Conference Notes 8/21

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PEM: Orthopedic injuries and NAT- Dr. Warnick

  1. 4 types of child abuse: physical, sexual, emotional, neglect
  2. Consider developmental milestones: start to roll at 4 months, crawl at 9 months, taking steps at 12 months
  3. TEN4FACES: bruises on torso, ears, neck, angle of jaw, cheeks, eyelids, subconj hemorrhage, frenulum tear; bruises on 4 months or younger; patterned bruising
  4. Workup: trauma labs, skeletal survey (under age of 2), CT Head
    • UA > 50 RBC –> CT abd
    • ALT 3x upper limit –> CT abd
    • if low hgb –> look at context
  5. Bucket handle fracture/corner fracture = concern for abuse
  6. Posterior rib fractures
  7. Spiral fracture vs toddler’s fracture
  8. Social work, Law Enforcement, CPS report, Transfer to pediatric center

Hand injuries- Dr. Shaw

  1. Perfusion: pulses, cap refill, most distal part of hand
  2. Sensation: ulnar, median, radial, palmar/volar vs dorsal
  3. Motor: “rock, paper, scissors, ok”; FDS vs FDP
  4. Phalanx dislocation: frequently have ligamentous disruption, reduction with traction, splint with alumafoam to MCP
  5. Nail avulsion: inspect for underlying laceration, repair as needed, suture/dermabond nail back in place
  6. Fingertip avulsion injury: finger tourniquets
  7. Subungal hematoma: assox with tuft fracture, trephination, abx if open fracture
  8. Boxer’s fracture/metacarpal fracture with fight bite: closed reduction with 20-20-40 rule, hematoma block, ulnar/radial gutter splint
  9. Scaphoid fracture: assess snuffbox, prone to malunion, thumb spica, follow up outpatient
  10. Lunate dislocation: require emergent hand eval
  11. Paronychia: I&D, abx if inflammation or abscess
  12. Herpetic whitlow: topical acyclovir
  13. Sporotrichosis: itraconazole 4-6 months
  14. Felon: I&D lateral margin, bactrim
  15. Flexor tenosynovitis: kanavel signs- sausage digit, pain with percussion of flexor sheath, held in passive flexion, pain with passive extension; hand consult, IV abx, OR
  16. Water bath for ultrasound

680 thoughts on “Conference Notes 8/21”

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