Abbreviations CT, computed tomography; HH, hook of the hamate Case ReportA 54-year-old right-handed woman was referred by a hand surgeon because of local pain in the ulnar aspect of the right wrist radiating down into the fourth and fifth fingers. She had a fall on both wrists 4 months previously. Standard anteroposterior and lateral radiographs obtained after the accident showed a displaced fracture of the left distal radius but no traumatic lesions of the right wrist. She was successfully treated by osteosynthesis of the left radius. After 4 months, because of persistent pain in the right wrist, she consulted a hand surgeon, who asked for an sonographic examination to rule out tenosynovitis of the flexor tendons.Clinical examination showed a normal appearance of the hand and wrist without local swelling or redness. Case Report ractures of the hook of the hamate (HH) account for approximately 2% of wrist fractures and can follow local acute trauma or chronic overuse in racket, club, and bat sports, mainly tennis, golf, and baseball. Because of limitations in detecting them on standard radiographs, they can go easily undiagnosed. When unrecognized, they can evolve into painful nonunions and can be followed by local complications such as tenosynovitis and tendon rupture of the flexor tendons of the fourth and fifth fingers as well as impingement on the ulnar nerve and artery. Because of recent technical improvements, sonography is nowadays considered a useful imaging technique in the assessment of musculoskeletal disorders, including traumatic soft tissues lesions. In addition, fractures that are difficult to diagnose by standard radiography can be detected by sonography because of its tomographic capabilities. We report a case of a fracture of the HH diagnosed by sonography that was undetected on standard radiographs.

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Background Ultrasound-guided fascia iliaca compartment block (US-FICB) is not part of the learning curriculum of the emergency physicians (EP) and is usually performed by anesthesiologists. However, several studies promote EP to use this procedure. The goal of this study was to assess the feasibility of a training concept for non-anesthesiologists for the US-FICB on a simulator based on a validating learning path. Method This was a feasibility study. Emergency physicians and medical students received a 1-day training with a learning phase (theoretical and practical skills), followed by an assessment phase. The primary outcome at the assessment phase was the number of attempts before successfully completing the procedure. The secondary outcomes were the success rate at first attempt, the length of procedure (LOP), and the stability of the probe, corresponding to the visualization of the needle tip (and its tracking) throughout the procedure, evaluated on a Likert scale. Results A total of 25 participants were included. The median number of attempts was 2.0 for emergency physicians and 2.5 for medical students, and this difference was not significant (p = 0.140). Seven participants (28%) succeeded at the first attempt of the procedure; the difference between emergency physicians and medical students was not significant (37% versus 21%; p = 0.409). The average LOP was 19.7 min with a significant difference between emergency physicians and medical students (p = 0.001). There was no significant difference regarding the stability of the probe between the two groups. Conclusion Our 1-day training for non-anesthesiologists with or without previous skills in ultrasound seems to be feasible for learning the US-FICB procedure on a simulator.

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BACKGROUND Carbon monoxide poisoning is an important cause of morbidity and mortality worldwide. Symptoms are mostly aspecific, making it harder to identify, and its diagnosis is usually made through blood gas analysis. However, the bulkiness of gas analyzers prevents them from being used at the scene of the incident, thereby leading to the unnecessary transport and admission of several patients. While multiple wavelengths pulse oximeters have been developed to discriminate carboxyhemoglobin from oxyhemoglobin, their reliability is debatable, particularly in the hostile prehospital environment. OBJECTIVE The main objective of this pilot study was to assess whether the Avoximeter 4000, a transportable blood gas analyzer, could be considered for prehospital triage. METHODS Blood samples from an emergency department cohort of 68 patients and 12 forensic specimens were tested using the Avoximeter 4000. A standard intra-hospital blood gas analyzer (ABL827 FLEX) was used as gold standard. RESULTS The Avoximeter overestimated carboxyhemoglobin levels by a mean difference of 1.8% (95% CI 1.5-2.1) and yielded a diagnostic specificity of 95.6% (95%CI 87.0-98.6) according to commonly accepted diagnostic thresholds. CONCLUSIONS The limited difference, which erred on the side of safety, and the relatively low overtriage rate warrant further exploration of this device as a prehospital triage tool.