Author: John Winkler, M.D. Educational Pearls: -Lower mechanisms of injury have a lower chance of an associated fracture or major ligament injury. -One major concern is having a fracture fragment in the joint (can lead to chronic arthritic pain). -Evaluation should involve checking the neurovascular status of the arm and reduce the fracture as soon…
Read MoreAuthor: Sam Killian, M.D. Educational Pearls: Spinal cord injury without radiographic abnormality (SCIWORA) is a diagnosis defined as traumatic injury to spine with clinical sx of traumatic myelopathy (paraplegia, paresthesias, FND) without radiographic abnormalities. Term was established in 1970’s before MRI and accounted for about 15% of injuries at the time (mainly children). Today SCIWORA…
Read MoreAuthor: Michael Hunt, M.D. Educational Pearls Rhabdomyolysis is caused by the destruction of skeletal muscle that leads to the release of myoglobin, which causes renal failure. It presents with pain and weakness in the affected muscle, as well as dark urine. Diagnosis is made with creatinine kinase levels It can happen to extreme athletes after…
Read MoreAuthor: Sam Killian, M.D. Educational Pearls The tongue blade test is done for mandible fractures, which make up 40-60% of facial fractures. The test is done by having the patient bite down on a tongue depressor on one side of the mouth. The provider then tries to snap the tongue depressor. This is repeated on…
Read MoreAuthor: Nick Hatch, M.D. Educational Pearls The force required to break a clavicle is significant, so clavicle fracture may be associated with other injury (pneumothorax, vascular injury). Most fractures occur in the middle 1/3 of the clavicle. Traditionally, clavicle fractures have been managed without surgery. However, recent studies have shown that surgery may be beneficial…
Read MoreAuthor: Donald Stader, M.D. Educational Pearls: The most common ankle injury mechanism is an inversion. Most common broken bone in the ankle is the fibula. During exam, it is important to palpate over the fibular head, medial and lateral malleoli, over the 5th metatarsal and over the cuboid bone. If no tenderness in these areas…
Read MoreAuthor: Sam Killian, M.D. Educational Pearls: Defined as fracture of neck (distal segment) of 5th metacarpal. Intrinsic muscles of hand pull segment to palmar aspect of hand. 30 degrees of angulation is allowed. Any more increases risk of chronic pain, grip strength and grasping deficits, and rotational deformities. Reduce fracture if more than 30 degrees…
Read MoreAuthor: Don Stader M.D. Educational Pearls: Non-traumatic back pain is a very common complaint in the Emergency Department. Conditions that can manifest with back pain include: ruptured abdominal aortic aneurysm, retroperitoneal bleeding, cauda equina syndrome, epidural abscess or cancer. Patients with cauda equina syndrome or epidural abscess prefer to sit forward, while people with disc…
Read MoreAuthor: Chris Holmes M.D. Educational Pearls: Mechanism of injury involves hyperextension/hyperflexion Pathophysiology: inside of the arteries in the neck becomes disrupted, similar to a dissection. This is thrombogenic and leads to cerebral infarction Neurologic deficit is common. Other risk factors include facial fracture and cervical-spine fracture. Treat with anticoagulation – aspirin or other antiplatelet agents…
Read MoreRun Time: 4 minutes Author: Michael Hunt M.D. Educational Pearls: Stinger – a stretch of cervical nerves from a lateral blow to the head and causes immediate pain and numbness in the arm. There is no specific treatment, and symptoms last seconds to minutes or as long as a few days. A small percentage of…
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