Episode 29: Hand Emergencies

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 15 January 2013

⏱️ 77 minutes

🔗️ Recording | iTunes | RSS

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Summary

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injuries, flexor tenosynovitis, gamekeeper's thumb, fight bites, hook of the hammate fractures and many more important hand emergencies. Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper's thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel's signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:14.9	In this episode number 29 on hand emergency pearls and pitfalls, we have with us Dr. Laura Tate and Dr. Andrew Arkand.
0:23.3	Dr. Tate is a plastic surgeon at the Toronto East General Hospital.
0:27.4	She was the Chief of Surgery and Co-Program Medical Director at Toronto East General.
0:32.1	She's an assistant professor of surgery at the University of Toronto and has won multiple teaching awards.
0:37.9	She was on the chair of the Women in Surgery Initiative at the University of Toronto and has won multiple teaching awards. She was on the chair of the Women in Surgery Initiative at the University of Toronto from 2004 to 2008.
0:44.8	Dr. Andrew Arkand is an emergency physician and chief of the emergency department at Markham-Stowville Hospital near Toronto.
0:52.3	Hand emergencies account for about 5% of all emergency visits, most of which are lacerations.
0:58.8	While the majority of these visits give the ED doc a chance to take a break from the chaos
1:03.4	and high demands of the really sick patients in the department and chillax while they sew up
1:08.2	a simple laceration, there's a significant minority of these patients
1:12.6	who can end up with permanent disability and even amputation if they're not diagnosed and managed
1:17.4	appropriately in the ED. What might first appear to be a relatively benign lesion can turn out
1:23.6	to be a devastating injury. In this episode, with the help of Dr. Andrew Arkand and Dr.
1:29.8	Laura Tate, we'll give you the tools necessary to pick up on these sometimes tricky
1:34.7	diagnoses and manage them like a seasoned pro. We'll also give you the answers to some
1:40.6	apparently simple questions we're faced with almost daily in the ED, like which
1:45.5	patients with lacerations need antibiotics, for example. So without further ado, I'd like to introduce
1:51.6	Dr. Laura Tate. Welcome. Hello. Hello. And Dr. Andrew Arkand. Thanks for having me. Great. So let's
1:58.3	jump right into our first case. The first case is out of a 19-year-old
2:02.1	man who presents to your ED on a Sunday afternoon with right hand pain since waking up that
2:07.4	morning. He's not sure how he was injured, but he does admit to being very drunk the night prior.
	...

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