Ultrasound
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Dx: Tendon Laceration 

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As your resident was scanning around the forearm, she picked up a laceration through the hyperechoic palmaris longus tendon (top) and lacerations through the flexor digitorum superficialis tendons (bottom). For good measure, she scans through the area a few more times in search of pieces of glass that might have been missed on his forearm X-ray. Satisfied with what you two see on the bedside ultrasound, you feel you have enough information to get your surgical colleagues down for a consult. If they require assistance with procedural sedation for an exploration and primary closure at bedside, at least you won’t have to sedate the patient twice, and you’ve minimized as much risk as you can for both the patient and your staff tonight.

The surgical team arrives in your ED; you watch with pride as your resident expertly summarizes the case and shows them her ultrasound findings. To your resident’s surprise, they opt to take the patient directly to the OR for definitive care, and thank her for a job well done. It looks like Goldilocks was able to win over the bear of surgical criticisms this night after all.

 

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