EMRad: Can’t Miss Adult Wrist Injuries

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 common and catastrophic injuries. 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. Last post, we reviewed the elbow. Now, the “Can’t Miss” adult wrist injuries.

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By |2019-12-15T16:20:09-08:00Jan 8, 2020|Orthopedic, Radiology, Trauma|

EMRad: Radiologic Approach to the Traumatic Wrist

This is EMRad, 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. Last post, we focused on the elbow. Now: the wrist.

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By |2019-12-15T16:32:58-08:00Jan 8, 2020|Orthopedic, Radiology, Trauma|

Trick of Trade: Topical lidocaine jelly takes the tears out of skin tears and road rash

Laceration Thin Skin topical lidocaine

Skin tears are a common injury treated in the elderly in the emergency department (ED). Often the skin is paper thin, and the area involved can have a large flap. By the time the patient has arrived, the may blood have dried with a retracted and rolled-in skin flap. Often the surface area is too big and skin to thin to inject local anesthesia around the entire site.

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SAEM Clinical Image Series: Eye Trauma and Vision Loss

globe rupture open globe

The patient is a 44-year-old male with a past history of end stage renal disease on hemodialysis, diabetes, and hypertension who presents with acute visual loss after assault 2 hours prior. He was struck in the eye by his partner’s fist (adorned with a large ring), but denies severe pain. He does endorses instant difficulty with his vision. There is no use of contacts or glasses. No other injuries, headache, or loss of consciousness are reported.

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By |2019-11-10T21:42:57-08:00Oct 21, 2019|Ophthalmology, SAEM Clinical Images, Trauma|

SAEM Clinical Image Series: A Page Turner

Gray Turner's sign

[Click for larger view]

Chief complaint: Abdominal pain

History of Present Illness: A 36-year-old male with a history of alcohol abuse, hypertension, hyperlipidemia, and myocardial infarction with a subsequent stent on ticagrelor and aspirin presents with abdominal pain.

He reports 3 days of epigastric and periumbilical pain and multiple episodes of non-bloody, non-bilious emesis. He denies fever, diarrhea, blood in his stool, and urinary symptoms. He endorses bruising to his bilateral flanks and multiple falls recently while drinking.

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By |2019-09-23T09:58:06-07:00Sep 23, 2019|SAEM Clinical Images, Trauma|

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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By |2019-09-13T09:18:01-07:00Sep 16, 2019|Orthopedic, Radiology, Trauma|

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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By |2019-09-13T09:28:50-07:00Sep 16, 2019|Orthopedic, Radiology, Trauma|