A Lisfranc injury describes an injury of the foot between the metatarsal and tarsal spaces. Around 20-40% of Lisfranc injuries are initially missed, so a high degree of clinical suspicion is required.
Category: Learning
Morton’s Neuroma
Morton’s Neuroma is a painful condition resulting from the fibrous thickening of the plantar interdigital nerve of the foot.
Often described as feeling like there is a pebble in the shoe, this is is a chronic condition not associated with acute trauma. It is gradual in onset but may present as acutely painful.
Paronychia
- Infection in the skin fold (or paronychium) to lateral edge of the nail (of the finger or toe, but most commonly finger).
- Leads to a pus filled abscess.
- Can result in cellulitis of the digit, and any other complications usually seen with this.
- Is often very painful.
- Common in nail biting.
COPD – exacerbations
COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.
Questions
- Is hospital the best place for them?
- Do they need NIV?
- Are they dying? – would you want to die surrounded by strangers or with your family?
Tick Bites
Though less common locally than in some areas, tick bites pre and post removal do offer some concern to patients.
Vaccination Schedules UK & International
Working out what your patient might have been vaccinated for can be tricky, and more so if they were raised outside of the UK. Luckily there are a couple of tools online you can use to make this easier.
Elbow Crutches
Measuring for and advising patients on the use of elbow crutches is an important skill for ED staff.
Mallet Finger
Mallet Deformity is an inability to maintain extension of the distal phalanx of the finger at the distal intraphalangeal joint.
Neck of 5th Metacarpal Fractures
Neck of fifth Metacarpal (Boxer’s) fractures are a common injury, and how we treat them locally is changing.
Pulmonary Embolism in Pregnancy
Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway
1. Investigation – of suspected PE
- Clinical assessment – its all on the history and exam scoring doesn’t work
- Perform the following tests:
- CXR – sheilding can protect the baby and may avoid further radiation
- ECG
- Bloods: FBC, U&E, LFTs, Clotting
- Commence Tinzaparin (unless treatment is contraindicated – use booking weight to calculate dose) –[BNF]
