Let the Hand Take a Bath with Ultrasound for Foreign Bodies
Some procedures are worth doing over and over because they are easy and fun. The bonus is they can improve outcomes for patients and prevent bouncebacks, costly follow-up exams, and prolonged pain and complications. This month we discuss the use of the ultrasound (US) water bath and bedside imaging for foreign bodies (FB). If you would like to see more about using ultrasound for FBs, see our previous blog post about wine glass in the foot. (http://bit.ly/2HSQLvZ.)Bedside US is an exquisite technique that can be used to examine and explore numerous parts of the body without using radiation. This procedure uses a s...
Source: The Procedural Pause - April 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Weird and Wild: The Hidden Compartment Syndrome
Compartment syndrome made it on our weird and wild list not only because it is uncommon but also because it is difficult to identify. It presents in strange ways, and is often missed the first time a patient seeks care. This rare but serious condition may result in permanent contractures or even loss of a limb. Complications from compartment syndrome escalate quickly if they're not treated promptly. Early recognition and treatment of this problem is imperative.The increased pressure in the space around certain muscles that creates compartment syndrome can be caused by fractures, bleeding, recent surgeries, burns, rhabdo...
Source: The Procedural Pause - April 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Curse of the Keloid
Each month, we try to bring you a case that is laced with unexpected care techniques. Our hope is that our procedural pearls help enhance your practice. Procedures rarely change over time, but new techniques and equipment may help you tackle new challenges. Once you have mastered simple procedures like incision and drainage and suturing and splinting, you can move on to more advanced procedures.This month we dare you to think outside the box and combine all your skills to help this weird and wild patient. We've said it before, and we'll say it again: It may not be an emergency, but it's an emergency to your patie...
Source: The Procedural Pause - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Weird and Wild: Back Piercing and Langers’ Lines
A patient presented to the emergency department with a request to remove her back ring. Yes, that's right, her back ring. We were a bit confused at first by the piercing. The stud was placed in her back with no obvious way of removal. Our original thought was to send the patient to dermatology or even plastic surgery. The piercing certainly didn't qualify for emergency surgery or removal.A 23-year-old woman with a back piercing in the left lower back. The underlying skin condition is not infectious. This is a classic example of tinea versicolor, and is not related to the piercing. It is a common fungal infectio...
Source: The Procedural Pause - January 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Weird and Wild: Piercing Problems, Tongue Rings, and TXA
Some of our patients are total daredevils. This unique population keeps us on our toes. Our weird and wild series recently discussed laceration repair involving tattoos, but problematic piercings also present to the ED.Traditional through-and-through piercing of the tongue body without complication. Photo: Creative Commons.An 18-year-old otherwise healthy woman presented to the emergency department with tongue swelling and mouth pain. Your first thought may be that this is an allergic reaction, but you quickly realize this is not the patient you expected. This patient just had her tongue pierced, and something ha...
Source: The Procedural Pause - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Taming the Tattoo
What do you do when something weird and wild comes into your emergency department? This month, we mean lacerations over tattoos or body piercings. Cosmetic repair of injuries involving tattoos and piercings are important to our patients. We should ensure proper wound closure while preserving the underlying body art.Tattoos and piercings are ancient practices of body modification. This form of art appreciation continues to be a popular and important cosmetic alteration for many people. Body art ranges from ear piercings ($20-30 for earlobes) to extensive tattoos that cost thousands of dollars.Many have sentimental value ...
Source: The Procedural Pause - December 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Weird and Wild: Scalp Abscesses and Kerions
Welcome back to the weird and wild, "what do I do with that?" series! We want to take you back to the magical land of abscesses. This scalp abscess case study and Procedural Pause pearl will help you relieve significant pain and decrease the risk for skin infections and complications. This case made it to our weird and wild list for being rare and interesting.Scalp abscesses and kerions can be tricky and complicated. At first glance, they can appear small and harmless. They are often underappreciated for this reason, but require immediate attention. There are several types of wound infections and rashes tha...
Source: The Procedural Pause - November 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Wine Glass in the Foot: A Case Study
Emergency department providers welcome the weird, the wild, the wonderful, and the unexpected. Routine chest pain workups and negative abdominal CTs occasionally bore us. Last summer we had the pleasure of meeting a man who was a line cook at a local restaurant. He came via ambulance for a foreign body in his foot. What we saw was unanticipated—he arrived with half a wine glass lodged in the sole of his foot. The stemware was lodged in the patient's foot, going through his shoe and sock. Photos by Martha Roberts.The patient was laughing and not in much pain. He said he had a high pain tolerance and could barel...
Source: The Procedural Pause - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Short and Long Posterior Splints for Leg Injuries
We use splints to help immobilize and stabilize injuries, but it's important to realize splinting also alleviates pain and edema and promotes healing until follow-up. If you are ever concerned that there is a fracture (even if it's not apparent on radiograph, i.e., navicular fractures), splint your patient before discharge. If you have the luxury of orthopedic consult in-house, talk to him before discharge.Indications for Short Posterior Splint-Fractures of the distal tibia and/or fibula-Ankle dislocations-Severe sprains-Fractures of the talus-Fractures of the calcaneus-Foot fractures such as fractures of the fifth m...
Source: The Procedural Pause - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
