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Grand Rounds Recap 8.16.23

Taming the SRU

to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 94
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Episode 14: Thoracotomy

PHEM Cast

Resuscitation; 2011: 1194-1197 pdf Equipment required for resuscitative thoracotomy: Surface anatomy: Appearance of pericardial clot A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out. Guidelines for withholding or termination of resuscitation in prehospital cardiopulmonary arrest.

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"The crowner hath sat on her and finds it Christian burial." [Hamlet]

Advanced Emergency Nursing from AENJ

" [Coroners Society] King Richard I (the Lionheart) needed vast sums of money for the Third Crusade, operation of the kingdom, and for his ransom fro m Duke Leopold of Austria. All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records.

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Impact of Emergency Department Crowding on Lung Protective Ventilation

RebelEM

First ED-based study to evaluate how operational effects such as crowding can affect patient care in the form of LPV Included ARDS criteria relating to the usage of LPV in the ED allowing evaluation as to whether patients with ARDS were more likely to receive LPV settings. 2011 Feb 15; Epub 2010 Aug 27. PMID: 19325480 Gajic O, et al.

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Acute Scrotum

Mind The Bleep

Initial Management (whilst Urology team are on their way) Bloods FBC, U/Es, CRP, Coagulation screen, Blood glucose levels, Blood cultures IV Antibiotics as per Trust guidelines (may be under section for Necrotising fasciitis) Urethral catheter- this will help with monitoring urine output and help identify the urethra during the operation.

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Animal Bites

Mind The Bleep

Document clearly: The location of all wounds Medical photography or drawn labelled diagrams can aid in explaining the exact location. Feel for any swelling/collection/abscess. Move: Assess the range of motion of the surrounding joints to help determine the involvement of adjacent structures. Assess active and passive movement of the joint.

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MI in Children

Pediatric Emergency Playbook

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. Fontan Operation and the Single Ventricle. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. Liu X et al.