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Author: Matthew Stapleton
Dr. Wise – EMS Inservice
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Dr. Messman – GI
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Dr King – Toxicology
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Soft Tissue US: Finger vs. Scooter
History:
77 year-old man presents to the ED with pain to his right hand following an accident on his motor scooter 4 days prior to arrival. He states he swerved into a field to avoid being struck by another motorist, lost control of his scooter, and as he laid the bike down his right hand was crushed by the scooter. He was wearing a helmet and sustained no other injuries.
Exam:
Afebrile, vitals signs stable.
Examination of the right hand reveals a mildly edematous hand (diffusely along the dorsal surface of the metacarpals) with no point tenderness of the metacarpals or the carpal bones. No scaphoid tenderness. Skin examination is warm and dry, capillary refill is <2s. The 1st & 3rd-5th digits are nontender and have full ROM at the IP joints and the MCP joints. The 2nd digit is diffusely edematous with the IP joints held in partial flexion. There is tenderness along the volar aspect of the finger and the PIP joint is unable to be actively extended whatsoever. The DIP joint is able to be actively extended approximately 5-10 degrees. The skin of the 2nd digit has two small abrasions on the dorsal surface of the middle phalanx and the distal phalanx, and a small puncture wound on the volar surface of the base of the middle phalanx. The 2nd digit is diffusely tender to palpation. No purulence from the wounds, no induration, no fluctuance. Continue reading
Ultrasound 2 – Xray 0 : Esophageal Food Impaction
History:
A 77 year old male with no known medical conditions presented to the emergency department (ED) with a chief complaint of food being stuck in his throat. He states that he was eating chicken 2 hours prior to arrival and felt it get stuck in his neck after swallowing. This has happened to him in the past, but he had always been able to either vomit the stuck food or to force it further down, but this time he was unable to. He is having a hard time managing his secretions and speaking but is otherwise asymptomatic.
Physical Exam:
AFVSS. He appears uncomfortable but not distressed. He is drooling & dysphonic.
He has a normal cardiopulmonary examination. He has no abdominal distention or tenderness. Throat exam reveals no abnormalities. External examination of the neck is normal, but the patient indicates that he feels the impacted food between his hyoid and cricoid.
Foreign Body Identification: US 1- X Ray 0
History:
53yo female with DM and COPD presents to your ED approximately 20 minutes after stepping on what she believes to be a toothpick, however since this foreign body is now trapped beneath the skin of the sole of her foot (at least according to her), she is actually not certain precisely what she stepped on. She was barefoot at the time of the incident and offers no other complaints.
Examination:
AFVSS
Extremity exam: small puncture wound on plantar surface of forefoot near the heads of the 1st and 2nd metatarsals. Beneath the puncture wound a soft mass measuring approximately 2cm in diameter with mild tenderness is palpable. No erythema, warmth, fluctuance, crepitance or purulence.
