People often get confused about which bit of a child's elbow is supposed to have appeared (ossified) and which bits are supposed to be invisible at any given age. What do you make of this 13 year old's Xray?
A teenager presented with pain in his right hip. It had been present for a couple of weeks after kicking a ball. There was a reduction in hip flexion to about 90 degrees, although an otherwise reasonable ROM. He was tender over the antero-lateral hip. He had an X-ray to exclude Slipped Upper Femoral Epiphysis (SUFE). What do you think?
Audit Presentation: Adult pain management in the ED
Click here to access the poster.
Areas of good practice:
RCEM Pain in Adults Best Practice guideline
Oxford analgesia league table
Burns in the ED
Plymouth is a burn facility.
5 criteria to guide referral decisions
National burn care referral criteria
Burns and Scalds leaflet for Parents
In the assessment of ACL injuries, the history is often the most important aspect in diagnosis.
In the assessment of patella dislocations, look out for these groups who will present with patellar instability.
1. Trochlear dysplasia
Other interesting eponymous knee injuries
Again it’s a Sunday afternoon in minors and its busy…
You see a 40+ old male with a ‘sore throat.’ It's Winter and he's the third such you've seen. He tells you that he’s had a mild sore throat for the past 2-3 days which is getting worse. He finds it very uncomfortable to extend his neck and feels like his throat is closing over. Its also become increasingly difficult to swallow. He thinks it should be getting better by now. He wonders if he might have strained his neck at work a few days before. You confirm the absence of cough and recent viral illness but he does describe a subjective fever (despite being afebrile at triage with no recent antipyretic treatment).
On examination he is sitting with an upright posture and holds his head/neck rather stiffly due to pain. He has a soft "hot potato" voice but no stridor. His pharynx is completely unremarkable but palpation of the anterior neck produces pain. He has a borderline tachycardia.
What are your differentials? What are you going to do?
As we mourn the passing of the Space oddity, here's an eye one for all you ED heroes. It’s a Sunday afternoon in minors and the triage nurse comes to tell you she’s just triaged a young man with ‘different colour eyes.’ He was playing Futsal (a kind of football in fashion at the moment) with all the young dudes when the ball ricocheted off an opponent’s knee and hit him in the face. Its a bit sore and he’s really worried as he ‘can’t see anything,’ out of his left eye. He doesn’t wear glasses or contact lenses and his formal visual acuity is recorded at right eye 6/5 and left eye light/dark but no detail. You take a closer look with a pen torch and discover the apparently brown left eye is actually red. What is the diagnosis? And how many Bowie songs are listed in this post?
A man in his 60s, who had a right total hip replacement 14 years ago, saw his GP complaining of right leg pain which started as he got out of his car the day before. He had been taking naproxen and tramadol but was still in pain, using crutches to weight-bear. He was referred to the ED for assessment and imaging.
He told the EM doctor a bit more: he had been feeling sweaty and nauseated but had not felt he'd had a raised temperature. His right hip was tender to palpation and flexion was limited to 45° by pain. Plain imaging of the right hip was requested:
The Derrifoam Blog
Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....