Residency Salary and Benefits. Salary AY 2. 01. PGY I    5. PGY 2    5. 5,8. Emergency medicine, also known as accident and emergency medicine, is the medical specialty involving care for undifferentiated and unscheduled patients with. EPM is the independent voice for emergency medicine, bringing together commentary from the top opinion leaders, clinical reviews from leading educators and quickhit. Read about anaphylaxis and how it differs from an allergic reaction. Learn about shock, symptoms, treatment, diagnosis, causes insect stings, latex allergy, food. PGY 3    5. 8,5. PGY 4    6. Resident Benefits, Policies and Contracts. Paid Memberships. Society for Academic Emergency Medicine. Emergency Medicine Residents Association. American College of Emergency Physicians. American Academy of Emergency Medicine Residents. Benefits. Vacation PGY 1  Three weeks PGY 2, 3, 4  Four weeks. Health and Dental Insurance. Disability Insurance. Life Insurance. Maternitypaternity leave. Retirement Plan. Malpractice Insurance. Meal allowance. White coats with embroidered name and laundry service. Other Benefits. PGY 1 Maryland ACEPPGY 2 SAEM, Society for Academic Emergency Medicine. PGY 3 ACEP, American College of Emergency Physicians. PGY 4 Resident Choice. Online Textbooks Clinical Practice of Emergency Medicine Harwood Nuss. Tintinallis Emergency Medicine Judith E. Tintinalli, et al. Clinical Procedures in Emergency Medicine Roberts Hedges. Rosh ReviewHippo. EW9kguPNL.jpg' alt='Tintinalli Emergency Medicine' title='Tintinalli Emergency Medicine' />Lacerations are among the most common reasons for visits to emergency departments over 11 million such wounds are treated each year in the United States. Although. The Harbor DEM faculty consists of 25 members who hold academic appointments at the David Geffen School of Medicine at UCLA and are members of the Professional Staff. Doctors must discuss previous experience and training in this procedure with the Director of the Emergency Department before proceeding, and should be fully familiar. EMJohns Hopkins Emergency Medicine Guide. Continuing medical education allowance. Certification in ACLS, ATLS and PALSAccess to departmental and university wide library services, including online journals, databases, and medical informatics services. The Johns Hopkins Department of Emergency Medicine Residency Program. Advanced search allows to you precisely focus your query. Search within a content type, and even narrow to one or more resources. You can also find results for a. E. Monument Street, Suite 6 1. Baltimore, MD 2. 12. Wrist Fracture in Emergency Medicine Background, Pathophysiology, Epidemiology. Anatomic considerations. The wrist or carpus is a highly mobile structure composed of a large number of small bones and joints. This complex system of articulations works in unison to provide a global range of motion for the wrist joint. Motion at the wrist joint occurs between the radius and the carpal bones, which function as a single unit, and between the carpals and metacarpals. Carpal bones. The 8 carpal bones are arranged in 2 rows to form a compact, powerful unit. Each is cuboid with 6 surfaces 4 are covered with cartilage to articulate with the adjacent bones, and 2 are roughened for ligamentous attachment. The proximal carpal row contains the scaphoid also called the navicular, lunate, triquetrum, and pisiform. It articulates proximally with the radius and the triangular cartilage. The ulna does not articulate directly with the carpus but is separated from the triquetrum by a triangular fibrocartilage, which acts as a stabilizing structure. The distal carpal row contains the trapezium, trapezoid, capitate, and hamate and articulates with the 5 metacarpals. Joints and ligaments. The wrist includes 5 large joint cavities in addition to the intercarpal joint spaces the radiocarpal joint, the distal radio ulnar joint DRUJ, the midcarpal joint, the large carpometacarpal joint between the carpus and the second, third, fourth, and fifth metacarpals, and the small carpometacarpal joint between the first metacarpal and the trapezium. The strength of the wrist is dependent on the integrity of the ligamentous network, which links the carpus together. The volar carpal ligament extends from the trapezium to the hook of the hamate and forms the anterior roof of the osseousfibrous tunnel. Within this tunnel lie the tendons for the finger flexors and the median nerve. Encroachment on this space results in median nerve compression. The second and third metacarpals are fixed at their bases and are immobile. The muscles of the hand originate primarily in the forearm and pass over the wrist. The only muscle with insertion into the wrist is the flexor carpi ulnaris, which inserts into the pisiform, a small sesamoid bone. Movement of the wrist is 8. Pronation and supination occur at the radial ulnar articulation in the forearm not at the wrist. Neurovascular anatomy. The wrist comprises several important neurovascular structures. The deep branches of the ulnar nerve and the ulnar artery run deep to the flexor carpi ulnaris tendon through the Guyon canal. They pass near the hamate and capitate and can be involved with injuries to these structures. The ulnar nerve innervates the intrinsic muscles of the hand, including the hypothenar muscles, interossei, ulnar lumbricals, and adductor pollicis. The median nerve lies between the flexor carpi radialis and the palmaris longus tendon in the carpal tunnel. The median nerve innervates the thenar compartment and provides sensation to the radial portion of the hand. Any displacement of the normal anatomic alignment of the wrist can injure this nerve. The blood supply to the hand is via the radial and ulnar arteries, which form the dorsal palmar arch. The scaphoid bone receives its blood supply from the distal part of this arch, which is prone to injury. Surface anatomy Several anatomic landmarks are important to recognize when performing an accurate and thorough examination of an injured wrist. The anatomic snuffbox lies on the radial aspect of the dorsum of the wrist. It is defined in the ulnar aspect by the tendon of the extensor pollicis longus and radially by the tendons of the extensor pollicis brevis and abductor pollicis longus. The floor is composed of the scaphoid proximally and the trapezium distally. The anatomic snuffbox is most easily observed with the thumb held in a position of extension with the wrist slightly deviated in the radial aspect. The next landmark is the Lister tubercle, a bony prominence over the dorsum of the distal radius. With the hand held in neutral, a line drawn between the third metacarpal and the Lister tubercle will cut through the capitate distally and the lunate proximally. Just distal to the ulnar styloid, the triquetrum can be palpated. At the base of the hypothenar eminence on the volar aspect of the wrist lies the pisiform. The hook of the hamate can be felt with deep palpation of the palm approximately 1 cm distant from the pisiform along a line pointing to the index metacarpophalangeal MCP joint. Carpal fractures and dislocations. Scaphoid fracture. The scaphoid bone is based in the proximal row of carpal bones but extends into the distal row, making it more vulnerable to injury than the other carpal bones. It is the most frequently injured carpal bone, accounting for 6. It is also a frequently missed injury, as approximately 1. More than three fourths of all fractures occur at the narrow midportion or waist of the scaphoid. How To Install Rifle Sling Swivels. Because blood is supplied to the scaphoid along its dorsal surface near its waist, fractures at this location potentially compromise flow to the proximal portion of the bone. As a result, avascular necrosis is a serious complication of this injury. Hyperextension of the wrist is the most common mechanism of scaphoid fracture either by a fall on an outstretched hand or by a direct blow to the palm. Often, the wrist has some degree of radial deviation. Hyperextension causes the radial styloid to impinge on the waist of the scaphoid as it crosses between the 2 rows of carpal bones. Scaphoid fractures are often associated with other injuries of the wrist, including dislocation of the radiocarpal joint, dislocation between the 2 rows of carpal bones, fracture dislocation of the distal end of the radius, fracture at the base of the thumb metacarpal, and dislocation of the lunate. Lunate fracture. Although a relatively uncommon injury, fracture of the lunate is the third most frequent carpal bone fracture. The lunate is located in the center of the proximal carpal row and articulates with the radius. Fractures can occur in any orientation, and diagnosis often requires a high degree of clinical suspicion. Fractures of the lunate most often result from hyperextension of the wrist or impact of the heel of the hand on a hard surface. This injury can also occur from a fall on the outstretched hand. Patients usually present with weakness of the wrist and pain aggravated with compression along the third digital ray. Triquetrum fracture. The triquetrum is one of the more commonly injured carpal bones. The triquetrum is the second most injured carpal bone associated with sports injuries. It lies on the ulnar aspect of the proximal row of carpal bones. Strong ligaments attach the triquetrum to the lunate, which adjoins its radial aspect. In addition, the triquetrum is connected to the distal ulna by a triangular fibrocartilage complex. The most common mechanism of injury is forced hyperextension of the wrist with ulnar deviation. In this position, the triquetrum is forced against the ulnar styloid, generating a shearing force that results in avulsion of ligaments and a dorsal chip fracture of the triquetrum. A second, less common, mechanism is a direct blow to the dorsum of the hand, which causes a transverse fracture through the body of the triquetrum. This is a high energy injury and is frequently associated with injury to other carpal bones. Capitate fracture.