M&M - Dr. Kiefer
Case 1: Inferior shoulder dislocation and traumatic pneumothorax
When Evaluating Complex Patients:
- Always regroup and reassess. It is okay to start over from scratch.
- Ensure work up is complete for life threatening pathology before patient leaves the ED
Inferior Shoulder Dislocation:
- High incidence of vascular and nerve injury. You must document a thorough exam!
- Reduction via hyperabduction with traction-counter traction or convert to anterior dislocation and then reduce.
Occult Traumatic Pneumothorax (i.e. visible on Chest CT but not on supine CXR):
- Supine CXR has sensitivity of ~50%
- Supine Ultrasound has sensitivity of ~90%. We should be doing FAST with thoracic windows on all patients, especially those with no plans for CT Chest
- Know/ Reference our trauma guidelines!
- No hard and fast guidelines in regards to management. Needs a chest tube if progresses (visible on CXR or if patient has respiratory distress).
- Most still feel positive pressure ventilation with occult PTX deserves a chest tube... although debated.
Case 2: Black Dot Poison Ivy
- Treat contact dermatitis with high potency topical steroid (ex. Clobetasol) for 2 weeks.
- If treating with PO steroids remember needs tx for 2-3 weeks with taper.
- Don’t forget adjuncts: Zanfel, Ivy Block (Research supports usage of both).
Case 3: Hx of Devic disease with missed posterior circulation stroke
- Know your limitations and don’t develop tunnel vision.
- A thorough CN II exam involves visual acuities, visual fields, light reflex and color testing.
- Optic neuritis typically has pain with eye movement (92%) and impaired color vision (Red first).
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