Northwestern EM Blog

MARCH 1, 2025

Absolute contraindications of prone positioning are severely increased intracranial pressure as positioning of the head in prone position can partially obstruct cerebral venous drainage, as well as unstable spinal fractures because the manipulation while repositioning a patient may lead to further injury (Guerin et. 2013; Mi et.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

The Skeptics' Guide to EM

DECEMBER 30, 2023

While your ED evaluation, computed tomography (CT) imaging of her head and spine demonstrated no traumatic injury and an x-ray of her pelvis showed no fracture or dislocation, she was unable to bear weight due to her hip pain, so you ordered a CT to further evaluate for occult fracture.

Hospitals 111

Hospitals Emergency Department Fractures Dislocations 111

RebelEM

FEBRUARY 24, 2025

just be careful with pelvic fractures or any femoral arterial punctures/ devices. July 2013; PMID: 23774337 Cavallaro, F et al: Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Oct 2013; PMID: 24079262 Gohar E, et al.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

AUGUST 12, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. April 9, 2013. Open Fracture. Medicine (Baltimore). 2019;98(44):e17823. doi:10.1097/MD.0000000000017823 0000000000017823 Rosskopf AB, Martinoli C, Sconfienza LM, et al. Sonography of tendon pathology in the hand and wrist. J Ultrason. 2021;21(87):e306-e317.

EMS 96

EMS Fractures Operations Ultrasounds 96

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Soft Tissue Injuries 154

Soft Tissue Injuries Dehydration Fractures Operations 154

Don't Forget the Bubbles

JUNE 30, 2023

She has a right parietal-occipital region haematoma, and you think you might be able to feel a step – you’re pretty convinced she has a palpable skull fracture. CRASH 2 , published in 2013 – was huge. 2013 Mar;17(10):1-79. Two IVs go in, one in each antecubital fossa. D – here, we have a problem.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. 2013 Jan;31(1):222-6. You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

EMDocs

OCTOBER 9, 2023

12 Weight gain (up to 70%), development of cataracts (up to 15%), fractures (up to 12%), and neuropsychiatric events (up to 10%) are the most common adverse events. Consider the other complications of systemic steroids: weight gain, cataracts, fractures, and neuropsychiatric events. Published 2013 Aug 15. 2013;9(1):30.

Basic Life Support 109

Basic Life Support CPR Fractures Emergency Department 109

Taming the SRU

JULY 25, 2024

Indication - skeletally mature patients with a radiographically documented femur fracture (hip to knee) Contraindications: Patient refusal Allergy to local anesthetic Infection over site of planned injection Obtunded/uncooperative patient Crush injury No available provider or space Medication: 0.5% for obstructive CAD, OR 1.8

Stroke 98

Stroke Fractures Operations Outcomes 98

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

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

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. J Trauma Acute Care Surg 2013; 75(3): 506–11 5. J Trauma Acute Care Surg 2013; 75(1): 122–8 11. 2011 Dec;71(6):1869-72 (full article free text) 2.

Hospitals 52

Hospitals Resuscitation Shock Military 52

Don't Forget the Bubbles

OCTOBER 19, 2023

An x-ray confirms a toddler’s fracture. You have four options: Above knee cast Below knee cast Boot Nothing Our approach to managing toddler’s fractures mostly comes from retrospective case studies and only two small prospective case series. Toddler’s fractures heal quickly, with excellent outcomes. But what will you do?

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

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. 2013 May 13;30(6):516–6. 2013 Jul 19;30(8):679–82. 2013 Dec 22;31(1):86–6. Elsevier Ltd; 2013 Jan 1;44(1):122–7. 2013 Dec 1;30(12):1067–9. 2013 May 23. J Emerg Med.

Fractures 52

Fractures Hospitals Shock Research 52

PHEM Cast

JULY 27, 2021

Crit Care Med 2013; 41: 1774-81. Kenji Inaba. 2015 Marik PE, Cavallazzi R. Does central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Cavallaro F, Sandroni C, Marano C, et al.

Ultrasounds 52

Ultrasounds Fractures Resuscitation EMS 52

Taming the SRU

FEBRUARY 12, 2024

CT HEAD Bilateral hemorrhagic contusions, left subdural hematoma with mass effect, scattered subarachnoid hemorrhage, occipital bone fracture and venous thrombosis adjacent to fracture site. Notable diagnostics Point-of-care glucose (initial): 274 PT/INR: 47.4/4.9 Rivaroxaban and the EINSTEIN clinical trial programme. Cohen, AT et al.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

EM Curious

JULY 24, 2015

It's a bit of a departure from what we've described above--he mainly goes right at a shaft fracture--but it's the same general idea: As always, these posts are for EDUCATIONAL PURPOSES ONLY. Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures. Do your research, and always be safe. Saunders 2014, Chapter 31 Beaudoin, F.

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. PMID: 23102885 Aykan AC et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

EMDocs

JULY 11, 2023

A 2013 study found oral mucosal and head bleeding due to injury were most common in those < 6 months. Fractures and dislocations are indications for full dose factor replacement. 2013 Dec;163(6):1781-3. Other presenting bleeds were post-circumcision (27%) and heel-stick bleeds (17%). What medications should be avoided?

Head Injuries 75

Head Injuries Pediatrics Dislocations CDC 75

EM Guide Wire

MAY 19, 2019

Delayed Identification of Pediatric Abuse-Related Fractures. 2013; 131(4): 701-107. Ravichandiran N, Schuh S, Bejuk M, et al. PEDIATRICS. 2009; 125 (1): 60-66. Sheets LK, Leach ME, Koszewski IJ, et al. Sentinel Injuries in Infants Evaluate for Child Physical Abuse. PEDIATRICS. Teeuw AH, Derkx BHF, Koster WA, et al.

Pediatrics 40

Pediatrics Soft Tissue Injuries Fractures Emergency Nursing 40

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

Mind The Bleep

NOVEMBER 6, 2023

Importance: the medial wall is thin and most easily fractured. Accessed on 14.09.22 <[link] Kanski and Bowling (2013) Synopsis of Clinical Ophthalmology, Third Edition Kaur et al. 2013) Traumatic Eye Injury Management Principles for the Prehospital Setting. This is commonly seen in open globe injury. Serrano et al.

Emergency Department 52

Emergency Department Dislocations Burns Fractures 52

Northwestern EM Blog

APRIL 25, 2022

X - ray : Many times, next step will be to get an X-ray to look for associated fractures. Figure 4: Traumatic arthrotomy on CT scan Source: Konda et al, 2013 Saline Load Test (SLT): Though not strongly backed by the literature, SLT is a standard tool used to assess for traumatic arthrotomy. CT is painless.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

PEMBlog

JUNE 5, 2024

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. Axial load can cause burst fracture, so someone that dives into a pool.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Don't Forget the Bubbles

SEPTEMBER 30, 2024

conducted over three years (2013-2015) in Florida, found that younger children and those arriving in the evening or overnight had higher rates of “Did Not Wait” cases. Gaucher et al. found that children arriving in the evening and those aged between 3 months and 11 years were likelier to leave without being seen.

Emergency Department 89

Emergency Department Research Pediatrics Hospitals 89

Taming the SRU

JANUARY 1, 2024

Contraindications to placing an IO include a prior attempt at the same site, known orthopedic fracture or local hardware, overlying skin infection, and structural bone disease such as osteogenesis imperfecta (6). 2013 Jul;30(7):521–6. Egan G, Healy D, O’Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Emerg Med J. Presley B, Isenberg JD.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

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

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Depending on the height of the child and the height of the car, the initial impact will cause a femur fracture, a pelvic fracture, or direct abdominal trauma. 2013 Sep;184(1):352-7. 2013 Jun;48(6):1377-83. Holscher CM, Faulk LW, Moore EE, Cothren Burlew C, Moore HB, Stewart CL, Pieracci FM, Barnett CC, Bensard DD.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 89

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

Pediatric Emergency Playbook

MARCH 1, 2016

He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. Rib fractures on CXR predict pulmonary contusions. 2013 Sep;184(1):352-7. 2013 Nov;206(5):655-60. 2013 Jun;48(6):1377-83. On arrival, he was in compensated shock, with tachycardia. J Surg Res. J Pediatr Surg.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 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 98

EMS Dislocations Fractures Operations 98

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. 10/20/2013. Still no pain medicine. There is also FOANed for Nursing.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Rural Doctors Net

AUGUST 30, 2013

Pull straight any fractures & splint them. Whilst we’ve ‘re-discovered’ balanced resuscitation (first described by Cannon back after WWI), there remains some limited controversy – listen to this 2013 take from Simon Carley at St. Wrap the pelvis – use a proper binder if there is ANY concern re: a pelvic injury.

Burns 52

Burns Hospitals Ambulance Services Wellness 52

EMDocs

FEBRUARY 22, 2025

Answer : CSF Leak Epidemiology: CSF leaks are broken into three main causes Craniofacial trauma: approximately 80% of cases 1 3% of blunt head and 9% of penetrating head trauma patients have CSF leaks Basilar skull fractures commonly occur with CSF leaks (up to 30%) Iatrogenic: approximately 16% of cases 1 3.8% 2013 Mar;40(2):144-57.

EMS 67

EMS Fractures Operations Wellness 67

ACEP Now

MARCH 11, 2025

Musculoskeletal complications include osteopenia with increased risk for long bone fractures. Gastrointestinal complications include gastric perforation because of acute gastric dilatation impeding venous return leading to necrosis, esophageal rupture, pancreatitis, and superior mesenteric artery syndrome. Int J Eat Disorder.,

Emergency Department 83

Emergency Department Psychiatric Dehydration Pediatrics 83

Pediatric EM Morsels

SEPTEMBER 1, 2023

For a 16-year-old girl who presents to the ED with a forearm fracture, asking confidentially about the home environment can help us differentiate an accidental vs. assault If we don’t ask, we won’t know Education Bullying is a known risk factor for suicide [Borowsky 2013] A child NOT enrolled in school is another red flag for human trafficking.

Pediatrics 164

Pediatrics Emergency Department Fractures EMS 164

EMDocs

JUNE 21, 2023

Labs do not play a significant role Imaging X-ray : Start with plain films to look for fracture near laceration, intra-articular free air, radiopaque foreign body. A 2013 study found a sensitivity of ~47% for TA of the knee using plain radiographs. 2013 Sep;27(9):509-14. While suggestive of TA, not sensitive or specific.

Soft Tissue Injuries 96

Soft Tissue Injuries Fractures Dislocations Radiology 96