Category: Procedures
Hip Dislocation
A 75-year-old male with voiding difficulty
DJ Mitchell, Glenn Canyon Dam, Flickr
Urinary Catheter Placement chapter written by Gul Pamukcu Gunaydin from Turkey is just uploaded to the Website!
A 75-year-old male patient was admitted to the emergency department with difficulty voiding. He had this complaint for over a year, and tonight, although he felt pain and distention in his lower abdomen, he could not urinate at all. On his physical exam, the patient had a palpable mass that was thought to be the distended bladder. He was agitated and tachycardic. He was diagnosed with acute urinary retention, and initial attempt to insert urinary indwelling catheter was failed. The second attempt with a Coude catheter was successful and 2 liters of urine was drained gradually. His rectal exam revealed prostate enlargement. He was discharged with instructions, uneventfully.
How to splint?
26-year-old male with no past medical history presents with left ankle pain after landing on another player’s foot while jumping up during a basketball game.
Splinting and casting chapter written by Joseph Pinero, Timothy Snow, Suzanne Bentley from USA is just uploaded to the Website!
Secure With Square Knot
Topic
Today, we just wanted to emphasize a vital part of the suturing procedure which is sometimes forgotten. This is square knot. Simple, easy and important.
Problem
Suturing is one of the most common procedures performed by medical student/interns in the ED. Although they are learning by practicing under supervision, many of the medical schools and clerkship programs still may not have formal suturing training sessions. Therefore, there are various fundamental differences in wound closure techniques.
Many physicians may ignore the importance of square knot.
What do we want?
In the wound closure, we want to gather two sides of the wound and ensure that they stay in that position until the healing occurs. So, we need to keep the wound edges in the exact position. Therefore, we use different wound closure techniques. Suturing is one of them. If we do not consider securing the stitch with the square knot, wound edges may be separated by time, and some cosmetic or infectious consequences happen.
What to do?
Every physician should pay attention to use the square knot if they want to secure the wound edges in place.
One minute video
Here is a sample from our video archive.
Is this AAA going to be ruptured?
Abdominal Aortic Aneurysm (AAA)
Lit Sin Quek
A 75-year-old obese man comes to the emergency department. He has history COPD, hypertension. He is a smoker and on regular follow-up with primary care. He describes sudden onset severe flank and back pain for past 2 hours. He denies any chest pain or dyspnea. He informs the physician about his chronic abdominal pain. His initial vital signs are HR 98 bpm, RR 24/min, BP 190/105 mmHg, T 36.9C. His examination revealed mild abdominal pain without rigidity or rebound tenderness. Bedside ultrasonography performed and the result is shown on the side.
What is the risk of rupture?
Touch Me
Risk of Rupture
increases with emphysema, smoking, hypertension. Regarding Powell’s (2003, 2007) study aneurisms above 5.5 cm have 9.4% to 32.4% rupture risk in one year.
Answer