How do I manage that from the ED??
" Knee pain" FML
Where should/could I send this ?
CMPA speed dial
100
11 yo boy with midshaft clavicle fracture, 1/2 shaft width displacement, no shortening,
Access Ortho
Paeds cast clinic
G23, U of C will see kids but not fractures
100
27 yo female, plant and pivot during basketball game 2 days ago. Couldn't play rest of the game, generalize knee discomfort, can hobble on it. Has a moderate knee effusion, x-rays including skyline negative. You think her MCL and LCL are ok. You don't feel confident about the rest of the clinical exam.
What's the ROM?
Access Ortho, G23, Acute Knee Clinic, Innovative.
100
71 yo female presents with atraumatic back pain x 4 days. Intermittent history of same for years. Has previously has an "injection" from GP 2 years ago. No red flags. 3rd ED visit this year for same. Degenertaive disease on community xrays. Improved enough post analgesia to ambulate to DC.
Consider Vivo Cura or Access Ortho Physiatry for pain management.
- Outpt sports med referral, write " for physiatry for pain management"
100
34 yo male, first time seizure, right shoulder pain.
Reduce, splint in ext rotation (there is a bolster splint). Axillary or Velpau post reduction. Sports med/Ortho FU
200
34 yo male playing football stepped on uneven ground twisting his foot, presents with midfoot pain.
Weight bearing views
NWB on crutches
Ortho in dept if obvious injury (fracture, 1-2MT joint space widening) so the pt can get to the right place ie: Talaris
200
68 yo female, knee pain while coming down stairs two days ago, worsening pain, thinks it's swollen. Small effusion on exam, some medial joint line tenderness. Xray's negative. Improved somewhat with Tylenol and Advil. You think it's a degenerative mensical injury
Physio rx - Tylenol +_ Advil, tell her it will take up to 8 weeks to get better.
GP
Vivo Cura
Innovative
U of C
Access - not acute injury clinic but gen sports med or physiatry will see
200
18 yo male, headed by another player earlier today. Plays on a club team. No LOC. Ongoing HA, intermittent dizziness, feels "off". Normal motorsensory exam. You diagnose a concussion.
Innovative
Vivo Cura
U of C Sports Med Clinic
200
74 yo male, fell walking his dog, unsure of exactly how. Right knee pain and difficulty ambulating. Dispo?
Zimmer splint, ortho consult in dept.
NOT an outpt referral.
300
38 yo male tripped and fell in his garage. Has a closed 3rd metacarpal shaft fracture, no significant displacement on X-ray.
Plastics follow up. May have to call depending on your site ( PLC vs hand clinic at FMC etc)
300
23 year old male, felt knee " dislocate" when landed on that leg during a lay up at pick up basketball. "Went back in place" on it's own. Generalized anterior knee pain, mod effusion, exam consistent with first time patella dislocation. Xray including skyline N.
How do you immobilize?
Dispo?
Zimmer from ED ( we will prob transitiion in to J brace)
- Really any sports med clinic is reasonable.
- Give them a prescription for physio
- Fractures, patella dislocations, shoulder dislocations reduced in ED get 4 AHS covered physio apt ( have to make sure clinic has contract).
300
26 yo male with third lifetime shoulder dislocation while reaching in to his back seat. First during hockey, second a fall during soccer. Reduced in ED, unremarkable post reduction, x-ray.
G23
U of C Sports Med
Innovative
Access Ortho
Vivo Cura
Give a physio prescription - get 4 AHS covered visits, make sure they confirm with clinic when booking.
300
47 yo male, tripped and fell while running after his kids. Presented with ankle pain.
" neg squeeze, fib head non tender, Achilles intact, extensor mechanism intact, extension.... "
- "Once you find a fracture, look for more fractures."
400
48 yo male trying to lift stack of lumber at work (in a warehouse) with sudden anterior right elbow pain.
Xray's negative, tender distal anticubital fossa, pain particularly with flexion, supination, equivocal hook test.
The exam can be subtle
Better fixed within a couple weeks.
US/MRI as imaging
Orthopaedics in dept
400
32 yo female, fell during soccer 3 days ago during collision with other player. Ongoing left knee pain, mostly medial, moderate effusion, medial joint line tenderness, flexion to 110, lacking 15 degrees extension compared to right. X-rays negative aside from the effusion.
Access Ortho, Innovative, Acute Knee Clinic, G23.
Indicate on referral " clinically locked knee, ? bucket handle medial meniscal tear, young pt".
Can send an MRI req indicating same if comfortable.
No brace, crutches, double tensor prn.
400
47 yo female admin assistant inverted ankle at work on uneven flooring. Otherwise healthy, no activities. Examines like a moderate ATFL sprain. X-rays negative.
Give work note and physio note.
Tell her it will take 2-3 months with physio to be somewhat back to baseline.
Could follow up at GPs, Access Ortho. Vivo Cura depending on other logistics (GP? Pt preference)
400
RAAPID call from community site: 32 yo male, acute on chronic back pain (had had intermittently for 5 years) worse in past two days. Radicular component. No motorsensory deficit, improved with opiods but PVR is 912mL.
-Since no MS deficits is it likely from the opiods? - Should we wait a while for the hydromorph to wear off then remeasure?
- Time sensitive dx, call rads and arrange MR then send to FMC.
- Had early cauda L4-5 disc herniation on MR, to OR as E2 at FMC.
- If nil acute, pain resolved could consider Vivo Cura, Access Ortho physiatry, Sciatica Clinic at FMC for ongoing FU/management.