EM Forum Case #114 "A Painless
FOOSH"
by Charlene Babcock Irvin, MD, FACEP
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A 68 y/o female slipped on the ice (Fall on
an Outstretched Hand=FOOSH). She had a
dinner fork deformity to her right wrist,
and no other injuries. She did not strike
her head, had no chest pain, shortness of
breath, back pain, abdominal pain or near
syncope before the fall. She has normal
stools (no melena or bleeding). Her only
complaint is pain in her wrist. No numbness,
but she’s not sure how well her fingers are
working because of all the pain.
PMH:
CAD, stents x4, CABP 10 yrs ago. She also
has a history of A-fib, Congestive heart
failure, and mild COPD (although she only
uses an inhaler when needed, which is less
than 2 times a month). She notes her COPD
only acts up when she gets a cold. She does
have a history of diabetes (type II) and she
had a bleeding ulcer about 2 years ago.
SH: Lives with her son.
X-ray
reveals a Colles’ fracture.
Questions:
1. What are the different ASA
classifications, and why should you care?
2. Is she on any medications
that might make a hematoma block dangerous?
3. What are contraindications to
Hematoma block? What are the complications?
4. How much lidocaine can you use? What
happens if you give too much?
5.
Besides an x-ray, how can you determine if
the reduction is adequate?
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