msk

MDM – Peds Head Trauma

MDM, Peds

LOW RISK, <2 y old

This pediatric patient presents with head trauma. Given mechanism, history, and physical exam findings, we have a low probability of serious injury to include intracranial bleed or skull fracture, DAI, or high risk of decompensation. Given lack of a severe mechanism, GCS 15 or lack of AMS, no occipital/parietal scalp hematoma, and no LOC, risk of obtaining a CT scan outweighs the potential benefit. Will observe patient, PO challenge, reassurance and reassessment, anticipating discharge with PMD follow up.

LOW RISK, >2 y old

This pediatric patient presents with head trauma. Given mechanism, history, and physical exam findings, we have a low probability of serious injury to include intracranial bleed or skull fracture, DAI, or high risk of decompensation. The patient has a GCS of 15 and is not altered, and has no or minimal LOC history. The mechanism is of low energy. In this group, PECARN rules demonstrate an exceptionally low risk of serious intracranial injury and obtaining further imaging is likely to be of little or no benefit.

Plan: observation, pain control, PO challenge, reassurance/reassessment, likely discharge

HIGH RISK: 

This pediatric patient presents with a history concerning for a serious intracranial injury. Unable to clear patient with PECARN rules given ***. Will obtain CT imaging to rule out intracranial injury or skull fracture. Patient is protecting airway and otherwise has an unremarkable secondary trauma survey.

Plan: CT scan head/neck, pain control, reassess

MDM – Toe Pain (Injury)

MDM

This patient presents after a soft tissue injury to the toe. Considered, but doubt, acute fracture including open fracture. Low index of suspicion for a dislocation or Lisfranc injury. Doubt other acute causes of toe pain at this time.

Plan: plain films, pain control, reassess, likely discharge with podiatry/orthopedics followup, WBAT***

MDM – Biceps Tendon Problem

MDM, Physical Exam

This _ presents with upper arm pain and exam findings suspicious for a biceps tendon rupture. Differential includes bursitis, muscle strain, partial tear, fracture, and elbow pathology. Neurovascularly intact distal to the injury.

Plan: plain films, urgent orthopedic referral, pain control, reassessment, anticipating discharge

 

PEARLS:
– Classic mechanism for biceps tendon rupture:
— FOOSH – proximal rupture
— Elbow forced straight against resistance – distal
– Exam: “popeye’s sign” from rupturing of the long head of the biceps. Probably will be able to still flex a little if it’s proximal.
– If they have a distal rupture, they will have marked ecchymosis over the AC and marked weakness on flexion
– Hook test: you should be able to get about 1 cm under the biceps tendon with your finger as a ‘hook’

  • Proximal ruptures are usually managed nonop; distal ruptures require near-term urgent ortho f/u.

DC Inst – Wrist Pain

DC

You have been evaluated in the Emergency Department today for wrist pain after a fall. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _______ // no evidence of any acute fractures or dislocations.

You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package. Please also rest, ice, and elevate your arm to control pain and inflammation.

Please follow up with your primary care physician within two days. If your pain persists in 7- 10 days please have repeat x-ray. // Please follow up with an orthopedic surgeon within 1 week.

Return to the Emergency Department if you experience worsening or uncontrolled pain, numbness or weakness to your hand, color change to your hand, or any other concerning symptoms.

Thank you for choosing us for your care.

DC Inst – Muscle Strain

DC

You have been evaluated in the Emergency Department today for your ______ pain after _____. Your pain is most likely muscle strain which will improve on its own.

Please follow up with your primary care physician in 2-3 days.

Please rest, ice, and elevate your ____ to control pain and inflammation.

Return to the ER immediately for worsening or uncontrolled pain, numbness or weakness to your ____, color change to your ____, or for any other concerning symptoms.

Thank you for choosing us for your care

DC Inst – MSK Pain

DC

You have been evaluated in the Emergency Department today for *** pain. Your evaluation did not find evidence of medical conditions requiring emergent intervention at this time.

We have provided crutches for you to use while your *** heals. Please rest, ice, and elevate your ***, and resume normal activities as tolerated.

We recommend you take 600mg ibuprofen every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take ibuprofen, then at 3pm take tylenol, then at 6pm take ibuprofen.

Please schedule an appointment for follow up with your primary care physician this week.

Return to the Emergency Department if you experience worsening pain, numbness, tingling, change of color in your toes, or any other concerning symptoms.

Thank you for choosing us for your care.

DC Inst – Lac Repair

DC

You have been evaluated in the Emergency Department today for a laceration to your ***. Your laceration was repaired in the ED with sutures. Please keep the area surrounding the laceration clean and dry. Please keep the area out of the sunlight for the next 6 months to help prevent scarring. You should have the sutures removed in 7-10 days by your primary care physician, or at your local urgent care or ER. If you develop redness or swelling at the site of your laceration please come back to the ER for a wound check.

We recommend you take 600mg ibuprofen every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take ibuprofen, then at 3pm take tylenol, then at 6pm take ibuprofen.

Please follow up with your primary care physician in 7-10 days for suture removal. You can also return to the ER or another urgent care facility for this service.

Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, numbness, tingling, or any other concerning symptoms.

Thank you for choosing us for your care.

DC Inst – Knee Pain

DC

You were evaluated in the Emergency Department today for your knee pain. Your evaluation, including ***X-rays of your knee, did not show signs of fractures or other acute abnormalities which require further intervention at this time.

Your knee has been ace wrapped and you were given crutches in the ER to help your knee heal. Please rest, ice and elevate your knee, and resume normal activities as tolerated.

We recommend you take 600mg ibuprofen every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take ibuprofen, then at 3pm take tylenol, then at 6pm take ibuprofen. ***Please take your prescribed norco as directed as necessary for pain. Do not drive or take medications containing tylenol while taking norco.

Please follow up with your primary care physician within three days.

Return to the Emergency Department if you experience worsening or uncontrolled pain, numbness, tingling, or weakness to your legs, difficulty walking, worsening knee swelling or redness, or any other concerning symptoms.

Thank you for choosing us for your care.

DC Inst – Fracture Generic

DC

You have been evaluated in the Emergency Department today for *** pain. Your evaluation showed a fracture of your ***. We have placed your *** in a splint today, avoid getting the splint wet.

Please rest, ice, and elevate your *** to help it heal. ***We have provided crutches for you to use at home while your *** heals.

We recommend you take 600mg ibuprofen every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take ibuprofen, then at 3pm take tylenol, then at 6pm take ibuprofen. *** Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.

Please follow-up with an orthopedic surgeon in 1 week.

Return to the Emergency Department if you experience worsening pain, numbness, tingling, change of color in your ***, or any other concerning symptoms.

Thank you for choosing us for your care.

DC Inst – Peds MSK (No Fx)

DC, Peds

Your child has been evaluated in the Emergency Department today for *** pain. Your child’s evaluation, including X-rays, did not find signs of any concerning conditions such as fractures or dislocations.

Please rest, ice, and elevate your child’s ***, and resume normal activities as tolerated.

Give your child Tylenol and Ibuprofen per the attached dosing instructions for pain.

Please schedule an appointment with your child’s pediatrician for follow up this week.

Return to the Emergency Department if your child experiences worsening pain, numbness, tingling, change of color in your child’s extremity, or any other concerning symptoms.

Thank you for choosing us for your child’s care.