Triage: Fell, -loc, -thinners. C/o left wrist pain, no deformity noted. +PMS, hematoma to left side of forehead.
History of Present Illness: A woman in her 60’s fell dancing the night prior and comes in with left wrist pain. Hit head but no headache, LOC or vomiting. Denies other injuries
Vital Signs: T: 36.3 °C, HR: 60, RR: 16, BP: 177/75, SpO2: 97%
Physical Exam: The vitals are all normal. Tender to dorsal left wrist. Tiny contusion to left forehead
Relevant Test Results: Head CT and wrist X-ray both read as negative
What is the treatment?
- A) Velcro splint and refer to PCP
- B) Sugar tong splint and refer to ortho
- C) Ice and refer to rheumatology
- D) None of the above
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ANSWER:
- A) Velcro splint and refer to PCP
- B) Sugar tong splint and refer to ortho
- C) Ice and refer to rheumatology
- D) None of the above – CORRECT. There is a scaphoid fracture plus a die-punch fracture to distal radius. Treat with long arm thumb spica and call ortho from ED
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
CASE LESSONS:
- Radiologists sometimes miss things too