Back in September of 2009 Michelle shared valuable Tricks of The Trade regarding drainage of peritonsillar abscesses. Today we revisit the topic and add two more tricks to avoid hitting “big red” a.k.a. the internal carotid artery.
Can you see the pneumothorax?
Small pneumothoraces can be difficult to detect on chest xrays. Overlying ribs, other bony structures, and soft tissue can obscure subtle findings. For a patient at risk for a small pneumothorax, you can use your digital radiology PACS system to improve your ability to spot them.
Often times, I get called to triage to help decide whether a patient should be sent to Radiology for an initial x-ray after injuring their knee, ankle, and/or foot. After teaching one of the nurses about the Ottawa rules, she taped a list of these rules on the triage wall.
This installment of the Paucis Verbis (In a Few Words) e-card series reviews Ottawa Knee, Ankle, and Foot Rules.
With increasing awareness of CT’s irradiation risk, I thought I would review a classic 2001 article from the New England Journal of Medicine. Head CT’s previously were commonly performed prior to all lumbar punctures (LP) to rule-out meningitis. When can you safely go straight to an LP without imaging?
Caveat: This review only applies to those patients in whom you suspect meningitis. This does not apply to those being worked up for subarachnoid hemorrhage.
Ankle fractures are a common injury diagnosed in the Emergency Department. Being able to speak Ortho-ese (i.e. the language of orthopedists) is invaluable in consulting the orthopedist over the phone. One ankle fracture classification system that our orthopedists like to use is the Lauge-Hansen system.
Go to ALiEM (PV) Cards for more resources.
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.
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).