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The Evolution Of Penetrating Neck Trauma Management – Part 1

The Trauma Pro

In the old days, we quickly identified the zone of injury and proceeded to the operating room for Zone II injuries. J Trauma 72(3):576-584, 2012. The management of penetrating neck injury is one of those facets in trauma care that has undergone slow but steady progress over the past 40 years of my career.

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EM@3AM: Retroperitoneal Hematoma

EMDocs

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 2012 Aug;43(2):e157-61. For blunt injury to zone III, an alternative method for hemorrhage control should be pursued (e.g., angioembolization). J Emerg Med.

EMS 74
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REBEL Core Cast 94.0 – SBO

RebelEM

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

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Don’t Forget About the IO in the Critically Ill Patient

RebelEM

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. 2012 PMID: 21893125.

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Diagnostics and Therapeutics: Arterial Lines and Invasive Blood Pressure Monitoring

Taming the SRU

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. PMID: 35338337. Keville, M.

Shock 59
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The 85th Bubble Wrap Bristol Royal Children’s ED Journal Club x DFTB

Don't Forget the Bubbles

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Ten thousand children in the UK are operated on a year for fingertip injuries, and 96% of surgeons currently report replacing the nail plate intra-operatively.

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Cardiac Rhythms/ECG Module

Don't Forget the Bubbles

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

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