Arthrocentesis in the Emergency Department Abstract. Acute joint swelling is a common presentation to the emergency department. Although routine investigations like clinical exam, labs and eventually x-ray are usually obtained, definitive diagnosis must be established since timely recognition of septic arthritis in particular is crucial. Definitive diagnosis is achieved by performing an arthrocentesis of the affected joint. While arthrocentesis of larger joints and large effusions (e. g. knee) are relatively easy to perform using the landmark-technique, smaller and less accessible joints (shoulder, elbow, hip) are more difficult to access and it is therefore recommended to use ultrasound guidance. Compared with the landmark-technique, ultrasound-guided arthrocentesis is more successful and less painful. Synovial fluid should be analyzed for cell count with differential, crystals as well as for microbiological analysis such as Gram-stain and culture. Once the diagnosis of septic arthritis has been established, irrigation of the joint should be performed by orthopedic surgery. Antibiotic therapy should be withheld until the sampling of synovial fluid has been completed. After exclusion of septic arthritis, acute arthritis due to crystal arthropathy (CPPD or gout) is treated with either glucocorticoid-infiltration of the joint or with nonsteroidal anti-inflammatory drugs. In this article, the different technical aspects of arthrocentesis are discussed, including asepsis, landmark- and ultrasound-guided access, preanalytics and interpretation of the laboratory results.Onset and management of perianal vein thrombosis Abstract. Acute onset of anal pain is a classic symptom of perianal vein thrombosis. Along with the typical finding of a painful swelling perianal, the diagnosis can be made without further diagnostic measures and the targeted therapy can be initiated. An acute perianal vein thrombosis can be successfully excised within the first 72 hours.Treatment of Skin Abscesses in the Emergency Department Abstract. Skin abscesses are a common cause for presentation in the emergency department and are in most cases treated by incision and drainage. The diagnosis is usually based upon clinical manifestation. If there is uncertainty regarding the presence of an abscess, bedside ultrasonography is suggested to identify the presence, size and location of the abscess. Uncomplicated abscesses less then 5 cm in diameter often can be treated under local or regional anesthesia with or without additional procedural sedation within the emergency department. Sufficient anesthesia and analgesia are essential to avoid undertreatment of the abscess. Certain abscess localizations or conditions require referral to a surgeon and / or operation of the abscess in the operating room. Alternative to the classic incision and drainage the minimal invasive Loop Drainage Technique may be considered. A postoperative systemic antibiotic treatment is only indicated under certain conditions.Treatment of acute injuries of the hand Abstract. Injuries to the hand are a common presentation in primary care units. When accurately assessed, many open injuries may be handled in the emergency department without referral to a hand surgery specialist. We would like to give some recommendations on how to treat the most frequent injuries like lesions to the nail and nailbed, fingertip amputation as well as burns, infections and bites. But first, we highlight the different methods of local anesthesia and discuss the use of a tourniquet or vasoconstriction with adrenalin - WALANT - instead.Primary wound care in children Abstract. Successful wound care of infants and children is facilitated by good preparation and a calm atmosphere. There is not only the child as a patient but also the parents, with their fears and concerns. The physician has to take care of both of them. Parent and child should be informed about the therapeutic intervention appropriately. Reassuring of the child and distraction from the procedure are as important as the treatment itself (e. g. wound stitching or application of wound dressing). Topical anesthesia with LET Gel (lidocain, epinephrine, tetracaine), non-stinging methods to clean the wound (NaCl 0,9 % / Polyhexanid (Prontosan®) soaked swabs) and intranasal application of fentanyl / dormicum can be used to avoid fear and pain. Sedation is used deliberately in small children for wound care. Laceration wounds, mainly those affecting the scalp, chin or forehead can be treated in the emergency room without general anesthesia. Extensive wounds, burns and animal bites often require wound care under anesthesia in children.Urologic Emergencies Paraphimosis Abstract. Paraphimosis presents a rare but acute urological emergency whereby the foreskin becomes entrapped behind the coronary sulcus of the penis. Therapy is quick and feasible, even in an outpatient setting. In most cases compression of the preputial edema and subsequent reposition of the prepuce is sufficient. Rarely, surgical intervention in form of a dorsal incision of the constriction is required. With partial or full phimosis being the underlying condition, paraphimosis occurs predominantly in infants and toddlers. However, persistent or secondary phimosis can lead to paraphimosis in advanced age.Ingrown toenails Abstract. Ingrown toenails are the most common foot problems in primary care. Untreated or mistreated ingrown toenails will lead to unacceptable long suffering of the patient with negative impact on their daily life. Still there is no consensus reached for best treatment and usually the surgical options are the last solution. One reason might be the high variety in conservative und surgical treatment. But also, the high recurrence rates after surgery with up to 30 % described in literature.  https://www.selleckchem.com/products/atglistatin.html  We think, that these high numbers might be also a sign for improper performed surgery. In this article we would like to give you a step by step pathway in a minimal invasive partial nail avulsion with partial matricectomy, which we perform since several years in our clinic. We are convinced of the cosmetical, functional and long-term results of this procedure.