Your patient in the Emergency Department has a Zone II or Zone III finger amputation which requires primary closure of the wound prior to discharge with appropriate outpatient follow up. However, a protruding piece of bone often prevents closure of the skin flap and requires trimming by using a rongeur. While this process is typically carried out by an orthopedic or hand surgical consultant, this post aims to introduce the use of a ronguer during management of finger amputation in the Emergency Department.
The most commonly used induction agent for rapid sequence intubation in the acutely injured patient is etomidate, largely due to its rapid onset of action and hemodynamically "neutral" effects. The dose-dependent effect of etomidate in suppressing adrenal synthesis of cortisol leading to adrenal insufficiency has left the door open for ketamine to be also considered as the rapid induction agent of choice in these critically injured patients.
Patella fractures represent 1% of all fractures and are commonly seen after direct trauma to the bone (fall onto flexed knee, "dashboard" injury"). When to involve your consulting orthopedic surgeon is a key branch point in the management and care of these patients.
Case: 43 year old woman presents to Emergency Department after falling from height of second-story window after locking herself out of the house. Patient reports falling onto her left hip. On physical exam, no leg length discrepancy and no bony tenderness to palpation of left hip. The patient cannot move her left lower extremity at the hip and has significant pain with minimal passive range of motion.
During Week 12 of this NFL season, Washington Redskins tight end Jordan Reed injured his shoulder while attempting to catch a pass in the endzone against the Dallas Cowboys. While Reed continued to finish the first half, he was diagnosed with an AC joint separation at halftime. This posts will give an review of the evaluation and management of AC joint separations in the ED.
High-yield review of recent literature in Emergency Medicine: Kupas F et al. "Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similiarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients." Annals of Emergency Medicine. December 2016.
During a preseason exhibition game of this NFL season, Dallas Cowboys quarterback Tony Romo suffered a compression fracture of his lumbar spine against the Seattle Seahawks. While this was not a season-ending injury for Romo, the veteran quarterback lost his starting position to the exceptional play of rookie quarterback Dak Prescott during his absence. Also included in this post is key pearls about a Chance fracture, another important fracture of the thoracic/lumbar spine!
In Week 8 of this NFL season, Houston Texans offensive tackle Derek Newton suffered bilateral patella tendons rupture against the Denver Broncos. Newton's injury was particularly rare not only because of it's bilateral nature but also because it occured without direct trauma. This is a season-ending injury for Newton. On the field, Newton received immediate immobilization and eventually underwent surgery to repair the tendons.
Penetrating neck trauma is a serious cause of morbidity and mortality in the acutely injured patient. While a "no-zone" management approach to penetrating neck injuries is replacing the traditional three zone approach, knowledge of neck zone anatomy is crucial to anticipating and diagnosing pathology inherent to each zone. Zone I is the most caudal and includes the base of the neck and thoracic inlet.
Ankle sprains are one of the most common traumatic injuries encountered in the Emergency Department. The pathophysiology of an ankle sprain occurs when there is abnormal movement of the talus within the ankle mortise leading to disruption of the surrounding ligaments.