>EM Reflections – October 2016

Thanks to Dr Joanna Middleton for this summary

Edited by Dr David Lewis

 


1)  A fracture of the ulna should raise suspicion for a radial head dislocation (i.e. -Monteggia) – these can be subtle.  Proper elbow x-ray films assist in the diagnosis –  look at the radiocapitellar line to r/o radial head dislocation.

http://www.rch.org.au/clinicalguide/guideline_index/fractures/Monteggia_fracturedislocations_Emergency_Department_setting/

figure-1_1372210_monteggia-type-1_ulna-shaft_lat


2)  The posterior interosseous nerve is the most common neuropraxia seen with a Monteggia fracture-dislocation  The PIN is a branch of the radial nerve and is the motor supply to most of the extensor muscles (thumb and wrist extension).

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3)  A lactate >4 is a red flag and is associated with higher mortality, particularly if the lactate does not rapidly clear.

http://sinaiem.org/10278-2/

Prognostication: Lactate predicts badness and whether your treatment for badness is working.

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4)  Crohn’s patients are at risk for intrabdominal abscess, in particular, psoas abscess.  Consider this diagnosis in Crohn’s patients who present with hip pain, particularly if their pain is increased by hip extension

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5)  EtOH and head injury….low threshold for CT, particularly if there are any focal neurological findings.

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6)  EMS records are not always available when we initially see a patient but they often have helpful information.  It is worthwhile to have a look at them, particularly if the history from the patient is vague.

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