1/38. What if your patient prefers an alternative pain control method? Self-hypnosis in the control of pain.Despite the availability of specialized treatments for chronic pain, including biofeedback training, relaxation training, and hypnotic treatment, most physicians rely on the traditional approaches of surgery or pharmacotherapy. The patient in this case study had severe and chronic pain but found little relief from pain medications that also caused side effects. She then took the initiative to learn and practice self-hypnosis with good results. Her physician in the resident's internal medicine clinic supported her endeavor and encouraged her to continue self-hypnosis. This patient's success shows that self-hypnosis can be a safe and beneficial approach to control or diminish the pain from chronic pain syndrome and can become a useful part of a physician's therapeutic armamentarium.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/38. Ultrasound guided reduction of pediatric forearm fractures in the ED.Reducing badly displaced or angulated pediatric forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved. We have recently found that bedside ultrasound by emergency physicians is very helpful in guiding the reduction of difficult forearm fractures, allowing the physician to assess the adequacy of the reduction at the patient's bedside. In this report, we describe the technique we have developed for ultrasound-guided fracture reduction and present three case histories showing the usefulness of this technique.- - - - - - - - - - ranking = 0.66666666666667keywords = physician (Clic here for more details about this article) |
3/38. Cervical spine injuries in the athlete.Special considerations must be brought into play when the physician is consulted about when to allow an athlete to return to play following injury. This is especially true for brain and spinal cord injury. Although it is generally best to be on the conservative side, being too reticent about allowing any athlete to return may be very detrimental to the athlete and/or the entire team. Therefore, it behooves the sports physician to be circumspect with regard to not only the type of injury the athlete has suffered but also the nature, duration, and the repetitive aspects of the trauma along with the inherent strengths of any player. This article will provide the sports physician with criteria for making sound decisions regarding return to competition after cervical spine injury and "functional" cervical spinal stenosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/38. Case study. Fractured ankle.To improve our practice performance for patients admitted to the emergency department with fractured ankles, our Clinical quality improvement Team (CQI) developed the Fractured ankle Critical Path, for patients needing open reduction and internal fixation, but for whom surgery could or should be deferred as determined by the orthopaedic surgeon. Members of the team included an orthopaedic trauma surgeon, an emergency department physician, case managers, and representatives of the Home Care Department at rhode island Hospital. The critical path includes a Home Care referral procedure, an R.I. Hospital Fracture and Orthopaedic Information Sheet, and a Fractured ankle Home Care Protocol. The goal of the Fractured ankle Critical Path is to decrease length of stay while maintaining positive outcomes.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/38. Inability to obtain formal informed consent in the face of a standard surgical indication.A thirty-eight-year-old intoxicated man was admitted to the surgical trauma service following a single motor-vehicle accident. He had a severe closed head injury, bilateral pulmonary contusions, a fracture-dislocation of the right acetabulum, and an open injury of the right knee joint. The acetabular fracture pattern was an associated both-column fracture with the femoral head dislocated into a widely displaced posterior-column fracture line. The treating physicians agreed that it would be in the patient's best interest to take him to the operating room for emergent debridement and irrigation of his knee wound. At surgery, the patient also underwent attempted closed reduction of the acetabular fracture and placement of a skeletal traction pin. Radiographs obtained with the patient in traction showed reduction of the femoral head beneath a displaced superior dome fragment, but there remained a 12-mm gap in the posterior column, greater than 3 mm of step incongruity, and a large articular fragment entrapped in the anterior aspect of the hip joint. The patient remained intubated and sedated for several days. Upon weaning from the ventilator, it became evident that his head injury would prevent him from being able to give informed consent in the foreseeable future. The patient's family members refused to become involved with his care or medical decision-making, as he had become completely estranged from them as a result of his chronic alcohol abuse. Further delay in surgical treatment for the acetabular fracture would be associated with greater difficulty in obtaining an anatomic reduction, the potential for additional articular damage to the femoral head, and an increased risk of surgical complications. The question that arises is whether it is in the patient's best interest for the surgeon to proceed with open reduction and internal fixation of the acetabular fracture without having had the opportunity to fully inform him of the treatment options or the risks associated with an extensive surgical exposure.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/38. Tarsal navicular fractures in major league baseball players at bat.Tarsal navicular fractures in athletes, although rare, can present both a diagnostic and therapeutic dilemma. Failure to recognize this injury and initiate treatment early can have devastating consequences. The physician must have a high index of suspicion for the injury in any patient with midfoot pain after a direct blow. Two case reports of tarsal navicular fractures sustained by baseball players at bat in which the diagnosis was not made early are presented.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/38. Cast adrift: Gortex cast liners allow greater patient activity.Extremity fractures are a common injury, with nearly 1.5 million cases reported in the united states in 1998. Treatment often involves lengthy periods of immobilization. This report outlines the use of a Gortex cast liner by a subject who was able to engage in swimming and scuba diving during the healing process. We report that a Gortex cast liner may be considered for an active patient who is keen to return to limited activities during fracture healing. Apparently because of a lack of knowledge of their existence, physicians currently are underutilizing this method of casting in active patients. The use of Gortex liners elsewhere has been reported to have higher patient and physician satisfaction in both use and performance, with no reported detrimental effects on outcome.- - - - - - - - - - ranking = 0.66666666666667keywords = physician (Clic here for more details about this article) |
8/38. Traumatic diaphragmatic rupture in a pediatric patient: a case report.Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/38. A 22-year-old man with a swollen left hand after a motor vehicle accident.The following case is presented to illustrate roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon and emergency room physician. The initial history, physical examination, and pertinent roentgenographic findings are found on this page. The final clinical diagnosis is presented on the next page.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/38. Partial Hawkins sign in fractures of the talus: a report of three cases.OBJECTIVE: We introduce the concept of the partial Hawkins sign in three cases of talar neck fracture that are associated with incomplete avascular necrosis. Our objective is to call attention to the intraosseous blood supply of the talar body, which can be interrupted by fractures to produce patterns of incomplete avascular necrosis. CONCLUSION: We conclude that the Hawkins sign does not always have to be complete. Fractures of the talus occasionally can lead to partial avascular necrosis because of the disruption of end arteries within the body of the talus, even without subluxation or dislocation. Early recognition of the partial Hawkins sign should lead to MRI evaluation that can more readily define the involvement of the talar body and assist the treating physician in recommending when the patient can bear weight.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
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