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practice updates

Bleeding Hand Wounds

Hand and digital wound bleeding should be managed with hemorrhage control, an adequate exam and proper treatment. There are many tools to help manage bleeding and allow for an adequate exam. Using a topical analgesic such as lidocaine, can be helpful with pain control. The addition of epinephrine to a topical analgesic in hand and digital wounds may not be as scary as once thought and may be considered to help with hemorrhage control in certain wounds.

practice updates

Diagnostic accuracy of ankle x-rays: How often do we miss fractures? How can we improve?

Traumatic ankle pain is a common presenting problem to emergency departments. While sprains are the most common injuries (most common = anterior talofibular ligament), the patient still needs to be assessed for fracture. Since its derivation and validation in 1992, the Ottawa ankle rules are the most frequently used clinical decision tool when considering to obtain ankle x-rays.

practice updates

EM Cases: Occult Fractures and Dislocations

Missed occult fractures and dislocations, in general, may result in significant morbidity for the patient and law suites for you. Six cases are presented in this episode, ranging from common scaphoid fractures to rarer dislocations. Dr. Sayal & Dr. Mamen answer questions such as: Which fractures can mimic ankle sprains and how do you avoid missing them? What are the most reliable signs of scaphoid fracture? In which occult orthopaedic injuries should we anticipate limb threatening ischemia? Which is better to diagnose occult fractures – MRI or CT? Which calcaneus fractures require surgery and which ones can be managed conservatively? and many more……

practice updates

Wrist Injuries: Pearls and Pitfalls

Wrist pain is a frequent emergency department complaint. Most presentations are due to an acute traumatic injury. Furthermore, overuse or repetitive motion mechanisms cause ED visits for either an acute injury or an exacerbation of chronic pain conditions. For the purposes of this post, the wrist is going to be defined as injuries occurring to the distal radius and ulna, as well as any injury to the carpal bones. In addition, I feel it to be a poor use of this forum to simply list every conceivable form of wrist injury. Instead, I’d like to discuss the following:

  • Pertinent questions you need to ask your patient when evaluating a wrist injury
  • Pain management techniques including hematoma blocks
  • Which fractures have a higher likelihood of developing avascular necrosis
  • What type of splint is indicated for a particular injury


Hip Ultrasound and Arthrocentesis

"Emergency physicians with ultrasound training have been shown to be capable of visualizing effusions of the hip with a sensitivity between 80-85% and specificity between 98-100%"
Tyler Dschaak, MD provides a brief overview of hip ultrasound in the ED, including diagnosis of effusions and arthrocentesis.