Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.
Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this area is lim...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Feel the Burn, Heal the Burn: Wound Care Management
The Approach: How to Help HealWe promised you some information about soft tissue injuries, and you’ve got to hand it to us: we delivered! Last month, we discussed incision and drainage of large burns to the hand. Review it here before reading further: http://bit.ly/RobertsBurn. This month, we want to take an in-depth look at wound care management for burns and highlight other pearls needed for top-notch healing.
You should try to follow a few simple rules when it comes to treating burn patients. Soft tissue skin injuries heal in stages and are dependent on direct and correct treatment of the area, nutrition, and hydra...
Source: The Procedural Pause - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Feel the Burn
Hand burns from thermal injuries are common chief complaints in the emergency department. Sometimes, 2nd- and 3rd-degree burns may need immediate interventions and warrant special attention. These injuries are painful, and often have associated complications such as permanent scarring, cosmetic issues, prolonged pain, and even infection. ED providers can assist with the primary complications related to blistering of the hand or extremity. Careful follow-up and a detailed discharge plan produce better outcomes and minimize overall complications. Full body/surface burns or circumferential burns should always be seen and eval...
Source: The Procedural Pause - February 28, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Foreign Body to the Face and Facial Laceration Repair
Part 1 in a Series
Wound care and suture repair are two of the most frequently encountered issues in the emergency department. It is the midlevel provider’s job to be familiar with proper wound care and suturing techniques as well as quick and safe treatment of soft tissue skin injuries. You can use various suturing techniques and styles, but it is important to find a few that really work for you, often tailored to the area of injury.
This month, we are focusing on lacerations and puncture wounds to the soft tissue of the face. Future posts will touch on other suturing skills, with some great tips from our plastic surge...
Source: The Procedural Pause - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Point Taken: Finger Dislocations
Finger dislocations are relatively simple to identify and treat, but ligament and volar plate ruptures are often missed. Radiographs are not always indicated, but are useful in locating the area of injury and noting avulsion fractures. It is important to listen to the patient’s story to identify the mechanism by which the injury occurred because mimicking this mechanism is typically the best way to relocate the joint. Patients typically do not always need local anesthesia or digital block because relocation techniques are quick and can often be done while simply distracting the patient for a second or two. Treatment is d...
Source: The Procedural Pause - January 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Saga Continues: Posterior Shoulder Dislocation
We finish our shoulder dislocation series by paying our respects to posterior shoulder dislocation. Posterior shoulder dislocations are rare, and account for less than 4-5 percent of all shoulder dislocations, but all ED providers should know how to identify and relocate these injuries. Cases of misdiagnosis and even late diagnosis can occur. Early recognition and appropriate management can save a patient from complicated issues related to the dislocation as well as chronic pain.
Anteroposterior (AP) view, left, of a patient with a posterior dislocation. This dislocation may be difficult to appreciate on an AP view becaus...
Source: The Procedural Pause - December 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Yet Another Shoulder Dislocation
No series on dislocations would be complete without mentioning shoulder dislocation. Most shoulder dislocations (>90%) are anterior (forward), and it should be noted that shoulder dislocations make up about half of all dislocations seen in the ED. Most shoulders can be relocated easily, while others may frustrate a provider. Associated fractures, artery or nerve compromise, and even rotator cuff injuries can worsen the situation. Relocation techniques can be difficult, and may be physically challenging for the provider and patient.
Acute shoulder dislocation with fracture of tuberosity. (Photo by James Roberts)
T...
Source: The Procedural Pause - November 1, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Funny Bone, Serious Problem
Part 2 in a Series
Elbow dislocations are quite painful and often times accompanied by other injuries. ED providers caring for a patient with an elbow dislocation must be sure to properly examine and x-ray patients prior to putting an elbow back in place. Be wary of the associated complications to dislocations including fractures and nerve or artery injury. Soft tissue damage and swelling are also very common.
Acute elbow dislocation.Photo by Martha Roberts
Like many relocations, slow and steady traction and countertraction with your magical and carefully calculated combination of sedation and analgesia is the hal...
Source: The Procedural Pause - October 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Here, Fishy, Fishy
The skilled ED provider always takes proper precautions before attempting fish bone removal and preparing for patient discharge. And a sensible provider never sends an anxious patient down river without a thorough exam.
Fish bones are usually slightly waxy, bendable, and sharp. These tiny bones lodge themselves in the throat with a vengeance. Common nesting sites of fish bones include the base of the tongue, tonsils, posterior pharyngeal wall, aryepiglottic fold, or upper esophagus. Late complications of leftover fish bones in the throat may cause airway obstruction or rarely esophageal perforation. The patient is alway...
Source: The Procedural Pause - August 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Need to Know: Patellar Dislocation
This month, we are switching gears to focus on joint dislocations, their subsequent relocation procedures, and related complications. The first relocation technique, for treating a patellar dislocation, is a fast, uncomplicated procedure that every ED provider should be able to perform without the need for an immediate orthopedic consultation.
The procedure itself is not challenging, but pain management and related injuries can be troublesome for some patients. The concern for additional injuries such as patella fracture, quadriceps tendon rupture, meniscal or ligamentous tears, and distal femur and proximal tibial frac...
Source: The Procedural Pause - July 24, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Sometimes It’s Subungual
As you may have noticed, we have really put a finger on figuring out paronychia and the dreaded felon in the past two Procedural Pause blogs. This series, however, would not be complete without also touching upon complications related to a subungual hematoma and abscess. Hopefully, this month’s entry will point you in the right direction if you come across these two culprits.
Typically, a subungual hematoma will form from direct blunt trauma to the fingernail itself. Some common mechanisms of trauma range from slamming the digit in a car door, in a drawer, hitting it accidentally with a hammer, or from a sports-re...
Source: The Procedural Pause - June 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Feel the Felon
Last time we discussed some ways to approach and manage the acute paronychia, but yet another unfortunate criminal robs our nail of its fine fettle: the nefarious felon. The felon’s early signs and symptoms may be subtle so don’t be fooled. This tender, fingerpad infection is not to be ignored. The enclosed fascial spaces of the fingertip pulp will be tender, and appear red and hot, which should mimic your aggressiveness and approach to stop it in its tracks. Figure out that felon, be tender, and forge ahead!
Some thoughts before proceeding. Your fingertip has thousands of nerves, and is very sensitive. Consider all...
Source: The Procedural Pause - May 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Please Poke My Paronychium!
THE BASICSWhat is more satisfying than draining a pus-filled paronychium? Seeing the look of relief on the face of your patient when his painful, pulsating digit is relieved of all that tension! This rather elementary procedure could be perceived as stale and uneventful for some of you. The more thorough and astute clinicians, however, realize these tiny infections around the nail root may open the door to a mixed bag of insidious and harmful bacterial infections including MRSA, chronic reoccurrences, cellulitis, subungual abscesses, osteomyelitis, herpetic whitlow, or even the dreaded felon.
Whatever your pleasure, thi...
Source: The Procedural Pause - May 1, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
My tooth hurts, and I don't want narcotics!
It's Sunday evening, and a patient with tooth pain signs into triage. This pleasant but teary 44-year-old woman had a root canal two days earlier. Many ED providers would agree that dentists should not schedule root canals on Fridays unless they are truly emergent.
But the patient is in the ED asking for your expert dental advice. The good news is you can assist her temporarily until she gets back to her dentist. This quick and effective ED procedure will save you time and heartache.
THE BASICS
No other medical problems or surgeries.
Allergies: ASA, NSAID.
The culprit: Tooth #17
Medications tried: Vicodin, Percocet, an...
Source: The Procedural Pause - March 29, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
