ACEP Now

MARCH 15, 2024

3 Tenderness over the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite normal plain radiographs and fluoroscopic images. Children and older adults have weaker long bones than young adults and are more likely to sustain a distal radius fracture after a FOOSH than a carpal bone injury.

Fractures 52

Fractures Dislocations EMS Emergency Department 52

Mind The Bleep

NOVEMBER 6, 2023

In this injury, there is a fracture of the orbital floor and the inferior orbital rim remains intact. The “teardrop sign” is a radiological sign of inferior orbital wall fractures in which intraorbital fat +/- inferior rectus muscle herniates through the fracture. Teardrop sign (inferior orbital wall fracture).

Fractures 52

Fractures Radiology Radiology Emergency Department 52

RebelEM

MAY 25, 2023

Pelvic Fracture A score ≥2 present, consider MTP Clinical Take Home Point: Use of balanced transfusion (including PRBCs and clotting factors) helps avoid dilutional coagulopathy WHOLE BLOOD VS COMPONENT THERAPY Kronstedt S et al. Shock 2012. PMID: 31461138 Brotfain E et al. PMID: 23143053 Spaite DW, Hu C, Bobrow BJ, et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

AUGUST 30, 2023

New Delhi: JP Brothers Medical Ltd; 2012 Della-Guistina, D. J Spinal Disord Tech. 2015 Jul;28(6):E316-27 PMID: 26079841 Chowdhury V, Gupta A, Khandelwal N. Diagnostic Radiology: Musculoskeletal and Breast Imaging. Evaluation and Treatment of Acute Back Pain in the Emergency Department. Orthopedic Emergencies 2015 May; 33(2) 311-26.

Infectious Diseases 88

Infectious Diseases Fractures Radiology Radiology 88

ALiEM

SEPTEMBER 13, 2024

Laboratory Data CT Orbits/Sella w/ IV Contrast : No acute orbital fracture. 2012 Feb;26(2):212-7. Visual acuity: able to count fingers. Extraocular movements intact. Ocular pressure deferred. 1 mm superior eyelid laceration. No evidence of retrobulbar hematoma or emphysema. Intraconal and extraconal fat planes are preserved.

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

Downeast Emergency Medicine

FEBRUARY 9, 2022

He had an operative repair of his patellar fracture 10 days after his initial visit. ULTRASOUND PEARLS This case highlights an excellent use of musculoskeletal ultrasound for the diagnosis of patellar fracture. ULTRASOUND PEARLS This case highlights an excellent use of musculoskeletal ultrasound for the diagnosis of patellar fracture.

Ultrasounds 52

Ultrasounds Fractures Operations Emergency Department 52

Pediatric Emergency Playbook

NOVEMBER 1, 2016

Pediatric Elbow Films: Putting It All Together Watch this dynamic video by Dr Jeremy Jone s from Radiopaedia : Fracture Saviors: Fat Pads and Drawn Lines These three things can save us: fat pads, the anterior humeral line, and the radiocapitellar line. If not, assume a fracture-dislocation.

Pediatrics 52

Pediatrics Fractures Dislocations Radiology 52

RebelEM

APRIL 29, 2024

2012 PMID: 21893125. Additional sites such as the sternal, iliac crest, distal femur, and distal tibia have also been utilized, and the use of these alternative sites should be considered based on the clinical presentation. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

DECEMBER 17, 2022

EMS have already splinted an obvious mid-shaft femoral fracture, but he continues to be tachycardic and hypotensive. Background: Major trauma in older patients is increasing in frequency (1), with the median age of major trauma patients in the UK from 2012-2017 being 63.6 years ( 2 ).

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

The Skeptics' Guide to EM

AUGUST 17, 2019

Case: You are taking care of a 56-year-old woman who presented to the emergency department with a Jones fracture. Pain 2012). ACEP has a clinical policy regarding prescribing of opioids for adult ED patients that was published in 2012 ( Cantrill et al ). Corey Heitz is an emergency physician in Roanoke, Virginia.

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

EM Guide Wire

MAY 19, 2019

May 1, 2012. Delayed Identification of Pediatric Abuse-Related Fractures. 2012; 171: 877-885. ​ ACEP Now. The Recognition of Child Abuse. Colbourne M, Clarke MS. Child Abuse and Neglect. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. PEDIATRICS. 2009; 125 (1): 60-66. PEDIATRICS.

Pediatrics 40

Pediatrics Soft Tissue Injuries Fractures Emergency Nursing 40

ETM Course

JUNE 28, 2015

Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. Morrison et al Aortic Balloon Occlusion Is Effective in Controlling Pelvic Hemorrhage J Surg Res 2012; 177(2): 341–7 9. Martinelli et al. Norii, Crandall, Terasaka.

Hospitals 52

Hospitals Resuscitation Shock Military 52

The Skeptics' Guide to EM

APRIL 8, 2023

John Brown PhD is a Professor of Health Services Research in Ireland who has been studying rural healthcare issues since 2012. The pre-specified subgroup analyses showed a decrease in in-hospital or 30-day mortality for myocardial infarction, stroke, aortic aneurysm, and major trauma but not for pneumonia, bowel perforation or hip fractures.

Stroke 56

Stroke Emergency Department COPD Academics 56

PHEM Cast

JULY 14, 2016

An injury involving only the anterior column is considered to be stable, as will an isolated fracture of a spinous or transverse process. 2012 May;37(11):937–42. Posterior column: facet joints, ligamentum flavum, the spinous processes and the interconnecting ligaments. Emergency Medicine Journal. 2013 Jul 19;30(8):679–82.

Fractures 52

Fractures Hospitals Shock Research 52

Don't Forget the Bubbles

SEPTEMBER 30, 2024

A 2011-2012 Australian study by Blake et al. Let’s explore whether there are common factors among those who leave without being seen and whether this is a harmless issue, such as non-urgent cases, or a more concerning problem that may require specific interventions. What is happening internationally?

Emergency Department 89

Emergency Department Research Pediatrics Hospitals 89

PEMBlog

JUNE 5, 2024

2012 Jan 13;61(RR-1):1-20. The most common injuries seen in these younger patients are growth plate fractures and ligamentous injuries. You more often will see vertebral body and arch fractures as opposed to the growth plate fractures and ligamentous injuries in the younger children. MMWR Recomm Rep. PMID: 22237112.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

The Skeptics' Guide to EM

AUGUST 5, 2023

Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013. Annals of Emergency Medicine 2014.

Head Injuries 40

Head Injuries Pediatrics Fractures Outcomes 40

Taming the SRU

FEBRUARY 5, 2024

Pay close attention to the head and cervical spine for evidence of injuries that necessitate imaging, such as midline spinal tenderness and/or signs of basilar skull fracture (Table 3). 2012 Jan 15;85(2):123-32. Assessment of mental status is also critical in the concussed patient. JAMA Pediatr. 2021;175(11):1124–1131.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

Don't Forget the Bubbles

OCTOBER 10, 2024

The study excluded complex nail bed injuries, including those with distal phalanx fractures, germinal matrix injury or pulp lacerations, meaning outcomes are only relevant to simple nail bed injuries. 2012 Aug 15;(8):CD004872. However, in the secondary outcome of parental assessment, nail discard patients had higher median scores.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

In fact, one of my surgeon grandfather's ortho buddies (perhaps with the help of some lunchtime martinis) took a look at the x-rays of my Boxer's Fracture and snapped it back into place without any analgesia or procedural sedation, casted me, and sent me home. Still no pain medicine. Prehospital Emergency Care, 4(4), 285-289. Sakran, J.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

AUGUST 30, 2023

Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I. 2012 Jul 23;2(1):32. Identifying serious causes of back pain: cancer, infection, fracture. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2017 Dec 14;9(6):7204-7218. doi: 10.18632/oncotarget.23208.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Taming the SRU

MARCH 14, 2023

Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing. You read about the patient’s history of VP shunt placement for aqueductal stenosis as a child and decide to order some imaging… What are you going to order? Neuroradiology. 2008) Shprecher, Schwalb, Kurlan.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EB Medicine

MARCH 1, 2019

In terms of radiography, a chest x-ray should be obtained as rib fractures, hemopneumothorax, and mediastinal free air are all things you wouldn't want to miss and are also associated with blunt cardiac injury. Nachi: Perfect, so that sums up treatment, next we have one special circumstance to discuss: sternal fractures.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EMDocs

NOVEMBER 16, 2024

6 Periprosthetic fracture Occurs at an estimated rate of 3.5-4.1%. 5 CT if concern for occult fracture. Periprosthetic Fractures Pain prior to injury may point toward underlying pathology like infection, implant loosening, etc. Unified classification system used to describe periprosthetic hip fractures. 10% of patients.

EMS 94

EMS Dislocations Fractures Operations 94

Don't Forget the Bubbles

AUGUST 2, 2023

We know that fractures are the precipitating event in about 5–14% of cases and surgical procedures in 10–15%. in 2012 of 19 children with CRPS treated with CBT and physical therapy showed that 89% eventually had full symptom resolution. Pain Res Manag 2012; 17:386–90 Harden RN, Oaklander AL, Burton AW, et al. Autoimmun Rev.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

RebelEM

JANUARY 24, 2024

You will notice the squeeze will cause no motion if there is a full rupture/tear, and diminished motion if there is a partial tear Performance Characteristics ( Garras 2012 ) Sensitivity Specificity (+) LR (-) LR 96-100% 93-100% 13.7 Clin Orthop Relat Res 2012; 470(8): 2268-2273. Coll Antropol. 2007; 31:279-284. Bone Joint Surg Am.

Operations 90

Operations Ultrasounds Fractures Outcomes 90

EMDocs

JULY 3, 2023

3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck. 2012 Jun;14(2):84-9. Presentation Traumatic SAH occurs following a direct or indirect traumatic mechanism leading to TBI that allows for bleeding into the subarachnoid space.

Seizures 98

Seizures Stroke Outcomes EMS 98

Pediatric Emergency Playbook

JANUARY 1, 2017

For example, a very anxious caregiver can easily transmit his or her anxiety to the child, which may either inhibit or amplify presentation of symptoms ( Bearden 2012 ). Long-bone injuries Fracture pain should be addressed immediately with splinting and analgesia. 2012 Jul;37(6):680-6. 2013 Dec 12;(12):CD004624. N Engl J Med.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Mind The Bleep

JANUARY 28, 2025

Enquire about any associated trauma such as head injuries and fractures. Investigations Imaging: X-rays : Obtain if there’s suspicion of fractures or foreign bodies. The average age of patients presenting with pretibial lacerations is in the mid-seventies, with a higher incidence in females. (1) fall, bump against an object).

Documentation/Coding 52

Documentation/Coding Head Injuries Fractures Emergency Department 52

EMDocs

NOVEMBER 13, 2023

23 Blunt carotid injury is more likely in patients with at least one of the following: Glasgow Coma Scale (GCS) ≤ 6, fracture of petrous bone, presence of diffuse axonal brain injury, and LeFort II/III fractures. 23 BCVI should be suspected with any high-energy trauma or any fractures of the maxilla or mandible. 21) Romero, J.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Taming the SRU

MAY 22, 2023

Ankle fractures are the third most common fracture in the ED [2] and more than 20,000 patients are seen in the ED for ankle sprains each day [3]. traumatic axial loading with calcaneal fractures, pilons, and vertebral compression fractures) [5]. Gross deformities often suggest fracture or dislocation [Image 2].

Fractures 77

Fractures Dislocations Operations Radiology 77

Dr. Smith's ECG Blog

JANUARY 21, 2023

CT head showed traumatic SAH and small SDH with a traumatic occipital fracture. Europace 2012 Shinde R, Shinde S, Makhale C, Grant P, Sathe S, Durairaj M, Lokhandwala Y, Di Diego J, Antzelevitch C. Given the absence of signs of trauma at the scene and on the patient — How did he sustain an occipital fracture with traumatic SAH?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

EMDocs

SEPTEMBER 9, 2023

Answer : Extensor tendon laceration Epidemiology: Hand extensor injuries make up >25% of orthopedic soft tissue injuries 2, 3 Common in young men in manual labor Dominant hand more likely to be injured 4 2012 study on 86 patients reported 83% men with a mean age of 34.2 Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c

EMS 97

EMS Fractures Soft Tissue Injuries Ultrasounds 97

RebelEM

NOVEMBER 13, 2024

cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e. vancomycin) If significant soft tissue injury, add gram negative coverage like late generation cephalosporin, extended-spectrum penicillin, or aminoglycoside (i.e.

Soft Tissue Injuries 97

Soft Tissue Injuries Fractures EMS 97

Mind The Bleep

JANUARY 24, 2025

Upper limb fractures and dislocations can lead to associated arterial and nerve damage. First aid such as irrigation, tourniquet use, reduction and splinting of fractures/dislocations. Fracture reduction and immobilisation : Fracture and/or dislocation reduction can restore alignment and vascular supply as well as reduce pain.

Dislocations 52

Dislocations Fractures Soft Tissue Injuries Infectious Diseases 52

Taming the SRU

OCTOBER 28, 2024

Potential causes include: -Trauma: Blunt or penetrating thoracic injuries, rib fractures, esophageal rupture (Boerhaave syndrome). 2012 Mar-Apr;11(2):58-63. -SPM is more common in young, healthy individuals, particularly males. Secondary Pneumomediastinum: -Caused by underlying conditions or external factors. Eur J Trauma Emerg Surg.

COPD 79

COPD Pediatrics Emergency Department Ultrasounds 79

Dr. Smith's ECG Blog

MARCH 8, 2025

She sustained a large scalp hematoma along with several rib and vertebral fractures, but with CT scanning of chest/abdomen/pelvis/C-T-L-spine and head, no life threatening injuries were found. A woman in her late 60s presented after a car crash. Her husband was driving and she was a passenger. They were hit at high speed. link] Mostofsky, E.,

EKG/ECG 77

EKG/ECG CPR Resuscitation Wellness 77