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"Episode 8"

"Show Notes"

"Posterior Shoulder Dislocation"

 

A middle-aged female presented with instant left shoulder pain following a throwing action.

 

Previous history of right shoulder dislocation.

 

There was no obvious loss of contour compared to the other shoulder.

Here is the X-rays showing posterior shoulder dislocation,

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Post manipulatiopn X-ray

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"Knee Dislocation"

 

A middle-aged male presented with a jiu-jitsu injury causing him severe knee pain.

Here is the knee X-ray,

This is a rare condition.​

Why is it bad?

  1. Injury indicates severe disruption of ligamentous structures.

  2. High risk of popliteal artery/nerve injury.​

Management:

  • Reduce the knee under procedural sedation.

  • Apply long-leg POP.

  • Orthopedics admission.

  • Circulation should be checked repeatedly – damage may not be apparent for several hours.​

  • Angiography is usually required.​

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"Teenage Leukaemia"

This was a teenager who presented with a two-week history of fever along with generalised body aches, loss of appetite, and weight loss.

The chest was clear.

The abdomen was soft and non-tender, with no organomegaly.

ENT examination showed: Throat to be hyperemic but with no pus.

 

Ears: NAD. No lymph node enlargement.

Vital signs: Unremarkable apart from unexplained Tachycardia (Afebrile and not in pain).

Because the patient was still tachycardic (unexplained),

The plan was:​

  1. Refer the case to the pediatric team for admission. ​

  2. Chase blood tests to see if any results would explain the presentation.​

 ​

Blood results came back with a surprise,

CRP:104      WBC: 5.8      Neutrophils: 0.58       Platelets: 95​

Blood film: 57% blast cell (Suspected Leukemia)

 

Learning Points:

  • Never underestimate tachycardia in children especially if not well explained.

  • Consider other uncommon differential diagnoses for these cases like malignancy, Autoimmune diseases, etc.

Useful further reading:

"EDGovCast Team"

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Dr. Helen Bates

Pediatric Emergency Medicine Consultant in Hampshire Hospitals.

UK

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Dr. Gareth Davies

Emergency Medicine Consultant in Hampshire Hospitals.

Founder of ED GovCast.

UK

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Dr. Lee Barnicott

Pre-hospital & Emergency Medicine Consultant in Hampshire Hospitals.

UK

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