In this week’s edition of Grand Rounds Zack performed a quick review of the RUSH exam for undifferentiated shock and Theresa outlined some easy to miss orthopaedic injuries. Below are a few resources on both below!
The RUSH Exam
In the patient with undifferentiated shock you can use the power of the ultrasound to evaluate the “Pump, Tank and Pipes” or the HI-MAP. See the EMCrit post from the original creators.
Happy scanning with our new high frequency probe!!!
Easy to Miss Ortho Injuries
There is far too much to cover from Theresa’s awesome review on this topic. I’ve decided to highlight a couple of the injuries that she mentioned with links to the resources about those injuries for some quick reading.
The lateral elbow x-ray is your friend. Keep your eye out for signs of occult fracture in this view.
I really appreciated Theresa’s discussion of the Ottawa Ankle rule. She reminded us that these rules can help assess the need for imaging but the components do not make up a complete or thorough ankle exam. Remember to check the proximal fibular head and examine the whole ankle and foot.
Theresa’s 10 Commandments for Ortho Injuries
- Know what you are looking for
- Obtain proper, perpendicular views, multiple views and specific views
- Be aware of specific, occult and dislocation radiographic signs
- Know what “normal looks like”
- Avoid being distracted
- Develop a systematic approach to xrays
- Use cognitive forcing strategies – (i.e. always document snuffbox tenderness and DRUJ findings in wrist exams)
- ALWAYS obtain post reduction films
- Examine the joint above and below
- History and physical trump ALL. Examine, image, re-examine.