recent articles

practice updates

EM Cases: Hand Emergencies

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injury, flexor tenosynovitis, gamekeeper’s thumb (or skier’s thumb), fight bites, hook of the hamate fractures and many more important hand emergencies. Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper’s thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel’s signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?

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

Seizure Mimics

The pediatric patient with seizure, or is it really a seizure? A host of other conditions can look just like seizure. This Peds EM Morsel provides you with some answers.

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

R.E.B.E.L. EM – Is Too Much Supplemental O2 Harmful in COPD Exacerbations?

Does hyperoxia suppress a COPD patient’s respiratory drive? Does it cause V/Q mismatch? Does it change the chemistry of the patient’s blood through the Haldane effect? It’s enough to make you want to give up and page respiratory therapy. Well lucky for you we sifted through the primary literature to bring you the myths and facts, and the short answer is… it’s complicated.

practice updates

Acute Mastoiditis: Pearls and Pitfalls

Acute mastoiditis is a common complication of acute otitis media. Diagnosis includes clinical evidence of mastoid inflammation and may necessitate further imaging to exclude other complications. IV antibiotics and a surgical consult are required.