Dr Morrissy’s slides
Dr Swaminathan’s references:
Is There a Role for Tamsulosin in the Treatment of Distal Ureteral Stones of 7 mm or Less? Results of a Randomised, Double-Blind, Placebo-Controlled Trial
Tamsulosin Hydrochloride vs Placebo for Management of Distal Ureteral Stones
Catheter image from http://squelchyyo.wordpress.com/2013/03/22/whoa-hold-on-a-sec-free-catheters/
The post Urology and Urinary Tract Infections. Dr Dan Morrissy, with input from Dr Anand Swaminathan appeared first on EM Tutorials.
50-year-old woman, twisted ankle while walking on uneven ground. No wound. Neurovascularly normal.
What is this injury? How will you manage it?
Weber C distal fibular fracture (fibular fracture above the syndomosis) with talar shift.
The syndomosis (the tibular fibular ligaments) have ruptured and allowed the talus to shift in the mortice (the space between the talus and the medial malleolus is greater than the space between the top of the talus and the adjacent surface of the tibia, and the gap between the tibia and fibula is increased on the AP oblique (the image on the right)
The ankle is unstable and needs a screw inserted to hold the fibular and tibia together to allow the ligaments to heal.
ie analgesia, backslab (with bilateral compression on the ankle to reapproximate the tibia and fibula and to reduce swelling), admit ortho for operative repair.
Products of Conception
As mentioned in the last post on bleeding in early pregnancy be careful not to call anything “products of conception”, an “embryo”, “fetus”, “baby” etc. It is very easy to think endometrium or clot is products of conception. If you see some membrane or tissue tell the patient that you have seen some “tissue” but you are not sure what they are.
Always ask the patient what she wants done with any POC. Ideally they should be sent to the lab to be identified and possible to have genetic testing performed (gynae can ask for this later). The patient may want the POC destroyed. Woman of any ethnicity may want to take the fetus home for burial instead of, or after, going to the lab. It is the woman’s choice.
Fetuses delivered live but not viable
Occasionally a fetus will be passed in your ED, alive, moving but not mature enough to survive. Unfortunately these fetuses can sometimes live for an hour after delivery. This can be quite disturbing for all concerned. It is a good idea to weigh the fetus to reassure yourself and the patient that the fetus is not viable. Generally under 500g is not considered viable in a secondary hospital- but check the cut off at your hospital.
Ask the patient what she would like done with the fetus. Does she want to hold it? Does she want another family member to hold it? Our paeds charge nurse says she will look after any of these fetuses until they die. Understandably this can be very difficult for all involved.
In New Zealand if the fetus breathed you need to do a death certificate.
Written by Dr Chris Cresswell FACEM
Edited by Dr Beth Winn RMO
Music: Ol’ Man River. Paul Robeson
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