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.

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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).