Background:The government is encouraging the adoption of electronic medical records (EMRs). There is little information about using EMRs in the obstetric literature and none about using them in family medicine residencies. Our purpose was to assess if using an EMR was associated with improvement in the ordering and availability of prenatal tests.Methods: A retrospective chart review comparing the rate at which prenatal laboratory values were present on the chart, ordered on time, and recorded on a prenatal flow sheet.Results
An elite collegiate boxer developed extensor tendon subluxation in the small finger of his dominant right hand. He was thought to have a radial sagittal band disruption and was allowed to complete his season with custom padding. Surgical exploration revealed intact sagittal bands with divergent dislocation of the two extensor tendons to the small finger with underlying capsular rupture. These lesions were repaired and he successfully returned to boxing. Soft tissue injuries to the dorsal MCP joint may involve the collateral ligaments, the sagittal bands, the extensor tendons, or the joint capsule. Symptoms usually involve persistent pain, swelling, and tendon subluxation or dislocation. Accurate recognition and treatment is crucial as nonoperative treatment is generally unsuccessful and surgical reconstruction is required for optimal return to function.
First metatarsal stress fractures are uncommon in young athletes, and to have them occur bilaterally is even more unusual, as in this case of a 14-year-old female field hockey player. The patient sought treatment after several days of bilateral foot pain with swelling and tenderness to palpation over the proximal aspect of the first metatarsals. Initial plain x-rays were negative, but a subsequent bone scan and MRI revealed bilateral first metatarsal stress fractures. The patient was successfully treated with relative rest and rigid-soled shoes. Clinicians should be aware that initial x-rays may not reveal first metatarsal stress fractures, and further imaging may be needed.
Introduction Chemical prophylaxis using low-molecular-weight heparin (LMWH) is considered a standard of care for venous thromboembolism in trauma patients. Our center performs a head computed tomography (CT) scan 24 hours after initiation with prophylactic LMWH in the setting of a known traumatic brain injury (TBI). The purpose was to determine the overall incidence of ICH progression after chemoprophylaxis in patients with a TBI. Methods This retrospective study was performed at a Level I trauma center, from 1/1/2014 to 12/31/2017. Study patients were drawn from the institution’s trauma registry based on Abbreviated Injury Score codes. Results 778 patients met all inclusion criteria after initial chart review. The proportion of patients with an observed radiographic progression of intracranial hemorrhage after LMWH was 5.8%. 3.1% of patients had a change in clinical management. Observed radiographic progression after LMWH prophylaxis and the presence of SDH on initial CT, the bilateral absence of pupillary response in the emergency department, and a diagnosis of dementia were found to have statistically significant correlation with bleed progression after LMWH was initiated. Conclusion Over a 4-year period, the use of CT to evaluate for radiographic progression of traumatic intracranial hemorrhage 24 hours after receiving LMWH resulted in a change in clinical management for 3.1% of patients. The odds of intracranial hemorrhage progression were approximately 6.5× greater in patients with subdural hemorrhage on initial CT, 3.1× greater in patients with lack of bilateral pupillary response in ED, and 4.2× greater in patients who had been diagnosed with dementia.
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