• Emergency Medicine Physical Diagnosis

    Emergency Medicine Physical Diagnosis

LISFRANC JOINT INJURIES: PALPATE AND TWIST

We think of the foot as a simple thing but it actually comprises one fourth of all the bones of the body, with 26 overall. Although some stability comes from the arch structure (the Roman arches did not require mortar) most of the stability of the foot is ligamentous. It therefore should not be surprising … Continue reading

PHYSICAL DIAGNOSIS OF OCCULT HIP FRACTURES

An elderly female presents after a fall. You were concerned about hip fracture but the x-rays were negative. You go back to examine her and she is able bear weight but she has a very slow and antalgic gait. You order a CT scan of the hip and this also comes back normal. You go … Continue reading

LUMBAR SPINE NEUROLOGICAL EXAMINATION TEMPLATE

The neurological examination is relative to the pathology you are investigating. This should not be used in a cut and paste fashion but rather for reference.   MOTOR Hip flexion “pull your knee to your chest” (L2/3) 5/5 Hip adduction “pull your knees into each other” (L2/3) 5/5 Hip abduction “pull your knees apart” (L4/5/S1) … Continue reading

TWIST AND SHOUT – DIAGNOSING OCCULT TODDLER’S FRACTURE

A 2 year old presents with leg pain and a limp after slipping on a “slip and slide” water toy slide. X-rays are negative. The child will step when asked but will not walk on his own. Is this an occult fracture? This is a situation where the reference standard, radiography, has limitations in sensitivity. … Continue reading

CAPACITY TO REFUSE CARE: DO THEY UNDERSTAND THE PAST, PRESENT, AND FUTURE?

A patient presents brought for medical clearance prior to transport to the county psychiatric facility. She is on a 5150 for being a threat to others. The patient states that she refuses the required screening tests. What do you do? If she has the capacity to make decisions then she can indeed refuse care. Being … Continue reading

PALPATE JUGULAR VENOUS DISTENSION

An obese patient presents with edema. You look for jugular venous distension and wonder if you see the ebbing in the neck (“Y descent”). Before you order BNP, there is one more thing you can do. Palpate the vein. Large veins are palpable. In the days before we used ultrasound for central lines many of … Continue reading

RECOGNIZE APNEA RISK FOR BRONCHIOLITIS IN THE FIRST 2 MONTHS OF LIFE

A 5 week old presents with nasal congestion and difficulty breathing. RSV bronchiolitis is ultimately diagnosed. Can the patient go home? Not every infant with bronchiolitis can be admitted. But the ED provider must be aware that the dreaded complication of apnea tends to occur in patients who are under 2-3 months old. The studies … Continue reading

HAND LACERATION: TEST RESISTED RANGE OF MOTION

A patient presents with a laceration to the flexor side of her left forefinger. The student tells you function was normal. “How did you determine that?” you ask. “Range of motion.” You ask the patient to repeat the range of motion test, but this time you apply active resistance and simultaneously check the opposite side … Continue reading

MANUAL REDUCTION OF SPERMATIC CORD (TESTICULAR) TORSION

A patient presents with right-sided testicular pain and swelling for 1 hour, associated with nausea and vomiting. Physical examination shows tenderness and swelling in both the epididymis and testicle itself. The epididymis is anterior to the testicle, and palpation of the spermatic cord reveals a 1cm nodule about 2 cm above the testicle. You call … Continue reading

SPERMATIC CORD TORSION (TESTICULAR TORSION): PALPATE THE CORD

Most people use the term “testicular torsion,” but throughout history it has also been called “spermatic cord torsion.” Many urologists prefer this term. One introduced it as “acute spermatic cord torsion, more commonly and not so exactly named testicular torsion (TT)…”(Drlik M. J Ped Urol 2013) The reason spermatic cord torsion is a better term … Continue reading

Follow

Get every new post delivered to your Inbox.