Nailbed Lacs

A young man comes into your ED after slamming his right middle finger in the door. You see a large gash over the nail, and your hand specialist is not available to take care of the injury. What do you do?

Twisted Ankle

A 32 yo M presents with ankle pain and swelling after forcefully externally rotating it while playing soccer. He is unable to ambulate.  Ankle x ray is shown below. What other joint should you image?

Physical Exam in Septic Arthritis

CASE: 40yoM no PMHX with a swollen, painful right hip joint.  Worsening x5 days. No history of prior episodes, no other joints involved, no fever, no trauma, no GU symptoms, no rash, no vision changes, no IVDU. On exam, pt is afebrile, nont…

Ouch, My Back

34 yo M BIBA s/p fall from 3 stories, suicidal attempt. Pt is AO3, CTA b/l, pelvis stable, able to lift all extremities off stretcher, sensation and peripheral pulses intact. Pt has right lateral heel/ankle deformity. +step off L1-L2 area,…

Thumbs Up

A 25 year old rugby player presents with R thumb pain that began yesterday. She reports that she was trying to make a tackle and was stiff-armed. She fell to the ground, landing on an outstretched hand. Her pain is localized to the MCP join…

10 y F p/w right neck pain starting last night, she has decreased ROM with her head tilted to the left. This child has atlanto-axial subluxation, sometimes called Grisel syndrome. The key to identifying this condition and differentiating it…

Sinai Em Pearl 04/11/2013

Oh bother *sigh* its Thursday April 11, 2013. Cloudy today 56 degrees with 30% chance of rain, going down to 44 degrees tonight with 60% chance of rain.      Let’s try to brighten up our day with another wonderful pearl by y…

Fractures and Nerves

Board review: fractures/dislocations and associated nerve injuries: Acetabular fracture – sciatic nerve Anterior shoulder dislocation – axillary and musculocutaneous nerve Humerus – radial nerve Elbow dislocation – ulnar or median nerve Ole…

Pearl 10/31

Dx: Jones fracture Ankle and foot paint are common presenting complaints to the emergency department.  It is important to be able to tell the difference between a Jones fracture displayed above and a Pseudo-jones fracture.  Both of these fr…

Clinical Pearl: July 19th

A 29 year old soccer player presents to your ER with a shoulder deformity after falling backwards onto an outstretched arm. He has dislocated the same shoulder three times previously. What two specific lesions should you look for on the xra…

Daily Em Pearl 4/16/12

A 55yoM is BIBEMS after an MVC c/o RLE pain w/obvious deformity at the thigh. Distally he is NVI but is in excruciating pain. The portable plain film shows a mid shaft fracture. You order dilaudid but he’s still really uncomfortable….

daily EM pearl, 4/13/12

A young woman presents with a painful wrist, no trauma history. On exam, there is an effusion present, no erythema and tenderness to palpation. She is afebrile. How do you rule out a septic joint? What pathogen should be considered?  

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