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We have previously discussed how the surrounding ligaments and tendon are often stronger than the weakest part of the child’s bone necessitating our vigilance when addressing the pediatric extremity complaint (ex, Ankle Pain , Elbow Injury , Supracondylar Fractures ). Of course, we cannot assume all anterior knee pain is benign.
This places a significant responsibility on the EM physician to diagnose and treat fractures. Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture. 2) It is a specific type of a Weber C ankle fracture.
to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%
Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. Inoculation usually occurs by penetrating injury , which seeds the tendon sheath. Unrecognized or persistent infection can lead to necrosis of the tendon. There are no extensor tendon sheaths (A) in the hand.
The value of ultrasound for detecting hand fractures: A meta-analysis. Open Fracture. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c 0b013e3182a0148c Zhao W, Wang G, Chen B, et al. Medicine (Baltimore). 2019;98(44):e17823.
Laboratory Data CT Orbits/Sella w/ IV Contrast : No acute orbital fracture. An emergent ophthalmology consult is needed to plan for operative repair. Epub 2011 Dec 2. Visual acuity: able to count fingers. Extraocular movements intact. Ocular pressure deferred. 1 mm superior eyelid laceration. The globes are grossly unremarkable.
Feel: Palpate the area of the bite to feel for areas of tenderness as this could indicate a fracture or infection. There should be a minimum of 2 views in the plain film, or 3 in the hands if there is a suspicion of a fracture. Comorbidities Diabetes and immunosuppression increase infection risk and severity 11. Regular medications.
Notable Diagnostics CBC : unremarkable, BMP : unremarkable X-ray imaging of the left hand, wrist, and forearm: chronic degenerative changes without acute fracture or bony abnormality. 2011 Dec;77(12):1606-12. The remainder of the physical examination is unremarkable. J Vasc Interv Radiol. 1995 Mar-Apr;6(2):283-6.
Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. 2011 Aug;58(2):145-55. The most common injuries seen in these younger patients are growth plate fractures and ligamentous injuries. Axial load can cause burst fracture, so someone that dives into a pool.
He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management.
Depending on the height of the child and the height of the car, the initial impact will cause a femur fracture, a pelvic fracture, or direct abdominal trauma. 2011 Dec;71(6):1869-72. The initial impact is the greatest, and will vary depending on the child’s height and what part of his body reaches up to the bumper of the car.
A 2011 meta-analysis in the journal of Academic Emergency Medicine found ESR, CRP, and PCT were not acutely useful in the diagnosis of septic arthritis due to wildly varying sensitivities and specificities between studies. 2011 Jan;3(1):118-27. 2011 Aug;18(8):781-96. 2011 Sep;18(9):1011. In: StatPearls [Internet].
" [Coroners Society] King Richard I (the Lionheart) needed vast sums of money for the Third Crusade, operation of the kingdom, and for his ransom fro m Duke Leopold of Austria. All deaths involving hip fractures if the attending physician believes the fracture caused or contributed to the cause of death. Accessed 07/30/2016.
Physical examination should always include an attempt to ambulate the child unless there is an obvious contraindication noted immediately (eg open fracture). Management is orthopedic consultation for operative stabilization [12]. doi:10.1136/archdischild-2011-301245. References Smith E, Anderson M, Foster H. 2012;97(5):185-193.
Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.
Schedule follow up with orthopedics within 1 week for discussion of operative management vs early rehab protocols. Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al.
A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care. 2011 Dec;6:1-4. Clinical impact: The patient’s DVT ultrasounds were negative. 2023 Jan 1;53(1):140-2.
This is partly because the hands (including fingers) of children & young people have a tendency to fracture without as much compressive force being applied to the bones when compared with adult hands. The resulting injuries include crush injuries, fractures, avulsions, lacerations and amputations. No bone is exposed.
Labs do not play a significant role Imaging X-ray : Start with plain films to look for fracture near laceration, intra-articular free air, radiopaque foreign body. Common operator errors Failing to enter joint capsule before injecting STS. 2011 Nov;71(5):E110-3. While suggestive of TA, not sensitive or specific.
They also proved that only expired air resuscitation guaranteed sufficient inflation volumes; that exhaled air was a suitable resuscitating gas; and that the operator would have continuous feedback from each breath. Intracranial placement of a nasotracheal tube after facial fracture: a rare complication. June 6, 2011.
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