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Welcome to our world!! I was orthopedically challenged when I started too. I like Essentials of Musculoskeletal care --- it is concise, easy to read, very basic. Wheeless' is good to -- but I don't have time to read when I am in the ED. I keep it near my desk and when I get something a little different from the ordinary or cannot remember which I should worry about - a proximal 5th MT fx or a distal 5th MT fx, I can look it up very quickly. You will learn it fast, so don't sweat it!!!

 

jackie kazik

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Most important things to learn, is which fractures require what splints (sugar tong, thumb spica, stirrup, posterior short leg, etc), what type of fractures require ortho consult, and always remember to check neurovascular status and the joint above and below the injury (I always do this first on exam so i dont forget) :) oh if someone is extremily tender and cant move or bear weight, treat it as a fracture even if x-rays are negative (splint and ortho f/u). consider septic joint in kids with significant joint pain with no injury (labs). Kids with an injury with growth plates who are real tender with negative x-rays, always treat as fracture, could be salter harris fracture. Ok thats all the pearles I can think of off the top of my head. I never read any ortho books so i cant tell you what to read lol

 

disclaimer- Im not a vet, i'm less than a year in the game

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  • 2 weeks later...

I'm an ER PA coming from ortho. I see more osteoarthritis in people 50 on up. Remember the contributors: weight, age, genetics, and trauma/surgery. For most of my OA patients I tell them, "NSAIDs, ice, and low-impact exercise (stationary bike, elliptical machine)".

 

For knee sprains or probable ligamentous injury, knee immobilizer and crutches...cleared by ortho follow up...you won't typically diagnose ACL or meniscus tears in the ED because of the acute nature of the injury...the pt can't relax enough...the swelling is too much...for a proper knee exam to be performed.

 

Women in their 50's who come in for shoulder pain, consider risk factors, and consider an EKG...but 9/10 times it's rotator cuff tendinopathy...sling if needed, NSAIDs, ice, and ortho f/u.

 

Tendonitis in wrist...velcro wrist splint, NSAIDs, and ortho f/u.

 

The key for ortho problems is to tee them up for ortho. Splint them, xray them, treat their pain appropriately. The rest is fun...you'll see some fun xrays.

 

Let me know if you have any questions.

 

p.s. I use UpToDate for splint and fracture reminders...I still need reminders.

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Most important things to learn, is which fractures require what splints (sugar tong, thumb spica, stirrup, posterior short leg, etc), what type of fractures require ortho consult, and always remember to check neurovascular status and the joint above and below the injury (I always do this first on exam so i dont forget) :) oh if someone is extremily tender and cant move or bear weight, treat it as a fracture even if x-rays are negative (splint and ortho f/u). consider septic joint in kids with significant joint pain with no injury (labs). Kids with an injury with growth plates who are real tender with negative x-rays, always treat as fracture, could be salter harris fracture. Ok thats all the pearles I can think of off the top of my head. I never read any ortho books so i cant tell you what to read lol

 

disclaimer- Im not a vet, i'm less than a year in the game

 

As an 30 plus year ortho vet ^^^^^^this is spot on.

 

Great advice.

 

Also be able to identify the common ER fx's on xray:

 

Distal radius including Smith and Colles (sugar tong)

Navicular fractures (thumb spica)

Boxer fractures (ulna gutter)

Mid Shaft forearm (long arm)

Olecranon dislocation and fracture including nursemaids (long arm for dislocation/nothing for nursemaids, just reduce)

Mid-shaft and humeral head fractures (depends, can be sling, hanging arm cast or co-aptation)

Anterior and Posterior shoulder dislocation and associated fractures (shoulder imm. post reduction)

Clavicular fractures (sling)

AC and sterno-clavicular separations (sling, usually)

Hip fractures (bucks traction 5-10lbs)

Total hip dislocations (put em back, propofl, push in 40mg doses till out, then reduce)

Femur fractures (bucks)

Tibial plateau fractures (Jones dsd, long leg)

Mid-shaft tib/fib fractures (long leg)

Bi and trimalleolar fractures (Jones or short leg)

Pylon ankle fractures (short leg or Jones)

Jones and base of the fifth metatarsal fractures (walking boot, or short leg, NWB if Jones)

Lis Franc mid-foot fractures(short leg)

Pediatric femur and tibial toddler fractures (pedi hip spica cast/ short leg cast)

 

of course , all those are splints, plaster is king, fiberglass is evil (for acute fx's, great for casts),

 

of course, no casts in ER except the hip spica and maybe the toddler fx.

 

All short legs have stirrups, not just posterior.

 

good luck

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ALSO ...swollen tender extermity with pain out of proportion to exam consider a ddx of compartment syndrome in the right clinical setting. check compartment pressures with stryker guage and arrange OR stat for fasciotomies if elevated compartment pressures.

best one I ever saw was a guy on coumadin in minor mva. thigh into dash. no fx. howling in pain. tense /inflamed thigh when compared to opposite thigh. pressure> guage max. this was with the old stryker guage that was like a round tire guage. I think the top was 60 mg hg and it was past that.

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We don't even HAVE the compartment pressure gauges in our ED's- have to always call Ortho to bring theirs for suspicion of compartment syndrome. Annoying- I'd rather do it myself before calling someone.

 

Gotta rock it old school, art line and pressure transducer.

 

That's how we did it before the Stryker, which can never be found anyway.

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