Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow β check first
Diagnostic flow β check first
- Trauma β XR.
- Pain out of proportion β think compartment / nec fasc / arterial.
- Left arm + cardiac risk β ECG + troponin.
- Unilateral swelling without trauma β Doppler.
Differential diagnosis β checklist
0/13
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Traumatic0/4
Vascular / neuro0/4
Soft-tissue / inflammatory0/3
Referred0/2
Initial ED workup
Bedside0/5
- Vitals
- Inspect deformity, swelling, color, capillary refill
- Assess radial / median / ulnar / axillary nerves
- Check radial + brachial pulses; compare sides
- ECG if left-sided or risk factors
Labs0/3
- CBC, CRP if infection
- Troponin if cardiac risk
- CK if compartment / rhabdo suspected
Imaging0/3
- XR for trauma
- Doppler US if DVT suspected
- CTA if arterial occlusion
Initial management0/4
- Splint, elevate, ice, analgesia
- Emergent fasciotomy for compartment syndrome
- Anticoagulate DVT
- Cath lab for STEMI
Pearls / pitfalls
Pearls
- Radial nerve palsy is common with humeral shaft fractures β document before/after splinting.
- Pain out of proportion to exam = compartment syndrome until proven otherwise.
- Effort thrombosis (Paget-Schroetter) in young athletes β needs vascular and thrombolysis, not just anticoagulation.