Approach to the Critical Patient

Immediate priorities

Limb-threatening injury screen

Neurologic and compartment screen

Extensor mechanism and open joint screen

Monitoring and targets

Serial vascular assessment

Pain and swelling control targets

Immediate consults

Consultation triggers

History

Mechanism and presentation

Injury mechanism

Cardinal symptoms

Important negatives and clues

Features lowering ACL probability

Associated injury clues

Risk factors

Demographic and intrinsic risk

Activity and modifiable risk

Prior injury and family history

Physical Exam

Inspection and general

Effusion and gait

Neurovascular exam

Ligament provocative tests

ACL-specific maneuvers

Concomitant injury maneuvers

PITFALLS

Acute exam limitations

Missed associated injury

Differential Diagnosis

Cannot-miss and structural injuries

Limb-threatening

Periarticular fractures

Ligament and soft-tissue mimics

Other ligament injuries

Intra-articular and patellar

Laboratory Tests

Indications for laboratory testing

Routine testing

Joint aspiration analysis

Perioperative and inflammatory labs

Preoperative labs when reconstruction planned

Inflammatory markers

Diagnostic Tests

Scoring Systems

Ottawa Knee Rule

ACL Injury Score

KT-1000 arthrometer

MRI

MRI without contrast

CT

CT indications

Ultrasound

Point-of-care ultrasound

Disposition

Discharge pathway

Emergency department discharge

Admission and escalation

Orthopedic consultation in ED

Emergent vascular consultation

Observation or admission

Treatment

Initial ED stabilization

RICE protocol

Immobilization and aspiration

Analgesia

First-line agents

Restricted agents

Definitive management

Shared decision-making

Guideline variation

Timing and reassessment

Perioperative and prophylaxis

DVT prophylaxis after reconstruction

Rehabilitation principles

Special Populations

Pregnancy

Imaging and analgesia adjustments

Geriatric

Older adult considerations

Pediatrics

Skeletally immature considerations

Background

Epidemiology

Incidence and burden

Pathophysiology

Injury mechanics

Consequences and natural history

Therapeutic Considerations

Operative versus nonoperative balance

Prevention as treatment

Bracing role

Patient Discharge Instructions

copy discharge instructions

Knee injury home care

Follow-up plan

Return to ER immediately for

Recovery expectations

References

Guidelines and key sources

Clinical guidelines

Landmark and diagnostic literature

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.