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

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…”

Under Pressure: An Uncommon Location for Compartment Syndrome

A 35-year-old-patient presents following motor vehicle collision as a restrained passenger. The vehicle's dashboard was displaced into the cabin, causing prolonged entrapment of the patient’s lower extremities. The patient’s left thigh was noted by EMS to have an obvious deformity with bleeding from an anterior wound. A tourniquet was placed to the proximal left thigh. A deformity was also noted to the right thigh without obvious external hemorrhage…

Orthopedics, Sports Medicine, TraumaJeffrey SavarinoOctober 29, 2021Compartment SyndromeComment

Age Matters: Managing Femur Fractures in Kids

“In one overnight shift on the orthopedics service, our team evaluated three different pediatric patients with the same underlying injury: a femoral fracture. But, the management of all three children was different and the underlying reason for the different management: age….”

Nothing Humerus About It: An Approach to Shoulder Dislocations

A 52 year old male with a history of type 2 DM presented to the ED with right shoulder pain after a fall while stepping off a bus. The patient noted that he was unable to range the shoulder. Vitals were significant for HR of 104, otherwise unremarkable. On examination, the patient had a flattened shoulder with a “squared-off” appearance, a prominent acromion with the elbow flexed, and the arm held in slight abduction…

Sports Medicine, Procedures, OrthopedicsKyle VolpeMay 21, 2021Shoulder Dislocation, OrthopedicsComment

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