Aquifer Case 4: 19 yo Female w/ Sports Injury

Question 1

what are signs of limb-threatening injury to look for in a PE?

Answer 1

6 P’s:
1. pain

2. pallor
3. pulselessness
4. paresthesia
5. perishing cold
6. paralysis

Question 2

what are the signs/symptoms included in the grading of ankle sprains?

Answer 2

1. ligament tear
2. loss of functional ability
3. pain
4. swelling
5. ecchymosis
6. difficulty bearing weight: the ability to take 4 steps independently

grade I: stretching/small tear of ligament; mild tenderness/swelling; slight/no functional loss, no instability

grade II: incomplete tear and moderate functional impairment; tenderness, pain, welling and ecchymosis; some loss of motor function and mild to moderate instability

grade III: complete tear and loss of integrity; severe swelling and ecchymosis with inability to bear weight and mechanical instability; significant stretching of the joint with stress without a definite stopping endpoint

Question 3

what are the Ottawa ankle rules?

Answer 3

a clinical tool to help evaluate whether ankle injuries need an x-ray (97-100% sensitivity)

x-ray of the ankle required if: pain in the malleolar zone AND either bony tenderness along the distal 6 cm of the posterior edge of either malleolus OR inability to bear weight 4 steps both immediately after the injury and in the emergency department

x-ray of the foot is needed if: pain in the midfoot region AND one of the following: (a) bony tenderness at either the navicular bone or base of the fifth metatarsal OR (b) inability to bear weight four steps immediately after the injury and in the emergency department.

Question 4

what are the PE maneuvers for diagnosing ankle injury?

Answer 4

1. negative inversion test: invert ankle; laxity indicates injury of the calcaneofibular ligament
2. crossed-leg test: patient crosses their legs

Question 5

what is the most effective compression for an ankle injury?

Answer 5

semi-rigid ankle support like an Aircast or a soft lace-up brace

Question 6

how do you diagnose a UTI?

Answer 6

presence of multiple urinary tract symptoms in young women who present without vaginal symptoms is suggestive of a urinary tract infection. even if the urinalysis comes back negative

start treatment for an uncomplicated UTI and keep in mind regional antibiotic resistance