ER PEARLS Flashcards
What 4 techniques can you use to relocate a shoulder?
Traction-counter-traction; External rotation; Scapular rotational; Stimson’s
Which technique involves having a patient in the prone position holding a weight?
Stimson’s
What’s the MOI for a shoulder dislocation?
Adducted and externally rotated
After you reduce a shoulder what should you do?
Check sensation/circulation; Post-reduction films; immobilize shoulder (sling & swath); Educate patient that they can’t externally rotate/abduct shoulder → F.U with ortho!
What should we remember about older patients with shoulder dislocation?
More likely to get adhesive capsulitis (will need sooner f.u with ortho and possibly hanging motions)
What are the stages of wound healing?
Inflammatory phase (2-5 days; vasoconstriction, platelet agg, and phagocytosis)
Proliferative phase (up to 3 weeks; collagen deposition & wound contraction)
Remodeling phase (3 weeks – 2 years; new collagen which increases tensile strength [scar tissue])
What are the 3 sub-phases of the proliferative phases?
Granulation (new capillaries/fibroblasts lay a bed of collagen)
Contraction
Epithelialization
When it comes to wound closure, what involves wound edges approximated at or close to the time of injury and is best for wounds that are clean and uncomplicated?
Primary intention
If you allow a wound to heal on its own, usually for wounds that are >12 hours old or abscesses, fight bites, or dirty wounds?
Secondary intention
What is it known as when a wound is left open for 1-several days and is then surgically closed? Often done to allow tissue edema to reduce or likely have a chance of infection.
Tertiary intention
What is important to remember when initially evaluating a wound?
Don’t miss potential injuries → Consider deeper structures (move extremity through flexion/extension while visualizing the tendon)
Clean & Irrigate!
Evaluate blood supply
If a wound is non-surgical, how is it closed?
Dressing only, steri-strips, and dermabond
If you have a laceration that needs suturing in the eyebrows, what do you do about the hair?
Don’t shave it off! Some don’t grow back…
Do inner lips require suturing?
No
If a laceration crosses over the lips, what is key to success?
Attention to the vermillion border (first stitch is the most important)
What should you do if a laceration involves the full-thickness of the ear and cartilage?
Speak with ENT or plastics
What is it known as when there is a collection of blood between the nailbed & fingernail?
Subungual Hematoma
How/when do you treat a subungual hematoma?
Always indicated if hematoma involves greater than 50% of nail
Trephination (with cautery stick)
What must you always do prior to trephination?
Clean the nail!! But alcohol can catch fire… so just use betadine
What is the desired effect of conscious sedation?
Relaxation, cooperation while the patient maintains protective airway reflexes
What medications are commonly used for conscious sedation?
Benzos (but CAN produce respiratory depression → reversal with flumazenil)
Narcotics (morphine, fentanyl, dilaudid)
Dissociative agents (Ketamine)
Hypnotics (propofol)
What must we always monitor when using conscious sedation?
Continuous pulse Ox; sequential BP monitoring; cardiac monitoring
What bacteria is the most common cause of an abscess?
Staph aureus (MRSA is on the rise)
What’s the definitive treatment for an abscess?
Scalpel (possibly add Abx)
Pus should spontaneously drain, once all the pus is out, what do you do?
Irrigate → pack → dress
When should the person f/u and what will you do at that time?
24-72 hour; removing packing, re-irrigate and sometimes re-packed
What bacteria is the most common cause of paronychia?
Staph aureus… again
Are topical Abx used for paronychia?
Nope! Oral (cephalexin or Dicloxacillin)
How would you treat paronychia?
Scapel & drain pus (lido not needed)
If nail is involved = wedge resection (linear cut) with a DIGITAL NERVE BLOCK
How do you reduce a nursemaid’s elbow?
How do you reduce a nursemaid’s elbow?
What must we always remember with ankle dislocations and evaluating for other injuries?
Associated fractures are the rule, not the exception
What must we always check with ankle dislocations (any dislocation really)?
Vascular compromise & sensation
What is our primary goal with ankle dislocations?
Immediate reduction of the joint & relief of neurovascular stress
What’s the most common direction for an ankle dislocation?
Posterior
How do we reduce an ankle dislocation (posterior)?
Plantar flexion with axial traction; then downward pressure on the tibia; followed by anterior replacement
Do you always HAVE to get a finger xray before relocation?
Not if significant delay would result
What must we always do after relocated a finger dislocation?
Confirm tendon function!!! Then splint/post-reduction xrays
What direction does a finger most commonly dislocate? How do you relocate it?
Usually dislocates dorsally
Reduce with traction, increase angle slightly, then reset in position
What are some methods to extracting ear foreign bodies?
Irrigation, grasping with forceps, lighted cerumen loop, right angle needle or suction catheter
*But be careful since it can be painful and TM can be easily damaged
What are some techniques to nasal foreign body removal?
Blow their nose while occluding other nostril; mother’s kiss; consult ENT!
