Limited access to hand surgical care in the emergency room appears to be a problem in north Florida and probably other parts of the country, as well. In this study, hand surgeons in 3 major cities were contacted to determine what on-call services they provide for hospital emergency departments in their areas. Additionally, hospitals that accept trauma patients were queried about how many hand surgeons they have on staff and if there were times when no surgeon was on call and how they managed hand trauma when that problem is encountered. Results showed that although there are numerous hand surgeons in each city, there were many times in which a hospital would have no hand surgeon on call for an emergency. Our data suggest that on a regionally selective basis, hospital emergency facilities are deficient with respect to the availability of appropriate specialists for those patients requiring emergency hand procedures.
Spontaneous effort-induced thrombosis is a rare but reported phenomena that was originally described over 100 years ago. The pathogenesis of this thrombosis arises from an abnormality of the thoracic outlet usually combined with a history of physical activity that includes repetitive arm motions, usually of the dominant hand. We present the case of an adolescent patient who presented to a pediatric emergency department with progressive pain, discoloration, and swelling of the shoulder of his nondominant hand. The pain became acutely worse with graying appearance of his arm. The patient was diagnosed with spontaneous thrombosis of the upper extremity extending from the left subclavian vein extending to the axillary vein. Treatment of this patient included aggressive anticoagulation, thrombolysis, and costectomy.
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