Emergency Procedures: Intraosseus Needle Insertion

emergency procedures-Intraosseus Insertion

Indications

  • Emergency intravenous access is required and Peripheral intravenous access is difficult or has failed.

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Patella Relocation

emergency procedures-patella relocation

Indications

  • Patella dislocation

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Shoulder Immobilisation

emergency procedures-shoulder immobilisation

Indications

  • Shoulder dislocation (post reduction)
  • Acromioclavicular injuries (grade 1-3)
  • Fracture of humeral head, greater tuberosity or clavicle

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Finger Splint

Indications

  • Fractures of distal and middle phalanx
  • Volar plate injury
  • Post reduction of dorsal PIP dislocation
  • Mallet injury (distal phalanx extensor tendon rupture with or without avulsion fracture)

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Short Leg Backslab

emergency procedures-short leg backslab

Indications

  • The distal tibia and/or fibula fractures
  • Ankle injuries
  • Tarsal injuries
  • Metatarsal injuries

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Long Leg Backslab

emergency procedures-long leg backslab

Indications

  • Tibia and/or fibula shaft fractures
  • Knee and patellar fractures
  • Distal femur fractures

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Volar Short Arm Slab

emergency procedures-volar short arm slab

Indications

  • Soft tissue injuries to hand and wrist
  • Carpal bone fractures (excluding scaphoid/trapezium)
  • Buckle fractures of the distal radius

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Long Arm Backslab

emergency procedures-long arm backslab

Indications

  • Acute management of elbow region injuries such as radial head fractures, distal humerus fractures, after reductions of elbow dislocations; 
  • Proximal and mid-forearm, and wrist injuries such as Colles or Smith fractures;
  • Acute management of distal radial (nonbuckle) and/or ulnar fractures in children.

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Emergency Procedures: Thumb Spica Splint

emergency procedures-thumb spica splint

Indications

  • Injuries to scaphoid/trapezium
  • Nondisplaced, nonangulated, extra-articular first metacarpal fractures
  • Stable thumb fractures with or without closed reduction

This video has been provided by Emergency Procedures App developers (Dr John Mackenzie and Dr James Miers) in order to help medical students, interns in training. Please visit the video source or Emergency Procedures app for more procedure videos and information. 

Contributors

Dr John Mackenzie

Dr John Mackenzie

Dr John Mackenzie MBChB , Dip MSM, FACEM . Staff Specialist Emergency Medicine, Consultant Hyperbaric Medicine Specialist, at Prince of Wales Hospital. Known for cycling endlessly for no apparent reason. 20 years of developing virtual learning for clinicians at all levels.

Dr James Miers

Dr James Miers

Dr James Miers BSc BMBS (Hons) FACEM, Staff Specialist in Emergency Medicine, Prince of Wales Hospital, Sydney. Passion for gypsy jazz and chess. Lead author of Lead author of Emergency Procedures App.

Further Reading

Acromioclavicular Joint Injuries Illustrations

Acromioclavicular joint (AC) injuries are associated with damage to the joint and surrounding structures.

ANATOMY

The acromioclavicular joint, together with the sternoclavicular joint, connects the upper limb to the skeleton.

The support of the acromioclavicular joint is provided by the ligament and muscle surrounding the joint. The capsule surrounding the acromioclavicular joint is strengthened by the acromioclavicular ligaments. The joints are acromioclavicular ligaments that provide horizontal stability.

The coracoclavicular ligaments consist of two parts, the lateral trapezoid, and the medial conoid, and connect the distal lower clavicle to the coracoid process of the scapula. The coracoclavicular ligament is the main stabilizing ligament of the upper limb.

Acromioclavicular joint injuries occur at all ages, but are most common in the 20-40 year age group, 5x times more common in men than women. It is a common contact sports injury in young male athletes (1).

There are two main mechanisms of acromioclavicular joint injury; direct and indirect (2). A direct blow or fall to the shoulder results in a superior force on the acromion with restricted clavicular movement in the joint, the acromion is forcibly pushed down and medially relative to the clavicle. It can occur indirectly as a result of a fall on the hand or elbow, causing the humerus to be pushed into the acromion, resulting in lower-grade injuries that typically protect the coracoclavicular ligament.

Imaging can be used to classify acromioclavicular injuries and is the most widely used Rockwood classification. 

ROCKWOOD CLASSIFICATION

References and Further Reading

  1. Dyan V. Flores, Paola Kuenzer Goes, Catalina Mejía Gómez et-al. Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment. (2020) RadioGraphics. 40 (5): 1355-1382.
  2. Vanhoenacker F, Maas M, Gielen JL. Imaging of Orthopedic Sports Injuries. (2006)
  3. Tintinalli’s Emergency Medicine, A Comprehensive Study Guide 9th edition. ( 2019)
  4. Rockwood classification of acromioclavicular joint injury

  5. Acromioclavicular injury

 

Cite this article as: Murat Yazici, Turkey, "Acromioclavicular Joint Injuries Illustrations," in International Emergency Medicine Education Project, June 30, 2021, https://iem-student.org/2021/06/30/acromioclavicular-joint-injuries-illustrations/, date accessed: October 6, 2022

 

iEM Image Feed: Scaphoid fracture

iem image feed
87 - Figure 6 - Fracture of the proximal pole of the scaphoid
  • Falling on an Out-Stretched Hand (FOOSH) is the most common mechanism of wrist injuries, with the wrist in extension.
  • Immature, weaker epiphyseal plate or metaphysis of the radius in children are more likely to sustain injuries, sparing the still-cartilaginous carpal bones.
  • Young adults with active lifestyles are more likely to be injured with greater forces.
  • In the elderly, especially in women with some degree of osteoporosis, distal radial metaphysis is more fragile resulting in Colles fracture.
  • “Anatomic snuffbox’’ on the dorsum of the wrist is an important landmark. Because the scaphoid is palpable with its triangle by styloid, extensor pollicis brevis tendon and the extensor pollicis longus tendon. Tenderness in this area may indicate a scaphoid fracture. The image above shows scaphoid fracture.
  • The examination should include assessment of neurovascular status motor and sensory function of the median, radial and ulnar nerves. Because acute median nerve compression is a common occurrence, the sensation of thumb and index fingers is important, especially with severely displaced fractures. In all injuries to the wrist, radial and ulnar pulses should be evaluated.

Further reading

Cite this article as: iEM Education Project Team, "iEM Image Feed: Scaphoid fracture," in International Emergency Medicine Education Project, May 12, 2021, https://iem-student.org/2021/05/12/iem-image-feed-scaphoid-fracture/, date accessed: October 6, 2022

iEM Image Feed: Viscus perforation

iem image feed

A 35 years old previously healthy gentleman presented to the Emergency Department with a sudden-onset severe and diffuse abdominal pain which started an hour ago. Chest X-ray was ordered; what do you see?

Abdominal pain is one of the commonest ED presentations. Like acute MI, AAA rupture, or DKA, viscus perforation should be in our worst-case scenario list. The image shows free air under the diaphragm.

The expected hints for this type of patient are a history of peptic/duodenal ulcer disease, severe abdominal pain that patients do not want to move, and a rigid and very tender abdomen, which any palpation gives much pain to the patient. 

We need to remember that this situation is a surgical emergency. There are some steps that we need to do immediately for this patient.

  1. Proper history and examination
  2. Attaching to monitor and following vital signs and intervene if necessary to normalize them
  3. Opening 2 large-bore IV lines and fluid resuscitation as needed
  4. IV pain medication
  5. IV antibiotics
  6. Stopping oral ingestion and placing NG tube
  7. Contact surgery
  8. Sending basic biochemistry lab, coagulation profile, blood type and cross, CBC, which will be asked by surgery soon. 
  9. Arranging transfer to the OR
887.1 - viscus perforation

Abdominal pain is one of the commonest ED presentations. Like acute MI, AAA rupture, or DKA, viscus perforation should be in our worst-case scenario list. The image shows free air under the diaphragm.

887.2 - viscus perforation

The expected hints for this type of patient are a history of peptic/duodenal ulcer disease, severe abdominal pain that patients do not want to move, and a rigid and very tender abdomen, which any palpation gives much pain to the patient. 

We need to remember that this situation is a surgical emergency. There are some steps that we need to do immediately for this patient.

  1. Proper history and examination
  2. Attaching to monitor and following vital signs and intervene if necessary to normalize them
  3. Opening 2 large-bore IV lines and fluid resuscitation as needed
  4. IV pain medication
  5. IV antibiotics
  6. Stopping oral ingestion and placing NG tube
  7. Contact surgery
  8. Sending basic biochemistry lab, coagulation profile, blood type and cross, CBC, which will be asked by surgery soon. 
  9. Arranging transfer to the OR

Additional reading

Cite this article as: iEM Education Project Team, "iEM Image Feed: Viscus perforation," in International Emergency Medicine Education Project, April 14, 2021, https://iem-student.org/2021/04/14/viscus-perforation/, date accessed: October 6, 2022