ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Joint dislocations are time-sensitive ED emergencies where early analgesia, muscle relaxation, and a documented neurovascular exam matter more than brute force. Shoulder, hip, elbow, patellar, and finger dislocations each carry distinct vascular, nerve, and fracture pitfalls. Separately, representation and community connection can materially shape how emergency physicians practice and lead.
Emergency Medicine Career and Identity
- Unconventional path to medicine: An NFL roster spot delayed medical school, but the through-line was disciplined progression toward emergency medicine rather than a reinvention of identity.
- Representation at the bedside: Appearance-based role assumptions remain a real barrier for Black physicians, and Towns makes the point that visible representation can change trust and connection in acute care.
- Community-rooted emergency practice: Practicing in the same Birmingham community where he grew up turns routine ED work into longitudinal service, with empathy shaped by shared history and familiarity.
- Emotional tone in the department: Emergency physicians set the emotional climate of the shift, and a consistently positive stance can counter cynicism while improving the work environment for teams and learners.
- Sports medicine fellowship value: Sports medicine added professional variety and better work-life balance after residency, a practical anti-burnout angle we get into in the episode.
ED Dislocation Reduction Pearls
- Neurovascular exam before and after: Every dislocation needs documented pulses, capillary refill, motor function, and sensation before and after reduction because interval change is a complication signal, not paperwork.
- Relaxation over brute force: Successful reductions depend more on analgesia, positioning, and muscle relaxation than traction strength; if you are sweating and pulling harder, the technique is probably wrong.
- Two-attempt escalation point: After two failed reduction attempts with appropriate analgesia or sedation, rethink the diagnosis, look for associated injury, and involve orthopedics early.
- Imaging exceptions and confirmation: Most dislocations get pre-reduction radiographs, but recurrent anterior shoulder dislocations with classic low-energy presentations may be reduced first. We walk through the exceptions in the chapter.
- Post-reduction priorities: Reduction is not the endpoint: immobilize appropriately, confirm alignment on imaging, and decide who needs urgent orthopedic involvement versus close follow-up.
Shoulder, Hip, Elbow, Patella, Digits
- Anterior shoulder injury pattern: Anterior dislocations make up about 95% of shoulder dislocations, and the axillary nerve is the key associated injury, checked by sensation over the lateral deltoid.
- Posterior shoulder red flags: Think posterior shoulder dislocation after seizures, shock, or a direct strike, and remember it is commonly missed on initial radiographs because standard views can be deceptive.
- Intra-articular lidocaine option: For many anterior shoulder reductions, intra-articular 1% lidocaine offers similar success to procedural sedation with faster discharge and less resource use.
- Hip dislocation time risk: Native hip dislocation is a true orthopedic emergency because avascular necrosis risk rises substantially after six hours, making early sedation planning and reduction a priority.
- Terrible triad and hidden injuries: Elbow dislocation with radial head and coronoid fractures is the terrible triad, while patellar osteochondral injury and volar PIP central slip injury are easy misses. We cover the bedside pitfalls on the show.
Subscribe to ERcast: Clinical Perspectives to listen to the episode.
References:
- Cayllahua Curiñaupa AJ, Rojas Palma YS, Cajachagua Castro M, Huancahuire-Vega S. Attitude toward teamwork and work engagement as predictors of job satisfaction in nurses: a cross-sectional study. BMC Nurs. 2025;24(1):791. Published 2025 Jul 1. PMID: 40598017
Faculty
- Anne Steckowych, APRN
Emergency medicine is in Anne’s blood; her father has been an Emergency Medicine physician for the last 30 years. After earning her nursing degree from the University of New Hampshire (UNH) in 2018, Anne worked as an EMT at her local fire department, gaining practical experience that prepared her for five years as a nurse in the emergency department. She eventually returned to UNH to become an NP and has spent the last 8 years in the same ED, building relationships with a clinical team dedicated to providing the best possible patient care. Outside of the hospital, she’s usually skiing, hiking, or running in the New Hampshire hills. ERcast is her first podcast, and she’s thrilled to be part of the Hippo team.
- Brett Murray, MD
Dr. Murray is an Emergency Medicine physician practicing at a busy community trauma center. After attending Boston University School of Medicine, he completed his residency training at Brown University / Rhode Island Hospital, where he also served as Chief Resident from 2020 – 2021. His clinical interests center on medical education, performance science, and Emergency Medical Services.
- Jeremy Driscoll, MD
Dr. Driscoll is a board-certified in Emergency Medicine physician that practices in Scottsdale, Arizona. He graduated from the University of Arizona with a degree in Molecular & Cellular Biology, graduating Summa Cum Laude and Phi Beta Kappa honors. Dr. Driscoll attended medical school at the University of Central Florida in Orlando, where he was inducted into Alpha Omega Alpha Medical Honor Society. He completed his training in Emergency Medicine at Carolinas Medical Center in Charlotte, North Carolina. Dr. Driscoll also serves as a Clinical Instructor of Emergency Medicine at the University of Arizona College of Medicine - Phoenix.
- Matthew Hall, CRNP
Matthew started his career as an ER nurse and part-time flight nurse at the University of Alabama at Birmingham. After graduating from NP school, he continued in the Department of Emergency Medicine at UAB as an NP, eventually serving as the clinical educator for the APP team. Matthew joined Hippo as a medical editor for ERcast in 2023 and, in 2025, moved into the role of clinical manager and senior editor. He lives in a small town outside of Birmingham, Alabama, with his wife, two children, three dogs, and a small flock of chickens.
- Jeremy Towns, MD
