Never Trust a Norwood: Emergency Management of the Sickest Congenital Heart Patients

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Author: Ashley Grigsby, DO, PGY-4
Indiana University
RSA Social Media Committee Member

For many emergency physicians, the scariest patient to come through the doors is the crashing neonate. But make that same neonate a child with congenital heart disease (CHD) and you have a recipe for the so-called, “Code Brown.” One of the most unstable types of CHD is Hypoplastic Left Heart Syndrome (HLHS), a ductal dependent lesion that can be stabilized in the first few weeks of life with intravenous prostaglandins while awaiting surgical management. All patients with HLHS or single ventricle physiology, will require a stage 1 palliative surgery which is usually the Norwood procedure. Norwood patients are, arguably, the sickest of all CHD kids and are the most vulnerable to sudden death, leading many to live by the mantra, “Never trust a Norwood.”

Acute Carpal Tunnel Syndrome in Pediatric Distal Radius Fractures

Authors: Andrew W Phillips, MD MEd and Emily Niu, MD
Stanford University/Kaiser Emergency Medicine Residency Program and
Stanford University Orthopedics Residency Program

Summary points:

• Acute carpal tunnel syndrome complicates up to 9% of distal radius fractures.
• Large displacement increases the probability of developing acute carpal tunnel syndrome. 
• Early carpal tunnel release is associated with improved outcomes.

The common scenario: An adolescent child crashes bicycle and presents with only L wrist pain. He reports mild numbness of his index finger but full sensation and movement are present on physical exam of the entire left hand. Is it a simple splint and follow up with orthopedics in a few days?

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