The Need for Clinical Hand Education in Emergency Medicine Residency Programs.

Background: Complaints related to the hands, wrists, and fingers comprise approximately 3.7 million emergency department visits annually. The complexity of this subject can confound timely diagnosis and treatment, particularly if the treating physician has not received specialized training.

Sideline coverage: when to get radiographs? A review of clinical decision tools.

Context: Sidelines coverage presents unique challenges in the evaluation of injured athletes. Health care providers may be confronted with the question of when to obtain radiographs following an injury. Given that most sidelines coverage occurs outside the elite level, radiographs are not readily available at the time of injury, and the decision of when to send a player for radiographs must be made based on physical examination.

Foot and ankle update.

The purpose of this foot and ankle update is to educate the reader on important foot and ankle topics including current controversies, physical examination, diagnostics, and management. Quick-view lists are used to give easy access to the most significant knowledge points for providing patient care for these entities. These topics were chosen either because they are very common or because of the high morbidity involved should there be a misdiagnosis or mismanagement.

Giant bulla mimicking pneumothorax.

It is usually thought by emergency physicians that the diagnosis of a pneumothorax is straightforward and easy to make and to treat, but the diagnosis may sometimes pose a challenge. The present report describes a case of a giant pulmonary bulla in a 40-year-old man that progressed to occupy almost the entire left hemithorax and also subsequently ruptured to produce a large left pneumothorax. The giant bulla was diagnosed only as a pneumothorax, and initially managed with a chest tube only.

Use of a sedation-analgesia datasheet in closed shoulder reductions.

A three-page conscious sedation (CS) monitoring datasheet and sedation-analgesia policy were implemented at the Lincoln Hospital Emergency Department (LHED) to maintain compliance with JCAHO and New York State standards on CS monitoring. The datasheet included areas for physical examination, medications, and vital signs. To determine effects of the new datasheet and policy, charts containing all closed shoulder reductions done at LHED from April 3, 1996 to June 30, 1999 (n = 237) were reviewed for use of CS, defined as the use of an analgesic and sedative-hypnotic concurrently.