Distal Radius Fractures

A 65-year-old right hand-dominant female was brought in by ambulance after a motor vehicle collision with left wrist pain and deformity. She states she was driving when another car turned and drove into the front of her car. She was wearing a seatbelt, the road speed limit was 35 MPH, and the front airbags deployed. There was moderate damage to the vehicle. However, the patient was able to self-extricate and was ambulatory on scene. She denied head strike, loss of consciousness, or taking blood thinners. She states she was in her usual state of health prior to this event…

Emergency Medicine, Orthopedics, Sports Medicine, TraumaChris KoehlerDecember 16, 2022Radius Fracture, Orthopedics, Ulnar FractureComment

Posterior Shoulder Dislocation

A 46-year-old male with no past medical history presents to the ED via ambulance after crashing his bicycle. He was traveling at 25 mph when a dog ran out in front of him, causing him to swerve and fall onto his left side. He was helmeted and did not lose consciousness…

Community EM, Sports Medicine, OrthopedicsKatherine BarrySeptember 26, 2022Posterior Shoulder Dislocation, Reverse Hillsachs, OrthopedicsComment

Lunate Dislocation

A 51-year-old male with no past medical history presents to the ED with wrist pain after a fall. Earlier today, he lost his balance and fell down 12 stairs, landing on his outstretched hand. He has had increasing swelling of the radial aspect of his left wrist as well as extreme pain with movement. He did not strike his head or lose consciousness, and reports no other injuries…

Community EM, Sports MedicineKatherine BarrySeptember 26, 2022Lunate Dislocation, OrthopedicsComment

$When laughter isn’t the best medicine: The serratus anterior plane block for multiple rib fractures$

When laughter isn’t the best medicine: The serratus anterior plane block for multiple rib fractures

A 67-year-old man presents to the emergency department after a mechanical fall from standing. During his trauma evaluation, he is found to have severe right-sided chest wall tenderness. His imaging demonstrates multiple right-sided rib fractures with an otherwise unremarkable workup. The patient is in significant discomfort and is given acetaminophen and morphine. Despite this, he remains in severe pain and has difficulty taking deep breaths. The patient is given an incentive spirometer and his maximum vital capacity is measured at 500 ml. What complications is this patient at risk of developing? What interventions can be performed in the emergency department to help manage his pain?

Community EM, Sports Medicine, Trauma, UltrasoundBrendan HolmesApril 15, 2022Ultrasound, Nerve BlockComment

Geriatrics Going to Ground : Ultrasound-Guided Femoral Nerve Block

“It would be unusual to go too many shifts as an emergency medicine provider without seeing the classic elderly female patient with hip pain after a fall. On exam, the patient would likely be uncomfortable with their hip appearing shortened and externally rotated on exam. Before you even view the X-ray, you know they likely fractured their hip. You ascertain whether it was a mechanical fall, if there were other injuries, if the injury is open or closed and if the patient is neurovascularly intact. You proceed to order your imaging and consider your plan for pain control. Sound familiar…”

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