SAEM Clinical Image Series: Man vs Pneumatic Nail Gun

X-ray hand

A 40-year-old male presents with injury to his left hand by a nail gun. While at work, the patient accidentally shot himself with a nail gun. The nail went through pneumatic air hose tubing, his third finger, and his thumb; keeping them all connected. He immediately felt uncomfortable in his left arm, and, upon arrival to the emergency department (ED), complained of swelling in his left arm extending to his neck. He feels shortness of breath and “fullness” in his throat.

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IDEA Series: Homemade Escharotomy Kit

Normal knee radiology AP

Although escharotomy is rarely performed by emergency physicians during the initial management of burns, it is a life and limb-sparing skill important to know as a trainee and provider in emergency medicine [1,2]. There are few models made to accommodate procedural training, and the ones available are often cost-prohibitive. It is critical to have a method for learning and practicing this important procedure [3,4].

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By |2020-07-03T15:50:13-07:00Jul 6, 2020|IDEA series, Trauma|

EMRad: Radiologic Approach to the Traumatic Knee

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 EM:Rad, a series aimed at providing “just in time” approaches to 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. We recently covered the elbow, wrist, shoulder, ankle, and foot. Next up: the knee.

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By |2020-06-24T07:34:48-07:00Jun 29, 2020|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Can’t Miss Adult Knee Injuries

knee radiology

Figure 1: Normal AP knee x-ray. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, annotations by Stephen Villa MD.

Have you ever been working a shift at 3am 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 a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. Now: the knee.

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By |2020-06-24T07:43:05-07:00Jun 29, 2020|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Can’t Miss Adult Shoulder Injuries

AP view shoulder

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 primary doctor 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 a comprehensive review of each body part, but rather aims to highlight and improve your sensitivity for these potentially catastrophic injuries. Now: the shoulder

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By |2020-05-14T22:35:01-07:00May 6, 2020|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Radiologic Approach to the Traumatic Shoulder

Normal-shoulder series

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific  to management, and offer a framework for when to get an additional view, if appropriate. We have already covered the elbow, the wrist, and the foot and ankle. Next up: the shoulder.

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By |2020-05-14T22:35:10-07:00May 6, 2020|EMRad, Orthopedic, Radiology, Trauma|

IDEA series: The Bleeding Arm Tourniquet Simulation

Tourniquet simulation

Education in emergency response to trauma is a global health priority [1]. Mortality rates are nearly twice as high in patients with trauma in low-income as compared to high-income countries [2]. With uncontrolled bleeding as the number one cause of death from trauma, tourniquet application has been the focus of training programs, like the “Stop the Bleed” campaign in the United States [3]. Although understanding how to apply a tourniquet is a life-saving intervention, use of a windlass tourniquet may not be intuitive [4].  The windlass tourniquet in its simplest form is the “stick-and-rope.” Winding the stick in the tourniquet creates a mechanical advantage for providing compression. Simulation of the windlass technique can be used to teach management of uncontrolled bleeding. Here we describe a low-cost simulation model that combines low- and high-fidelity techniques to train healthcare personnel on windlass tourniquet application.

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