Open Dislocation

[southerndoc]

So, among my many hand injuries today (thumb lac with FDS involvement, crush injury, another palmar lac), I had an interesting case of a guy involved in an altercation at midnight the night before. He presented at 2 pm. He was assaulted with a fist and was knocked to the ground. In the process of going to the ground, he dislocated the distal phalynx of his right thumb. Interestingly enough, it was an open dislocation.

I've never seen one before. It was kind of cool. At any rate, hand surgery came and washed it out, and then admitted him for IV antibiotics. This poor lad is going to have a rough recovery considering he's a diabetic who has been out of his insulin for 3 months and had a fingerstick glucose of 280. Talk about neutrophil inhibition.

All in all, it was a pretty cool day... a shoulder dislocation reduction, a distal radius fracture reduction, trephination for a subungual hematoma, a PE whose only signs/symptoms were tachycardia and tachypnea (no hypoxia, chest pain, or shortness of breath -- only diaphoresis and feeling weak), an SVT with a HR of 220, a diabetic gangrenous toe, and a traumatic arrest... and I was moonlighting for extra money!

Days like this make you appreciate choosing emergency medicine!

---

Members don't see this ad.

 

[leviathan]

So, among my many hand injuries today (thumb lac with FDS involvement, crush injury, another palmar lac), I had an interesting case of a guy involved in an altercation at midnight the night before. He presented at 2 pm. He was assaulted with a fist and was knocked to the ground. In the process of going to the ground, he dislocated the distal phalynx of his right thumb. Interestingly enough, it was an open dislocation.

I've never seen one before. It was kind of cool. At any rate, hand surgery came and washed it out, and then admitted him for IV antibiotics. This poor lad is going to have a rough recovery considering he's a diabetic who has been out of his insulin for 3 months and had a fingerstick glucose of 280. Talk about neutrophil inhibition.

All in all, it was a pretty cool day... a shoulder dislocation reduction, a distal radius fracture reduction, trephination for a subungual hematoma, a PE whose only signs/symptoms were tachycardia and tachypnea (no hypoxia, chest pain, or shortness of breath -- only diaphoresis and feeling weak), an SVT with a HR of 220, a diabetic gangrenous toe, and a traumatic arrest... and I was moonlighting for extra money!

Days like this make you appreciate choosing emergency medicine!

Niice, southerndoc!

How long are your moonlighting shifts? Just curious, for the PE, how long was the pt's wait before being seen / diagnosed? I'm assuming with those non-specific symptoms and normal vitals (s)he might have had to unfortunately wait for some time, but I guess that depends on how your triaging system works for whatever hospital you moonlight at.

 

[southerndoc]

We have a policy of not making patients wait long (it can have a downside in the ED can be packed sometimes). From triage to diagnosis by CT was 2.5 hours.

 

[canjosh]

Saw a guy in the ED last night (I'm a paramedic) with an impressive ankle dislocation. Tib/fib were 100% separated from the tallus; complicated by mid-shaft fibula fx. Dorsal pulse was intact prior to reduction by the EP. Admitted to floor--was scheduled to get some hardware this morning. Good stuff!