• X ray boxer's fracture

SplintER Series: Punched a Wall

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|Tags: |

A 27-year-old male presents to the ED with left hand pain after punching a wall. He has pain and swelling on the ulnar side of the dorsal hand. The above hand radiographs were obtained (image courtesy of Mark Hopkins). This patient has a fracture of the 5th metacarpal neck, otherwise known as a Boxer’s fracture. It is so named because a majority of these fractures come from punching an object [1]. Pearl: Unlike most hand and wrist fractures, metacarpal fractures are more likely to occur from axial loading than from a fall onto an outstretched hand (FOOSH) [1]. [...]

SAEM Clinical Image Series: Eye Injury

By |Categories: Academic, Emergency Medicine, Ophthalmology, SAEM Clinical Images|

An 11-year-old male presented to a pediatric trauma center following a motor vehicle collision (MVC). He was the restrained front-seat passenger when his vehicle was struck head-on, causing frontal airbag deployment. His primary complaint was pain around his right eye with associated blurry vision. He denied diplopia, pain with extraocular movements, flashers, floaters, or curtains in his vision. […]

  • Scaphoid Fracture

SplintER Series: Pain in the Snuff Box

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

  A 16-year-old male presents to the ED after injuring his wrist during a track meet. The patient was running hurdles when he fell forward, planting his wrist into the ground. The imaging is shown below (courtesy of Dr. Hani Makky ALSALAM, Radiopaedia.org). Scaphoid fracture (Image 2). Pearl: The scaphoid is the most frequently fractured carpal bone [1,2]. Pearl: Fractures occur at the waist, proximal third, and distal portion: 65%, 25%, and 10% respectively [3]. Image 2. Fracture of scaphoid. Case courtesy of Dr. Hani Makky ALSALAM, Radiopaedia.org, rID: 10398 (arrow added by authors). Occurs when [...]

Treating Blood Pressure in Intracranial Hemorrhage

By |Categories: Academic, Emergency Medicine, Neurology|

Blood pressure control in the setting of ischemic stroke has a clearly recognized benefit in patient outcomes. The impact of blood pressure control in hemorrhagic stroke is not as well understood. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with Dr. Latha Ganti (University of Central Florida College of Medicine). Dr. Ganti addressed the evidence behind recommended blood pressure targets and the available medications to achieve control. We present highlights from this discussion with Dr. Jason Woods.    What is the goal of blood pressure control in hemorrhagic stroke? Management of [...]

  • Normal knee radiograph

SplintER Series: A Case of Inability to Move the Knee

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

29-year-old F presents to ED with acute onset knee pain. Reports hearing an audible “pop” after twisting her leg while running down the stairs at home. She explains that her right knee is stuck, and she can neither flex nor extend it. An image is shown below (courtesy of Andrew Murphy, Radiopaedia.org)   […]

SAEM Clinical Image Series: Pitching Pain

By |Categories: Academic, Emergency Medicine, SAEM Clinical Images|

A twenty-year-old right-handed male presented to the emergency department with a past medical history of right coracoid impingement, and three months of increasing right shoulder pain that became suddenly worse. He had a right shoulder arthroscopy nine months ago and played a full season as his baseball team’s pitcher over the past four months. He endorsed no exacerbating symptoms other than movement and has only taken naproxen over the counter for this pain. He denied any family history of clotting disorders. […]

SAEM Clinical Image Series: Knee Pain

By |Categories: Academic, Emergency Medicine, Orthopedic, SAEM Clinical Images, Ultrasound|

A fifty-six-year-old male with a past medical history of legal blindness and remote right quadricep tendon rupture presents to the emergency department via emergency medical services (EMS) after a mechanical fall, complaining of left knee pain. According to the patient, he is in his regular state of health and was walking with his cane when he had a mechanical fall on the sidewalk after tripping on an unknown object and falling onto his left knee. The patient did not hit his head, did not lose consciousness, and has no head, neck, or back pain. The [...]

Anticoagulant Reversal in Hemorrhagic Stroke

By |Categories: Academic, Emergency Medicine, Neurology|

Acute management of cerebrovascular accidents can be challenging enough, but questions about anticoagulant reversal in the setting of hemorrhagic stroke add another layer of complexity. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with Dr. Joshua Goldstein (Massachusetts General Hospital, Harvard Medical School). Dr. Goldstein addressed common anticoagulants and their reversal agents, summarizing available literature to inform clinical practice. We present highlights from this discussion with Dr. Jason Woods.   What is the goal of anticoagulant reversal? Since it is impossible to go back in time to prevent intracranial hemorrhage (ICH), the [...]

SplintER Series: A Collision at the Plate

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 17-year-old male baseball catcher presents with right knee pain after an opponent slid into home plate, striking the anteromedial aspect of the patient’s knee while it was in extension trying to block the plate. An x-ray of the tibia and fibula was obtained (courtesy of Dr. Haytham Bedier, Radiopaedia.org). This is a proximal avulsion fracture of the styloid process of the fibula, indicating injury to the posterolateral corner (PLC) of the knee [1]. Pearl: In most cases, the avulsed fragment is attached to the lateral collateral ligament and/or the biceps femoris [2]. This injury usually occurs [...]

SAEM Clinical Image Series: Red, White, & Blue

By |Categories: Dermatology, Emergency Medicine, Environmental, SAEM Clinical Images, Tox & Medications|

A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient developed pain and swelling of her right calf following a spider bite while putting on her pants. The patient felt a “burning pain” and found a spider which she then killed. She went to a hospital and received cephalexin, trimethoprim/sulfamethoxazole, and oxycodone. Despite taking these medications she continued having aching pain rated 10/10 in her right calf along with generalized pruritus. The patient stated that the bite evolved from an [...]