A 4 yo M presents to Urgent Care with R shoulder pain after a fall off his bed. Father denies any head trauma or other injury. On exam, he has decreased ROM at the R shoulder and tenderness and ecchymosis along the distal/mid clavicle. Neurovascular exam is normal.

Good analgesia is crucial in fracture reduction. This can be achieved many different ways, including regional anesthesia, systemic pain medications, or procedural sedation.  For certain fracture types, such as wrist fractures, a hematoma block is often used.  Here are basic instructions, tips and tricks for performing a hematoma block.

Submitted by Alison Jaworski, MD

A 34-year-old woman at 32 weeks gestation presents to the emergency department with cough, dyspnea and hypoxemia. She rapidly progresses to severe ARDS despite lung protective ventilation, paralysis and inhaled epoprostenol. P/F ratio is 99 mm Hg. Is prone positioning safe to perform in pregnant patients with severe ARDS? If so, are modifications necessary to offload the abdomen and monitor the fetus? A recently published review in Obstetrics and Gynecology discusses this important topic. 

Submitted by Emily Damuth, MD

A 44 yo female c/o left eye pain

Submitted by Angela Ugorets, MD