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em@3am

EM@3AM: Metacarpal Base Fractures

A 22-year old male presents to the ED after landing on his right thumb while playing football with some friends. The pain and swelling became progressively worse as he notes pain with any movement of his thumb. He is right hand dominant. On exam, the right MCP joint is edematous with point tenderness and ecchymosis, though the skin is closed. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Pyogenic Flexor Tenosynovitis

A 40-year-old female presents to your Emergency Department with three days of pain and swelling in her right index finger. On exam, her right index finger is diffusely swollen, erythematous, and held in flexion. There is a punctate wound on the dorsal finger distal to the  DIP. She has significant tenderness to palpation of the flexor compartment of the finger and pain on extension. What is your next step in evaluation and treatment?

em@3am

EM@3AM: Posterior Shoulder Dislocation

A 28-year-old male presents to the ED with right shoulder pain after falling on an outstretched arm two hours earlier. He denies history of prior shoulder injuries. On exam, he is holding his right upper extremity in adduction and internal rotation at the shoulder. He is unable to externally rotate his shoulder due to pain, and you note prominence to the posterior shoulder on exam. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Osteomyelitis

A 51-year-old male with diabetes mellitus presents with pain in his left foot, as well as fever and chills. His physical exam is notable for a 3 cm ulcer over the plantar aspect of his left first MTP joint, with surrounding warmth and erythema. Using a sterile instrument, bone was easily probed. What is your next step in evaluation and treatment?