ER/Acute Care Pearls Flashcards
What is the second most common joint in the body to dislocate?
shoulder
How is the arm positioned with a shoulder dislocation?
arm is moved away from the body (abducted) & externally rotated
What is the re-dislocation rate in young athletes?
up to 90%
Which type of shoulder dislocation is most common?
(it is also the easiest to put back in place)
anterior
Which shoulder reduction technique is good for the elderly?
external rotation technique
Which shoulder reduction technique might be best for people without a significant amount of muscle mass?
scapular rotational maneuver
Which shoulder reduction technique uses weights?
Stimson’s technique
Which shoulder reduciton technique requires 2 people & is commonly employed for muscular patients/dislocated for long periods?
tractoin counter-traction
What should be done following shoulder reduction?
shoulder should be immobilized in a sling (2-4 weeks)
post reduction films
circulatory & sensatory status should be reassessed (axillary nerve)
With shoulder dislocations, older patients are at an increased risk for what?
adhesive capsulitis
(frozen shoulder)
Typical population/age group for nursemaid’s elbow
usually under 5 years old
What is the classic mechanism for a nursemaid’s elbow?
sudden pull on a young child’s arm
parent swings child around
What is the reduction method for nursemaid’s elbow?
with clinician’s thumb over the radial head & the other hand holding the child’s hand, the forearm is supinated & flexed then pronated & flexed
telltale ‘click’ signifies reduction
When should a child exhibit spontaneous & full movement after reduction of a nursemaid’s elbow?
within 10-15 minutes
What is the most commonly dislocated joint in the body?
PIP joint of finger
What is the hallmark of a dislocated finger?
deformity
Finger dislocations are usually ______
dorsal
With a finger dislocation, what do we want to confirm?
tendon function
What is the rule rather than the exception with ankle dislocations?
associated fractures
What is a principle concer with ankle dislocations?
neurovascular injury
With ankle dislocations, tented skin may be subject to what?
ischemic necrosis
What are the primary goals of treatment with ankle dislocations?
immediate reduction of the joint
and
relief of neurovascular stress
What are some ways to attempt to remove nasal foreign bodies?
patient may “blow their nose” while blocking opposite nostril
“mother’s kiss” technique
Attempts at removing nasal foreign bodies can cause?
airway hazards (by pusing the FB into the pharynx)
consult ENT before complications are created
Is sedation encouraged or discouraged with nasal foreign bodies?
discouraged
it can increase complications by reducing the gag & cough reflexes
Can the tempanic membrane be damaged by pushing an ear foreign body further in the canal when attempting to remove it?
yes
What are the keys to a successful removal of an ear foreign body?
adequate visualization
appropriate equipment
a cooperative patient
skilled clinician
What are some methods for ear foreign body removal?
irrigation with water
grasping with forceps
cerumen loop
right-angle needle
suction catheter
inflammation fo the nail fold
can be acute or chronic
paronychia
What does a paronychia usually result from?
mild trauma
nail biting
What is the usual bacterial agent that causes paronychias?
S. aureus
In rare cases, paronychias may be accompanied by what?
fever & painful glands at axilla
What is the treatment of choice for an ingrown toenail?
What is required for this?
wedge resection
digital block is REQUIRED
What is the most common agent causing skin abscesses?
What is increasing?
most common: S. aureus
increasing: MRSA
collection of blood between teh nail bed & the fingernail
subungal hematoma
What type of fracture is often associated with a subungal hematoma?
distal phalanx tuft fracture
What is the treatment for subungal hematomas?
nail trephination (with cautery stick)
reduces pain & may save the nail
Stages of wound healing:
immediate to 2-5 days
hemostasis
vasodilation, phagocytosis
inflammatory phase
Stages of wound healing:
2 days to 3 weeks
angiogenesis, collagen deposition, granulation tissue formation, epithelialization, wound contraction
proliferative phase
Stages of wound healing:
3 weeks to 2 years
new collagen forms which increases tensile strength to wounds
scare tissue is only 80% as strong as original tissue
remodeling phase
wound edges are approximated at or close to the time of injury
typically allows for the best cosmetic result to follow
best performed on wounds that are “clean” & uncomplicated
primary intention
wound is not surgically closed
allowed to heal on own through granulation & re-epithelialization
often allowed for abscesses, fight bites, or “dirty” wounds
may be chose as closure method for wounds > 12 hrs old
secondary intention
delayed primary closure or secondary suture
wound intentially left open for 1 to several days & then surgically closed
often done to allow tissue edema to reduce
often chosen for wounds with likely chance of infection
tertiary intention
With topical anesthesia, what is the “key to success”?
blanching
What are the desired effects of conscious sedation?
relaxation & cooperation
patient maintains protective airway
purposeful responses to verbal or tactile commands
safe return to baseline & ambulatory discharge
What are some undesirable effects of conscious sedation?
deep & non-arousable state
decreased respiration & dyspnea/apnea
airway obstruction
hypotension & bradycardia
agitation/non-cooperative
What are some comonly used medications for conscious sedation?
What side effect do they all have the potential to produce?
benzos, narcotics, dissociative agents, hypnotics
all can produce respiratory depression
