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Pediatric wrist and hand injuries are very common in the emergency department (ED). Early recognition and appropriate management are critical to maximize the chances of an optimal functional outcome. This article reviews five key injuries of the pediatric wrist and hand: scaphoid fracture, proximal thumb metacarpal fractures, skier's thumb/gamekeeper's thumb, phalanx injuries, and boxer's fractures/fight bites.
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In the intense focus of late on use of the ED by patients with non-emergent needs, it is perhaps easy to overlook another group of patients that is strongly linked with the ED: patients who are nearing the end of life.
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On any given day, the ED at Mercy Hospital in Springfield, MO, has two zone captains acting as mini-charge nurses, for the east and west sides of the department. There is also an up-front triage nurse who is the first person most patients see when they walk in the door, and a lobby nurse who regularly rounds through the waiting room, taking vital signs and monitoring patients who have yet to see a provider.
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As demand for emergency care continues its upward climb, The Joint Commission is taking steps to strengthen its accreditation standards pertaining to patient throughput, and it is putting hospital leaders on notice that they will be held accountable for patient flow challenges that occur in the ED.
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Increasing payer scrutiny over diagnostic interpretations and continued belt-tightening at the private payer level has resulted in a resurfacing of the EKG interpretation payment issue for emergency physicians. There is no doubt that the interpretation of diagnostic tests for ED patients is an invaluable service.
