The patient is a 52-year-old tourist who presents with a four-day day history of abdominal pain, constipation, not passing gas, and nausea. The patient was not comfortable but was hemodynamically stable. Temperature was normal, pulse was 94, BP was 195/99. The abdomen was markedly distended. WBC was 11. View the x-rays taken (Figure 1 and Figure 2) and consider what your diagnosis and next steps would be. Resolution of the case is described on the …
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Management of Distal Radial Fractures
Urgent message: Distal radial fractures in children can often be treated by non-orthopedists without the need for full casting in an urgent care center that can perform simple splinting, thus sparing hospital referral. Deena R. Zimmerman, MD, MPH, IBCLC, Scott Fields, MD, and Nahum Kovalski, BSc, MDCM Introduction Wrist fracture is a com-mon injury in children. Many of these fractures are buckle or torus fractures. Traditionally, treatment for buckle fractures has been short-arm casting for …
Read MoreClinical Challenge: August, 2007
The patient is a 9-year-old boy who received a blow to the shoulder from a height of approximately 6 ½ feet. He has limited elevation of the arm due to pain. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. <
Read MoreClinical Challenge 2: July 2007
The patient is an 18-year-old male who jumped or fell from a “short height” but landed hard on his heel. He is able to ambulate, but cannot put any pressure on his heel. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge 2: June 2007
The patient is a young child with three days of constipation with a non-specific history of abdominal pain. On exam, the child was asleep. The abdomen was easily palpable and soft. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described below.
Read MoreClinical Challenge: June, 2007
The patient is a 15-year-old boy who presents with pain in the wrist 40 minutes after stopping a soccer ball with his hand. There is no snuffbox tenderness. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge 2: May 2007
The patient is a 13-year-old male who presented to urgent care after taking a fall while running; he landed on his outstretched left hand. Upon examination, you find tenderness in the snuff box and observe swelling around the wrist. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: May, 2007
The patient is a 2½-year-old female who presented after falling, unobserved, from an unknown height with tenderness and swelling around the elbow. Neurovascular exam was normal. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Resulotion The correct diagnosis is a supracondylar fracture; note the loss of the normal angle at the distal humerus. The injury was managed …
Read MoreClinical Challenge 2: April, 2007
The patient is a 25-year-old male who presented to urgent care after falling from a height of two stories, landing flat on his feet. He is able to ambulate, though only with pain. In addition, he complains of back pain. He is generally healthy, and no neurological deficit was found. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: April, 2007
The patient is a 3-year-old female who presented after a fall while running and complaining of pain over the foot. There was minimal local tenderness over the foot and minimal limp, but no other remarkable findings. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
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