Social Media in the EM Curriculum: Annals of EM Resident Perspective article

Hand holding a Social Media 3d SphereThis month marks our second ALiEM-Annals Resident’s Perspective discussion. Similar to the ALiEM-Annals Global EM Journal Club series and the first Resident’s Perspective piece on Multiple Mini Interviews, we will be discussing the most recent Annals of Emergency Medicine Resident’s Perspective piece on the Integration of Social Media in Emergency Medicine Residency Curriculum. We hope you will participate in an online discussion based on the paper summary and questions below from now through August 1, 2014. Respond by commenting below or tweeting using the hashtag #ALiEMRP.

 

Google Hangout with the Authors

On July 31, 2014, we will be hosting a 30 minute live Google Hangout on Air with Drs. Kevin Scott (@K_ScottMDand Mira Mamtani (@MiraMamtaniPenn), the authors of the Annals of Emergency Medicine Resident’s Perspective paper on the how social media is being used in the EM educational curriculum. Also joining will be Drs. Stella Yiu (@Stella_Yiu), Michael Gisondi (@MikeGisondi), and Seth Trueger (@MDAware). Be sure to tune in! Later this year, a summary of this blog- and Twitter-based discussion will hopefully be published back into the journal.

[TBA]

Twitter Feed with #ALiEMRP

 

Annals of EM Resident Perspective Article

Scott KR, Hsu CH, Johnson NJ, Mamtani M, Conlon LW, DeRoos FJ. Integration of Social Media in Emergency Medicine Residency Curriculum. Ann Emerg Med. 2014 Jun 21. [early release] PMID: 24957931. Free PDF download (2.1 MB)

 

Introduction

This article is excellent overview of the current landscape of social media use and perspectives specifically in the graduate medical education world of EM. The authors, based in the University of Pennsylvania, share not only an introduction to social media and examples of best practices in medical education, but more importantly discuss the several barriers to more mainstream adoption of digital technologies.

Modalities and concepts discussed included:

  1. Blogs
  2. Podcasts
  3. Videocasts
  4. Twitter
  5. Google Hangout
  6. Flipped classrooms

Barriers discussed included:

  1. Generational gaps may lead to a lack of familiarity with social media
  2. Social media, such as Twitter, may cause a distraction and disrupt other aspects of residency education
  3. Core knowledge is currently less represented in social media content
  4. Residents may over-rely on social media education without critically appraising the literature
  5. Quality assurance is a constant concern amongst educators because social media resources, such as blogs, typically lack peer review before publication
  6. Learners may be overwhelmed by information overload using social media
  7. There is no validated study showing an objective improvement in resident knowledge and learning with social media
  8. As with everything in social media, privacy and professionalism issues are an underlying concern

FOAM Discussion to Date

The role of social media in the future of medical education is one of the most discussed topics among educators and students in the FOAM community. A comprehensive review of content produced since 2013, accomplished using FOAMSearch and Google queries, revealed 10 blog posts, 4 podcasts, and 2 open access journal articles discussing the role of social media in emergency medicine education. These resources, listed below, are a great overview of the many perspectives already shaping the role of social media in medical education. For those new to the idea of FOAM and social media in academia, be sure to check out Chris Nickson’s overview of FOAM at Life in the Fast Lane.

Website
Title
Author
Type
Country
Date
Academic Life in Emergency MedicineNew AIR Series: ALiEM Approved Instructional ResourcesAndrew GrockBlogUSA7/16/14
The Rolobot Rambles#FOAMed and #SMACC: Revealing the Camouflaged CurriculumDamian RolandBlogUnited Kingdom7/1/14
The Poision ReviewMust-read: getting started in online emergency medicine education and FOAMedLeon GussowBlogUSA6/28/14
Emergency Medicine CasesSocial Media & Emergency Medicine LearningAnton HelmanPodcastCanada6/24/14
Emergency Medicine CasesBest Case Ever 25 Rob Rogers on Social Media in EM EducationAnton HelmanPodcastCanada6/18/14
Ultrasound PodcastSocial Media and Medical Education. #FOAMED talk from #ACEP13Matt DawsonPodcastUSA5/14/14
ACEP NowTweets from Emergency Medicine-related Conferences Relay Latest Research About Social Media and Critical Care, Resuscitation Procedures, Ultrasounds, and ToxicologyJeremy FaustBlogUSA5/7/14
The Skeptics Guide to Emergency MedicineTiny Bubbles (#FOAMed and #MedEd)Ken MilnePodcastCanada4/25/14
Emergency Physicians MonthlyPRO/CON: Why #FOAMed is NOT Essential to EM EducationNicholas GenesBlogUSA4/7/14
Emergency Physicians Monthly
PRO/CON: Why #FOAMed is Essential to EM Education
Joe LexBlogUSA4/7/14
TakeokunResident Education in Ultrasound Using Simulation and Social Media AIUM14Jason NomuraBlogUSA4/2/14
iTeachEMHow we are flipping EM educationRob CooneyBlogUSA1/15/14
AAEM/RSA BlogFOAM — This is not the future of medicine, it is medical education NOW!Meaghan MercerBlogUSA7/23/13
Emergency Medicine NewsNews: How Twitter Can Save a LifePaul BufanoOpen Access JournalUSA4/12/13
ACEP Now
FOAMed appeal is simple: Get more, pay nothing
Jeremy FaustBlogUSA2/1/13
Emergency Medicine NewsBreaking News: Don't Call It Social Media: FOAM and the Future of Medical EducationGina ShawOpen Access JournalUSA2/1/13
Academic Life in Emergency MedicineLost in translation: What counts as asynchronous learning?Nikita JoshiBlogUSA1/18/13

 

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Featured Discussion Questions

The ALiEM team poses the following questions to explore current practices with social media and medical education, and perceptions about the benefits and drawbacks of this educational modality. If you have additional questions, feel free to pose them!

  • Q1. Educators: What are the biggest barriers for educators and how to overcome them?
  • Q2. Learners: How do we engage learners once the tech-innovation is employed? If you build it, they won’t necessarily come!
  • Q3. Programs: What are other examples of actual or potential innovations in GME that wasn’t described in the paper?

Please participate in the discussion by answering either on the ALiEM blog comments below or by tweeting us using the hashtag #ALiEMRP. Please denote the question you are responding to by starting your reply with Q1, Q2, or Q3.

 

 

Best Blog and Tweet

NEW! Contest for Best Blog Comment and Tweet

Thanks to Dr. Henry Woo and his colleagues in the Twitter-based International Urology Journal Club series (#urojc) hosted by @IUroJC, we are also implementing a contest for the Best Blog Quote and Best Tweet. What, emergency physicians – competitive? No… The winners will be announced in our Annals of EM publication curating this discussion.

 

This blog post was co-authored by Michelle Lin, MD (@M_Lin) and Scott Kobner (@skobner).

Disclaimer: We reserve the right to use any and all tweets to #ALiEMRP and comments below in a commentary piece for an Annals of Emergency Medicine publication as a curated conclusion piece for this Resident’s Perspective publication. Your comments will be attributed, and we thank-you in advance for your contributions.

 

Author information

Bryan Hayes, PharmD
Bryan Hayes, PharmD
ALiEM Associate Editor
Clinical Assistant Professor, University of Maryland (UM)
Clinical Pharmacy Specialist, EM and Toxicology

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I am Esther Choo – Researcher, Public Health Advocate, and Educator: How I Work Smarter

How I Work Smarter Logo

In the first post for the “How I Work Smarter” series, I called out Dr. Esther Choo (@choo_ek), because she is able to juggle so many interests and responsibilities flawlessly. She’s the principal investigator for a study, funded by the National Institutes of Drug Abuse, looking at a national computer-based intervention for women with substance use and interpersonal violence in the ED; Academic Emergency Medicine‘s first Senior Associate Editor for Social Media; and star presenter. Esther was kind enough to provide her best-practice tips for this ongoing series.

  • Esther ChooName: Esther Choo, MD MPH
  • Location: Providence, RI
  • Current job: Assistant Professor, Emergency Department, Warren Alpert Medical School of Brown University
  • One word that best describes how you work: Nocturnally
  • Current mobile device: iPhone 5s
  • Current computer: MacBook Pro

What’s your office workspace setup like?

I have the following:

  1. One analytic computer for data analysis that is separate from everything else: that’s my data brain and where I keep Personal Health Information (PHI)
  2. One separate computer that I use for my RCT, since the software and plug-ins only work on a PC
  3. My laptop, which does everything else.

I backup everything on SugarSync, so I can access my files everywhere. (The alcohol to the right is for champagne taps, not part of the productivity/efficiency plan.)

Choo Desk

What’s your best time-saving tip in the office or home?

I use the Dragon app on my phone to dictate long emails, parts of papers, or new ideas while I am walking on the treadmill, watching my kids play in the yard, or otherwise not near a computer, so I don’t lose the wording/thoughts/etc.

What’s your best time-saving tip regarding email management?

Cluster times for email at the beginning and end of the day, so it doesn’t dominate the whole day. Email can snowball, so a little benign neglect is key.

What’s your best time-saving tip in the ED?

Be kind to the ancillary staff: secretaries, med techs, supply guys, security. When you are crushed, these guys can make a lot of important stuff happen for you fast.

ED charting: Macros or no macros?

Macros, but cautiously: I have used them for typical patients with very common presentations (LBP, low-risk chest pain), individualized as needed.

What’s the best advice you’ve ever received about work, life, or being efficient?

  1. As much as possible, everything you take on should serve more than one purpose.
  2. As much as possible, everything you take on should be in line with your main goals and objectives and consistent with your values.
  3. If you have a hard time saying no, say “I’ll think about it.” Then go back and say no later with a decent explanation and an apology.

Is there anything else you’d like to add that might be interesting to readers?

I’m also an obsessive whiteboard person, but I use it for checklists. It keeps me on track by breaking down my workload into manageable pieces. My core research stuff is in the column on the right, and every day in the office I try to move at least one thing in that section forward. Once I finish a task, I check it off and leave it on for a week or two so I can have a sense of accomplishment.

Choo Whiteboard

Who would you love for us to track down to answer these same questions? (list up to 3 names)

  1. Deb Houry
  2. Lainie Yarris
  3. Zack Meisel

 

Author information

Michelle Lin, MD
ALiEM Editor-in-Chief
Editorial Board Member, Annals of Emergency Medicine
UCSF Academy Endowed Chair for EM Education
UCSF Associate Professor of Emergency Medicine
San Francisco General Hospital

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MEdIC Series | The Case of the Absentee Audience

LLSAslideHave you ever been at a lecture where the audience didn’t seem in ‘sync’ with the speaker?  Or perhaps as a junior presenter, some of you may have been at a lecture or two that just didn’t seem to work. This month, we ask you to advise Dr. Xiu, a presenter who is experiencing this exact problem. Come out and discuss the Case of the Absentee Audience.

MEdIC Series: The Concept

Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in pdf format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.

The Case of the Absentee Audience

by Teresa Chan (@TChanMD)

The view from the lectern was less than inspiring. Dr. Nelly Xiu, a newly appointed Associate Professor, stood in front of a half filled lecture hall. Of the nearly forty residents and medical students who were supposed to be at the Emergency Medicine conference day*, only about half were physically at the talk. Nelly viewed the learners, watching them pull out their computers, smart phones, and the occasional journal, and wondered if any of them were mentally present.

At the end of her lecture, the tepid applause from the audience further reinforced her impression. Nelly was surprised when the chief resident, Andrew Smith, came up to chat with her after her lecture.

“Hey Dr. Xiu, good talk. Therapeutic Hypothermia is a really important topic,” he started. “I was wondering if you’ve ever thought about doing this topic as a workshop instead?”

Nelly looked at him, perplexed by his question. Clearly the students and residents had been wholly disengaged with her lecture, couldn’t he see that?

“Andrew, this was a mandatory class, and only 20 of the 40 learners on our teaching unit came. And then the half that did come were too busy texting and emailing to listen.”

“Well, I don’t think that’s fair.  A bunch of them are post-call, some of them were still rounding with their attendings, and some of them were sick. You’re right – this is mandatory – but sometimes that isn’t enough to get people in seats anymore. And it’s definitely not enough to make sure they’re paying attention.”

Nelly pondered this thought for a moment. If the word mandatory wasn’t enough to ensure learner attendance and attention, then what would she need to do to reach her audience?

Key Questions

  1. Andrew says: “…sometimes that isn’t enough to get people in seats anymore. And it’s definitely not enough to make sure they’re paying attention.  Is he correct in his statement? Why or why not?
  2. What are some issues that occur when you make a session ‘mandatory’?
  3. As a teacher, are there any preventative measures that you can use to prophylax against an absentee audience?
  4. What are some strategies that you might advise Dr. Xiu to use in her future sessions?

Weekly Wrap Up

As always, we will post the expert responses and a curated commentary derived from the community responses one week after the case was published. This month the two experts are:

  • Dr. James Ahn (@AhnJam) is an emergency medicine physician in Chicago, IL. He is the associate program director and medical education fellowship director at the University of Chicago. His areas of interest include curriculum development and competency testing.
  • Dr. Stella Yiu (@Stella_Yiu) is an emergency physician in Ottawa, ON, Canada.  She is an assistant professor in the Department of Emergency Medicine at the University of Ottawa. She is the brains behind the Flipped EM Classroom.

On August 1, 2014 the Expert Responses and Curated Community Commentary for the Case of the Absentee Audience will be posted.  Please comment below to join in the discussion.  Your comments will help to form the basis for the curated community commentary.

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

Author information

Teresa Chan, MD
ALiEM Associate Editor
Emergency Physician, Hamilton
Assistant Professor, McMaster University
Ontario, Canada + Teresa Chan

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Child Whisperer Series: After the Pediatric Code Blue

mom_holding_baby_boy_400_clr_34534-168x300“We need to debrief” said the nurse manager after the medical team walked out of the critical care room after pronouncing a child who died after a traumatic accident. The social worker pointed at me (I am a Child Life Specialist) and looked at her and said “It’s our code blue now. We have to wait. We have a job to do”. Which was her way of saying we still had a lot of work to do with the family. At that point I walked in a room with the social worker and devastated parents, where the patient’s brother waited. He looked at me with big eyes and wanted to know if his sibling was ok. Not a conversation I would wish upon my worst enemy.

How do you support a family during the most horrible day of their life? How you do move on yourself when you have a job where you can’t tell anyone in your life about your day? How do you walk back into the hospital after a child has died on your watch?

No person in my life knows how many children I have said goodbye to, and I honestly am not sure myself. It has been too many. I’ve held siblings’ hands and cried with parents.  I’ve been strong and supported doctors when they have said, “there is nothing more we can do”.  I’ve been in the room with entire families while we watch their child slip away and seen the most brutal CPR on tiny fragile children. I have done handprints… so many handprints on children who have died. I hate handprints. But I do them, because I know how and the family needs me to. 

A very wise social worker said to me once:

There is a point in our care where we have to give the family back to their family and friends, it’s our job to give them as much support and as many tools as we can so that they can survive after we do our job and give them back.

When my job is done, I’ve hugged the parents, made the proper referrals, and sent them home with their families. I’ve got to go back to work. I’ve had moments where a death has had no effect on me, and I think my heart has turned to stone. I have also had moments where I felt like saying screw this place, call my manager, and get myself sent home. However, more times than not,  I’ve taken a few minutes and gone on walks and cried my eyes out. I’ve gone to a favorite social worker or a friend at work and talked it out. I can’t tell my husband or family about it, because I love them too much to give them that visual… and they just wouldn’t understand.

My advice is simple. Take care of yourself, and walk away from every situation knowing that you have done everything in your power to help someone through the most difficult day of their life. That means something. It has to.

Author information

Kristen Beckler, CTRS, CCLS
Kristen Beckler, CTRS, CCLS
Certified Child Life Specialist
Lucile Packard Children’s Hospital at Stanford
Pediatric Emergency Department

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Diagnose on Sight: Bilateral Leg Rash

Erythema Nodosum

Case: A pre-teen girl, living in central California, recently started on fluconazole, now presenting with a bilateral leg rash. What is your diagnosis? Click on the image for a larger view.

Poll

 

Diagnosis

Erythema nodosum, secondary to coccidioidomycosis

Explanation

Erythema nodosum is a cutaneous reaction consisting of inflammatory, tender erythematous subcutaneous nodular lesions. The classically painful rash is located on the lower extremities and usually regresses spontaneously. It is associated with a wide variety of disease processes [1,2] including:

  • Most common cause: Streptococcal infections
  • Other causes:
    • Behcet’s syndrome
    • Oral contraceptive use
    • Pregnancy
    • Sarcoidosis
    • Tuberculosis
    • Viral infections

Coccidioidomycosis is endemic to certain arid parts of the Southwest United States. Erythema nodosum is the most characteristic reactive cutaneous manifestation of coccidioidomycosis. It presents 1-3 weeks after onset of illness and is usually self-limited [3]. While strep infections are the most common cause of erythema nodosum, in a patient who has recently visited the American southwest, suspect coccidioidomycosis.

 

Master Clinician Bedside Pearls

Stuart Swadron, MD

 

 

 

Stuart Swadron, MD – Professor of Emergency Medicine, Keck School of Medicine of the University of Southern California (provided to ALiEM and recorded by Swadron, 2014)

 

References

  1. Psychos DN, Voulgari PV, Skopouli FN, Drosos AA, Moutsopoulos HM. Erythema nodosum: the underlying conditions. Clin Rheumatol. 2000;19(3):212-6. PMID: 10870657.
  2. Schwartz R, Nervi S. Erythema Nodosum: A Sign of Systemic Disease. Am Fam Physician. 2007 Mar 1;75(5):695-700 PMID: 17375516.
  3. DiCaudo DJ. Coccidioidomycosis: a review and update. J Am Acad Dermatol. 2006 Dec;55(6):929-4.2 PMID: 1711021.

Author information

Jeff Riddell, MD
Jeff Riddell, MD
Chief Resident
UCSF-Fresno Emergency Medicine Residency

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Sternoclavicular Joint Dislocations: Diagnosis and Treatment

Image obtained from healio.com

A 16-year-old football player presents to the emergency department directly from a game. He was tackled, falling onto his right shoulder. The patient is complaining of right-sided chest pain. On exam, there is tenderness over the right sternoclavicular joint (SCJ) with a prominent medial clavicle. Range of motion is limited in the right arm. What diagnostic studies need to be performed? What treatment is warranted in the emergency department?

Sternoclavicular Joint Dislocations

SCJ injuries are generally rare. However, due to the increasing amount of contact sports being played, emergency physicians must be aware of how to diagnose and treat these injuries.

The SCJ serves as an important fulcrum for movement of the shoulder girdle. It is the only true articular attachment of the upper extremity to the axial skeleton. Dislocations account for only 3% of all dislocations around the shoulder [1].

Anatomy

The clavicle is the first bone to ossify, but the medial physis is the last fuse, typically between the ages of 23-25 years of age [1]. The medial clavicle sits in a shallow, saddle joint with the superomedial manubrium. The joint requires the subclavius muscle and four separate ligaments for stability [2]. There is an intraarticular fibrocartilanginous disc between the clavicle and the manubrium, which is analogous to the meniscus of the knee [1]. Instability of the joint may be acute, recurrent, or persistent. Displacement can be directed in an anterior, posterior, superior, or inferior direction.

 

Mechanism of Injury

Dislocations typically are the result of a motor vehicle collision or a sports-related injury. Anterior dislocations are more common that posterior dislocations, but the posterior dislocation is the more concerning injury of the two with a mortality of 3-4% [1]. This is true for two reasons [1,3]:

  1. The force required for a posterior dislocation is 1.5 times that of an anterior dislocation.
  2. There is a greater chance (about 30%) of damaging underlying structures, including the brachial plexus, vascular structures, trachea, and esophagus.

Anterior dislocations are the result of a force directed on the shoulder while the arm is held in the abducted position. Posterior dislocations can result from two different mechanisms. First, a medially directed force to the shoulder with the arm adducted and flexed can cause a posterior dislocation. Alternatively, a direct blow to the anteromedial aspect of the clavicle can cause a posterior dislocation.

Physical Examination

The examination of the patient with a potential SCJ injury should be completed in the seated or standing position. Supine positioning may exacerbate severe pain, as may arm motion. The patient will have localized pain and swelling to the joint. Many times the arm will be held across the chest to minimize glenohumeral and scapulothoracic movement. Anterior dislocations will often have a prominent lump from the dislocated medial clavicle. Differentiating the anterior SCJ dislocation from a fracture of the medial clavicle can be challenging. A posterior dislocation can be quite subtle. There may be depression over the SCJ. Associated symptoms such as stridor, dysphagia or shortness of breath indicate compression of the trachea or esophagus, requiring urgent reduction.

Diagnostic Imaging

Standard antero-posterior radiographs may be difficulty to interpret due to the confluence of other bony structures. However, a chest x-ray should be performed to exclude other pathology, including pneumothorax, pneumomediastinum, or hemopneumothorax. The addition of the Serendipity view (40 degree cephalic tilt) allows visualization of a SCJ dislocation on plain radiographs [3]. CT has superseded plain films in the diagnosis of SCJ dislocations. CT provides a definitive diagnosis and shows the dislocation in relation to the underlying mediastinal structures.

 

Image obtained from msdlatinamerica.com

 

Serendipity View

Treatment

The goals of treatment are:

  1. Provide adequate pain control
  2. Reduce or immobilize joint
  3. Address associated injuries
  4. Minimize complications
  5. Arrange appropriate referral

Potential complications of SCJ injuries include:

  • Arthritis
  • Esophagel injury
  • Pneumothorax
  • Poor cosmesis
  • Vascular injury
  • Voice changes

Reduction of dislocations can be done either closed or open. Indications for early surgical intervention include failure of closed reduction and any sign of neurovascular compromise [3].

Image obtained from drguide.mohp.gov.eg

Closed Reduction Technique of Anterior Dislocation

Acute dislocations (within 7-10 days) are amenable to closed manipulation under procedural sedation in the ED or in the operating room. A bolster should be placed between the scapulae of a supine patient. Traction should be applied to the abducted ipsilateral arm. Pressure is then applied to the medial clavicle. With successful reduction, sling support with scapular protraction should be provided for up to 4 weeks. It is important to remember that there is a greater than 50% rate of repeat dislocation.

 

Closed Reduction Technique of Posterior Dislocation

Closed reduction of a posterior dislocation is indicated within 10 days of injury. After 10 days, open reduction in the operating room is recommended [1]. There are multiple methods for reducing a posterior dislocation in the literature.

Probably the most well known is the technique of using a towel clip to grasp the medial clavicle and pulling anteriorly until reduction is complete. There is also the abduction-traction technique, where the ipsilateral arm is abducted to ninety degrees and traction is applied. This extension force may translate the medial clavicle anteriorly [1].

Deren et al. described another method which involved extending the ipsilateral arm and abducting it with traction applied. Anterior-posterior pressure is then applied to both shoulders, over the glenohumeral joints [2]. No matter the technique used, a figure of eight splint is recommended for 6 weeks to encourage scapular retraction. Also, some authors recommend that all posterior SCJ dislocations should be admitted for observation, due to the close proximity of vital structures [2].

Case Resolution

You suspect an anterior SCJ dislocation based on the history and physical exam in this football player. You obtain a CT scan of the chest, which confirms the diagnosis. After obtaining consent and under procedural sedation, you easily reduce the dislocation. The patient is placed in a sling and follow up is arranged with orthopedics.

Clinical Bottom Line

Traumatic dislocations of the SCJ are rare, but with increased involvement in contact sports, these injuries will be seen in the ED. Maintain a high clinical suspicion for these injuries, given the proper mechanism. Also be on the look out for associated injuries for posterior dislocations. Reduction can be completed in the ED with subsequent immobilization and orthopedic referral.

References

  1. Sewell MD et al. Instability of the sternoclavicular joint: current concepts in classification, treatment, and outcomes. Bone Joint J 2013; 95-B: 721-31. PMID: 23723264
  2. Deren ME et al. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury. Orthopedic Reviews 2014; 6: 5245. PMID: 24744842
  3. Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID: 24209725

 

Images from:

  1. healio.com
  2. wikipedia.org
  3. msdlatinamerica.com
  4. drguide.mohp.gov.eg
  5. boneandjoint.org.uk

Author information

Matt Astin, MD
Matt Astin, MD
ALiEM Guest Contributor
Clinical Assistant Professor of Emergency/Internal Medicine
Mercer University School of Medicine
Houston Medical Center (Warner Robins, GA)

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