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Ortho Pearls: Metacarpal Fracture Management

Cook County EM Blog

2000 Sep;25(5):817-23. Why it Matters: Fractures of the second through fourth metacarpals should initially be managed by attempting closed reduction with splinting in either a palmar wrist splint or an ulnar gutter splint. If there are no indications for surgery, the patient can be immobilized in a cast for four weeks with good outcomes.

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Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway. Operators can manipulate the blade with less force to optimize the view, making it easier to identify and navigate the endotracheal tube into the trachea.

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Pediatric Pain

Pediatric Emergency Playbook

Facial grimacing is a weak indicator of pain in neonates ( Liebelt 2000 ). Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. Do not expect typical pain behaviors in neonates. They do not understand rational or logical thinking.