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. 2020; Koulouras et.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

RebelEM

FEBRUARY 24, 2025

just be careful with pelvic fractures or any femoral arterial punctures/ devices. May 2014; PMID: 24495437. There is evidence that pulmonary artery wedge pressures and central venous pressures fail to predict response to volume infusion. 14,15 You might use a passive leg raise, which carries a roughly 250cc fluid challenge.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

RebelEM

AUGUST 30, 2023

New York, NY: McGraw-Hill; 2014 Winters ME, Kluetz P et al. Semin Arthritis Rheum. 2009 Aug; 39(1):10-7. PMID: 18550153 Pruitt CR, Perron AD. Specific Disorders of the Spine. In: Sherman SC eds. Simon’s Emergency Orthopedics. Back Pain Emergencies. Med Clin North Am, 2006 May;90(3):505-23. PMID: 16473102 Zimmerli W. Vertebral Osteomyelitis.

Infectious Diseases 100

Infectious Diseases Fractures Radiology Radiology 100

Dr. Smith's ECG Blog

APRIL 18, 2024

The ECG is just a test: a Bayesian approach to acute coronary occlusion If a patient with a recent femur fracture has sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis, the D-dimer doesn’t matter: the patient’s pre-test likelihood for PE is so high that they need a CT. (THE Circulation 2014 2. Amsterdam et al.

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EKG/ECG Documentation/Coding Fractures Emergency Department 121

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. The Surgeon 2014 Jun;12(3):119-20 6. Shock 2014; 41(2): 130–7 12. 2014; pii: S0022-4804(14)00366-7 13. Ann Vasc Surg 2014; 28(5): 1286–95

Hospitals 52

Hospitals Resuscitation Shock Military 52

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. 2014 Dec;77(6):852-8; discussion 858. Two IVs go in, one in each antecubital fossa. D – here, we have a problem. Pupils are equal and reactive. doi: 10.1097/TA.0000000000000443.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

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. Saunders 2014, Chapter 31 Beaudoin, F. Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures. P., & Liebmann, O.

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

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. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

EMDocs

DECEMBER 19, 2023

Philadelphia: Elsevier Saunders; 2014:805-807. Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Venomous Marine Animals. link] Blohm E, Brush D.

Poisoning 105

Poisoning Seizures Anaphylaxis Burns 105

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. 2014 Feb 11;7(4):251–5. 2014 Mar 15;31(6):531–40. 2014 Jul 3;14(1):1–5. 2014 Mar 15;31(6):531–40. Journal of Emergencies, Trauma, and Shock. J Neurotrauma. Emerg Med J.

Fractures 52

Fractures Hospitals Shock Research 52

RebelEM

MARCH 9, 2023

Prerost 2014) In a patient with chronic alcohol use, hallucinations should prompt consideration of acute intoxication, alcoholic hallucinosis, or delirium tremens (DT). Hamilton 2014) Patients with alcohol intoxication have an extremely high risk of intracranial pathology, and the threshold for obtaining head imaging should be very low.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 CHEST 2010. PMID: 19741062 Kucher N et al. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. PMID: 24226805 Piazza G et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

The Skeptics' Guide to EM

AUGUST 5, 2023

Annals of Emergency Medicine 2014. Annals of Emergency Medicine 2014. Annals of Emergency Medicine 2014. Reference: Easter JS et al. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Reference: Easter JS et al. Reference: Easter JS et al.

Head Injuries 40

Head Injuries Pediatrics Fractures Outcomes 40

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 Jan; 151(1): 127-138. Cuker A, et al. J Am Coll Cardiol. Lu G, et al.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

EM Guide Wire

MAY 19, 2019

2014; 61(5): 923-935. Delayed Identification of Pediatric Abuse-Related Fractures. Petska HW and Sheets LK. Sentinel Injuries Subtle Findings of Physical Abuse. Pediatric Clinics of North America. Ravichandiran N, Schuh S, Bejuk M, et al. PEDIATRICS. 2009; 125 (1): 60-66. Sheets LK, Leach ME, Koszewski IJ, et al.

Pediatrics 40

Pediatrics Soft Tissue Injuries Fractures Emergency Nursing 40

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

million emergency department visits in the US in 2014 [1], with the most significant proportion of visits occurring in the elderly ≥75 (1,682/100,000) [1]. He is not on anticoagulation and there is no history of seizures. Background: Head trauma is an exceedingly common presenting complaint in the emergency department, with approximately 2.5

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

EM Curious

JULY 11, 2015

Given that both lunate and perilunate dislocations are associated with high energy trauma; be vigilant of associated fractures. Do not confuse this diagnosis for a perilunate dislocation where the radiolunate articulation is preserved and the rest of the carpus is displaced dorsally. References: Sherman, S. Emergency Orthopedics 7th Ed.

Dislocations 52

Dislocations Emergency Department Fractures Outcomes 52

The Injectable Orange

APRIL 4, 2017

The x-ray of her left shoulder is negative for any fracture. My newly discovered resource for keeping track of CPD portfolio is this great app from Ausmed Education. The Article Carpenter, C. Avidan, M. Fowler, S. A., & Lo, A. Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review.

Emergency Department 52

Emergency Department Evidence-Based Practice Academics Documentation/Coding 52

PEMBlog

JUNE 5, 2024

2014 May;133(5):e1179-88. 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. Pediatrics. doi: 10.1542/peds.2013-3505.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Don't Forget the Bubbles

SEPTEMBER 30, 2024

examined 977,907 first-time ED presentations by children aged 0-15 across thirteen acute hospital trusts (between April 2014 and March 2017), trying to figure out how many were non-urgent. Critically unwell or injured patients are prioritised, whereas those who are felt to be less unwell wait longer for clinical review. Simpson et al.

Emergency Department 89

Emergency Department Research Pediatrics Hospitals 89

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. Erratum in Mouth-to-Airway [adjunct] 4/22/2014. Still no pain medicine.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

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. 2014 Apr;63(4):460-2. 2014 Aug;49(8):1295-9. A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. Acad Emerg Med.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 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. 2014 Apr;133(4):e1104-16. The initial impact is the greatest, and will vary depending on the child’s height and what part of his body reaches up to the bumper of the car.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Cook County EM Blog

MARCH 20, 2023

X-rays showed radiopaque foreign bodies confined to the distal thumb without fracture. 2014 Jan;22(1):38-45. There were no signs of infection, compartment syndrome, tissue necrosis, or limb ischemia. Orthopedics was consulted and recommended outpatient follow up in several days. Ulus Travma Acil Cerrahi Derg. 2020 Nov;26(6):899-904.

Fractures 52

Fractures Documentation/Coding Operations Research 52

Taming the SRU

AUGUST 30, 2023

According to a 2014 review in the Journal of Rheumatology, PCT may be useful to determine the presence of bacterial infection in patients with rheumatologic disease because it is highly specific for bacterial inflammation, although it lacks sensitivity and should not be used to rule-out bacterial infection. Epub 2014 Dec 3.

Infectious Diseases 89

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

EMDocs

SEPTEMBER 21, 2024

7 See ALiEM for guide on this procedure Always obtain post-reduction imaging to evaluate for any underlying fractures and test for any joint, ligament or tendon injuries PIP dorsal : Apply traction, then hyperextend at the PIP joint while the other hand applies dorsal pressure to the proximal phalanx.

Dislocations 97

Dislocations EMS Fractures Operations 97

ACEP Now

MARCH 11, 2025

A survey that looked at 637 residency programs including pediatric, family, and internal medicine in 2014 found that only 42 programs offered formal training in eating disorders. Musculoskeletal complications include osteopenia with increased risk for long bone fractures.

Emergency Department 83

Emergency Department Psychiatric Dehydration Pediatrics 83

Pediatric Emergency Playbook

JANUARY 1, 2017

Some are simple comfort measures such as splinting (fracture or sprain), applying cold (acute soft tissue injury) or heat (non-traumatic, non-specific pain), or other targeted non-pharmacology. neutropenia) ( Babl 2011 , Dokko 2014 ). Long-bone injuries Fracture pain should be addressed immediately with splinting and analgesia.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

MAY 29, 2023

2014 Oct;43(10):417-20. Identifying serious causes of back pain: cancer, infection, fracture. 2014 Aug;37(2):E4. The Southwest Respiratory and Critical Care Chronicles 2018;6(26):1–6 (6) Litao MK, Kamat D. Erythrocyte sedimentation rate and C-reactive protein: how best to use them in clinical practice. Pediatr Ann. FOCUS14127.

Infectious Diseases 58

Infectious Diseases Emergency Department EMS Hospitals 58

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. 24) Kelts, G.;

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Don't Forget the Bubbles

JULY 17, 2023

Original clinical studies Distribution and pattern of hand fractures in children and adolescents. 2023 Jun 14;46:8-23 One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EMDocs

NOVEMBER 4, 2024

Costochondritis, rib fractures, and pericarditis are common causes of chest pain that can be treated with multimodal regimens. 7 Rib and Sternal Fractures: Rib fractures are often caused by blunt chest trauma. Up to two-thirds of rib fractures are missed on initial chest radiographs. Most cases abate by one year.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

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

Taming the SRU

MAY 23, 2023

fractures of the talar body, talar neck, and calcaneus require high-impact trauma). Stress fractures are caused by repetitive microtrauma and stress on the bone, and therefore present with more subacute or chronic symptoms. Gross deformities often suggest fracture or dislocation. RICE), and symptomatic management (e.g.,

Fractures 57

Fractures Dislocations Operations EMS 57

RebelEM

DECEMBER 18, 2024

2014; 47(6):676-81. Anterior dislocations: palpation of the TMJ can reveal one or both of the condyles to be anteriorly displaced in front of the articular eminence. GorchynskiJ et al. The “syringe” technique: a hands-free approach for the reduction of acute nontraumatictemporomandibulardislocations in the emergency department.

Dislocations 52

Dislocations Fractures Operations EMS 52

PulmCCM

MARCH 7, 2025

hospitals between 2014 and 2017, attention to postoperative practices to hasten recovery (encouraging patients to get out of bed) and reduce infections (removal of urinary catheters) both significantly declined over the weekend. ( Sayers et al (BMC Medicine 2017) concluded weekends did not affect outcomes in hip fracture repair in the U.K.

Outcomes 116

Outcomes Hospitals Operations Radiology 116

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] Bentzon, J.

EKG/ECG 75

EKG/ECG CPR Resuscitation Wellness 75