Septic Joints (Dr. Campbell):
- Watch Presentation
- An acute tender, swollen joint with decreased range of motion is nongonococcal septic arthritis until proven otherwise
- If sexually active young adults or teenagers, consider gonococcal septic arthritis
- If your clinical suspicion for septic arthritis is high and the aspirate results are nonsupportive, consider starting IV antibiotics and admitting the patient
Native Hip Dislocations (Dr. Singh):
- Watch Presentation
- Think of hip dislocations as a “red flag” and perform a full trauma assessment!
- What should I look for on a x-ray?
- Relationship of femoral head to acetabulum
- Posterior
- Anterior
- Central (through comminuted fracture of acetabulum)
- Femoral Head
- Posterior (closer to cassette in AP film)- appears smaller
- Anterior (further from cassette in AP film)- appears larger
- Lesser Trochanter
- Posterior dislocation (internally rotated)- not seen on AP projection
- Anterior dislocation (externally rotated)- in profile
- Shenton’s Line (continuous line from neck of femur to superior pubic ramus)
- Disruption: think about femoral neck fracture or hip dislocation
- Relationship of femoral head to acetabulum
- YouTube videos on reduction methods:
- Whistler Technique
- Allis Technique (forward video to around 2:15)
- Captain Morgan Technique
Shoulder Dislocations (Dr. Halperin):
- Instead of procedural sedation, try intra-articular injection of Lidocaine for your next shoulder reduction!
- Don’t forget your sterile technique (since you are injecting into a joint).
- Further reading from ALIEM
LGBTTQQIAAP 101 (Dr. Angiulli):
- Gender is a social construct- identity and expression
- Sexual orientation consists of Attraction, Behavior and identity
- Instead of assuming, just ask your patients directly: “What name do you go by?” or “What pronouns can I use?”
SIM Case 1 (Dr. Restivo, et. al): Compartment Syndrome
- Can lead to loss of limb or function
- Most common culprits:
- Tibial Shaft
- Forearm
- Hand
- Foot
- Thigh
- First symptom: pain out of proportion to physical exam findings (and mistaking as opiate seeking)
- Loss of pulse is a late finding
- Classic 6 P’s:
- Pain
- Paresthesia
- Pallor
- Paraylsis
- Pulselessness
- Poikilothermia
- Diagnosis via compartment pressures (ex: Stryker): Pressures 30-45 mmHg
- Further reading from EmDocs
SIM Case 2 (Dr. Restivo, et. al):
- Please refer to our prior post on Massive Transfusion Protocol
- Resuscitate before you intubate!
- Weingart: “HOp Killers” mnemonic for the 3 physiologic killers pre/peri-intubation
- Hypotension
- Hypoxemia
- Metabolic Acidosis
- If you need to intubate a hypotensive patient:
- Wide open IV fluids
- REDUCE dose of INDUCTION agent and INCREASE dose of PARALYTIC agent
- Induction: Consider Ketamine (in shock, reduce dose 0.25 to 0.5mg/kg IV)
- Paralysis: Consider Rocuronium (1.6mg/kg IV)
- Push dose epinephrine
- Take a 10cc normal saline syringe
- Remove 1 cc normal saline so only 9cc of NS left
- Draw up 1 cc of code dose Epinephrine (100mcg/mL) in the syringe
- Now you have 10mcg/mL epinephrine
- Dose 0.5-2mL (5-20mcg) every 2-5 minutes
- Peripheral pressors
- Low risk for tissue injury for ~4 hours
- Further reading from RebelEM
Hip dislocations aren’t “red flags” imho, because that’s like saying, the guy fell four stories, but we have to worry about the pt now because his hip is dislocated. We weren’t worried about the pt before we saw his dislocated hip? In general, hip dislocations occur in high-speed mvcs and falls from a long height, where we should be worried about the patient from the get-go. Some hip dislocations occur from simple tripped-on-the-sidewalk falls, but these usually involve prostheses.
In case this was not mentioned, almost all hip dislocations are posterior, and they come in adducted, internally rotated, and flexed (this is a frequent boards question). Acetabular fractures are common and almost universal.
A hip dislocation is not a knee dislocation. You don’t have to reduce it in the next few minutes, meaning you can transfer a pt with a hip dislocation.
If Halperin talked about the “shoulder whisperer” technique, it’s not as easy as it sounds, though he did it so well recently.
The same day as AA’s lecture, registration screwed up someone’s identity. Now this one pt has two different mrn with two different sexes.
There is zero trial evidence to most anything Weingart says. Look him up on Medline and see how many studies he has published that are not opinion pieces (reviews, etc). You may be surprised.