SplintER Series: A Case of Knee Pain

segond fracture xray

A 45-year-old male presents with right knee pain after he pivoted and felt a “pop” while making a move playing pickup basketball. You obtain knee x-rays and see a lateral irregularity in the AP view (photo courtesy of Dr. Gerry Gardner at Radiopaedia.org).

What is the most likely diagnosis, commonly associated injury, and appropriate management plan?

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Trick of the Trade: Save the Ultrasound Probe Cable

You need to perform an ultrasound on your patient. You walk up to the ultrasound and upon grabbing the machine, you notice it’s stuck! You look down and realize the ultrasound probe cable (particularly the linear probe) is impeding the wheel from rolling. You push the machine back, pick the cable up off the floor and off you go to scan to find that the probe is not working. As you try to figure out why it’s not working, you realize that the cable is exposed after repeated damage from the countless times the wheels on the machine rolled over the cable. Let’s prevent this from happening!

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2019-09-28T08:29:44-07:00

Techniques for Ultrasound-Guided IV Placement

Y junction access

Imagine a busy evening shift interrupted by the news that the unstable dialysis patient still has no access. Begrudgingly, you drag the ultrasound into the patient’s room. Buried beneath a layer of muscle, a tiny vein lurks below an intimidating artery with a nerve nestled close by. Making matters worse, the patient is becoming increasingly more frustrated. “This always happens. I told them not to remove my last PICC line,” he notes. The use of ultrasound-guided IV improves successful cannulation and decreases complications, but cases like this have caused many emergency providers to resent, even fear, this basic procedure.​1–4​ Below, we provide additional techniques to increase your success and to avoid the risks associated with central line placement.

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2019-09-19T17:39:55-07:00

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

Differentiating pericardial effusion from pericardial tamponade on ultrasound

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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2019-08-30T10:13:06-07:00