2019-09-09T13:56:11-07:00Sep 4, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

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Chief complaint: Foreign Body Ingestion

History of Present Illness:

A 4-year-old male presents to the Pediatric ED for evaluation of swallowed foreign body.

The mother reports the patient was at his grandmother’s house playing near a cabinet when they witnessed him put a small unknown object in his mouth and swallow. Family denies vomiting, difficulty breathing, change in behavior, abdominal pain, or any additional symptoms at this time.

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By Brett Berliner, MD|2019-09-03T11:18:06-07:00Sep 2, 2019|Gastrointestinal, SAEM Clinical Images, Tox & Medications|

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Chief complaint: Headaches for 1 year

History of Present Illness: A 31-year-old woman with no significant past history presents with a dull headache.

She notes the headache is generalized, has been almost daily for a year and is worsened by bending over. She denies nausea, vomiting, photophobia, trauma, seizures, focal weakness, numbness, or vision change. Acetaminophen and ibuprofen provide only mild, short-acting relief. She takes oral birth control and her periods have been normal.

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By Walter L Green, MD|2019-09-03T11:17:34-07:00Sep 2, 2019|Neurology, Ophthalmology, SAEM Clinical Images|

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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By Sergio Alvarez, MD CAQSM|2019-09-09T13:54:59-07:00Aug 30, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

Tamponade physiology, in which a pericardial effusion impedes cardiac output, is a medical emergency and requires prompt diagnosis and intervention before cardiovascular collapse ensues. However, not every fluid collection in the pericardial sac results in tamponade physiology. A clinical diagnosis of tamponade (Beck’s triad) has poor sensitivity and will occur only in the late stages of tamponade.¹ In order to know whether or not an intervention is necessary for the setting of pericardial effusion, ultrasound diagnosis of tamponade is paramount.

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By Leen Alblaihed, MBBS, MHA|2019-08-30T10:13:06-07:00Aug 28, 2019|Cardiovascular, Radiology, Ultrasound|