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. Lancet 2019. PMID: 31461138 Brotfain E et al. PMID: 31623894 Curry N et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Emergency Medicine Journal

NOVEMBER 28, 2023

Background There is a high rate of surgical fixation of displaced Colles’ type distal radial wrist fractures despite fracture manipulation in the ED. Point-of-care ultrasound has been used to guide ED manipulations but its effect on the quality of fracture reduction or subsequent need for surgical fixation is unknown.

Fractures 40

Fractures Ultrasounds Outcomes Research 40

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. 2019 Nov 9;394(10210):1713-1723. Epub 2019 Oct 14. 2019 Nov 9;394(10210):1712. Two IVs go in, one in each antecubital fossa. Pupils are equal and reactive.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

ALiEM

DECEMBER 22, 2023

The patient reported a history of falls resulting in shoulder, rib, and left hip fractures in the past. Occult femur fracture Occult fractures are defined as fractures that cannot be detected by standard radiographic examination until weeks after the injury either due to lack of displacement or limitations of the imaging study.

Fractures 64

Fractures Dislocations Academics Radiology 64

RebelEM

FEBRUARY 24, 2025

just be careful with pelvic fractures or any femoral arterial punctures/ devices. Jan 2019; PMID: 30138573. 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

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

The Skeptics' Guide to EM

NOVEMBER 9, 2019

Date: November 2nd, 2019 Reference: Lee and Yun. Date: November 2nd, 2019 Reference: Lee and Yun. This has included performing lumbar punctures, diagnosing acute abdominal aneurysms, acute heart failure, pediatric fractures, retinal detachments and endotracheal tube placement. Reference: Lee and Yun.

Ultrasounds 52

Ultrasounds Fractures Pediatrics Radiology 52

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

EMDocs

JUNE 25, 2024

Most common traumatic injuries are fractures, TBIs, and thoracic or abdominal injuries. National Burn Repository 2019 Update, Report of data from 2009–2018. link] (2019). Immediate goals are addressing the airway and hemodynamic instability. Always consider trauma and toxic exposure in the burn patient.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

EMDocs

DECEMBER 19, 2023

McGraw Hill; 2019. McGraw Hill; 2019. 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. link] Blohm E, Brush D. Marine Envenomations. link] Yip K.

Poisoning 105

Poisoning Seizures Anaphylaxis Burns 105

The Skeptics' Guide to EM

MARCH 15, 2019

Date: March 12th, 2019 Reference: Gottlieb, Holladay and Peksa. Date: March 12th, 2019 Reference: Gottlieb, Holladay and Peksa. Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med 2018. He hosts a great #FOAMed blog and podcast called TOTAL EM. Ann Emerg Med 2018.

Ultrasounds 52

Ultrasounds Fractures EMS Hospitals 52

Sensible Medicine

NOVEMBER 21, 2023

Like Dr. Järvinen’s piece on the prevention of fractures in older people published here a couple of weeks ago, his submission highlights how difficult it can be to express opinions that challenge mainstream thinking these days. The text of Reede’s lecture and my comment were published in the ACS Bulletin March 2019.

Leadership 126

Leadership Fractures Wellness 126

The Skeptics' Guide to EM

AUGUST 17, 2019

Date: August 9th, 2019 Reference: Daoust et al. AEM August 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: August 9th, 2019 Reference: Daoust et al. AEM August 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: Daoust et al.

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

The Skeptics' Guide to EM

JANUARY 26, 2019

Date: January 22nd , 2019 Reference: Frey et al Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial. Previous studies have demonstrated that only 35% of children presenting to a Canadian pediatric ED with fractures or severe sprains received any analge.

Pediatrics 52

Pediatrics Fractures Research Emergency Department 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

Date: September 10th, 2019 Reference: Fournier et al. Emergency Medicine Journal 2019. Date: September 10th, 2019 Reference: Fournier et al. Emergency Medicine Journal 2019. Adapting the Canadian CT head rule age criteria for mild traumatic brain injury. The CCHR is the most researched CDR in mTBI [3] and ha.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

PHEM Cast

JULY 27, 2021

link] ResusMe bibliography of PH ultrasound papers 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med 2010; 36: 1475-83.

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 Thromb Res. Jun; 127(6): 497-504. Cohen, AT and Bauersachs, R.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

Taming the SRU

OCTOBER 1, 2023

Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. PPV, rib fractures, and decreased GCS were predictive of conservative management failure [23]. Published 2019 Dec 3. doi:10.1155/2019/5271982 Lichtenstein D, Mezière G, Biderman P, Gepner A. Can Respir J. 2019;2019:5271982.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Cook County EM Blog

MARCH 28, 2023

The Case: The patient is a 61-year-old male with non-insulin dependent diabetes, hypertension, coronary artery disease status post CABG in 2019 who presented with blurry vision of the left eye after being hit on the face with a blunt object by his roommate approximately ten days prior to presentation.

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 52

EMDocs

JUNE 8, 2024

Orbital wall fractures: palpate bony structures surrounding the eye, check extra ocular muscle movements to rule out entrapment, obtain CT imaging if suspected [7]. 2019, wikem.org/wiki/Traumatic_iritis. Complications : injuries to assess for when evaluating a patient with suspected traumatic iritis. Review of Optometry , 15 Jan.

EMS 98

EMS Allergic Reactions Poisoning Emergency Department 98

Taming the SRU

NOVEMBER 27, 2023

Before definitive management, X-rays of the affected finger should be considered, especially in cases where there is suspicion for a foreign body or clinical concern for associated fracture, osteomyelitis, or necrotizing soft tissue infection [17]. Similar to complex paronychias, treatment of most felons relies on incision and drainage.

Soft Tissue Injuries 95

Soft Tissue Injuries Emergency Department EMS Fractures 95

The Skeptics' Guide to EM

APRIL 20, 2019

Date: April 17th, 2019 Reference: Little et al. Injury 2019 Guest Skeptic: Alison Armstrong is a Certified Emergency Nurse, Trauma Program Coordinator and TNCC Course Director. This was a special episode of the SGEM done live at the Talk Trauma 2019 Conference help in London, Ontario.

Emergency Nursing 40

Emergency Nursing Sepsis EMS Fractures 40

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%. 2019 Dec;35(12):933-940. Several neurological mechanisms for CRPS have been suggested, including central sensitisation, alteration in the central nervous system (CNS), and small fibre changes. Clin J Pain. doi: 10.1097/AJP.0000000000000759.

Psychiatric 98

Psychiatric Pediatrics Outcomes Fractures 98

EM Guide Wire

MAY 19, 2019

link] Accessed May 15, 2019. Delayed Identification of Pediatric Abuse-Related Fractures. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. Christian CW. The Evaluation of Suspected Child Abuse. PEDIATRICS.

Pediatrics 40

Pediatrics Soft Tissue Injuries Fractures Emergency Nursing 40

Taming the SRU

AUGUST 30, 2023

The 2019 Journal of Arthroplasty practice guidelines to screen for periprosthetic joint infections recommend using ESR at 30mm/hr and CRP at 10mg/L, citing pooled sensitivities and specificities ranging from 75%-86% and 70-72.3%, respectively, for ESR and 88% and 73-74%, respectively, for CRP [32]. 2019 Feb;34(2S):S187-S195.

Infectious Diseases 89

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

Emergency Medicine Journal

SEPTEMBER 27, 2023

The objective was to pilot new and existing measures to capture the perceived needs and expectations of young people attending ED following SH compared with those attending with suspected fractures (SFs). Methods Young people were approached to complete a questionnaire as they arrived in ED and again before they left.

Fractures 40

Fractures Research Wellness 40

Dr. Smith's ECG Blog

JANUARY 13, 2024

If it does not sense a native rhythm (perhaps from lead fracture or displacement), it will attempt to pace at 60 beats per minute, which can cause unnecessary pacing spikes interrupting normal cardiac function. "Failure to sense" occurs when the pacemaker does not recognize native function appropriately, and results in excess pacing spikes.

EKG/ECG 110

EKG/ECG Hospitals Fractures Emergency Department 110

Taming the SRU

NOVEMBER 14, 2023

A thorough trauma history and physical exam should be performed including evaluation for bony fracture in the surrounding structures of the face. Oxford Medical Case Reports, Volume 2019, Issue 9, September 2019, omz091. A) on LEFT: Auricular hematoma with overlying tattoos. Courtesy of wiki commons under CC Attribution 3.0

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

Broome Docs

APRIL 6, 2023

Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. 2019 Nov 1;179(11):1528-1536. Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. 2022 Jul 2;400(10345):39-47. JAMA Intern Med.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

PEMBlog

JUNE 5, 2024

2019 Jul;144(1):e20183221. 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.2018-3221.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

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). 3, 2019, pp. Assessment of mental status is also critical in the concussed patient. Annals of Emergency Medicine , vol. 4, 2020, pp.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

Mind The Bleep

FEBRUARY 12, 2024

Investigations A wound swab should be taken to identify causative pathogen and ensure appropriate antibiotic choice X-rays should be requested if there is a history of trauma to look for fractures, foreign bodies or evidence of osteomyelitis Routine bloods including WCC and CRP can aid diagnosis. 2019 Feb 15;99(4):228-236.

Fractures 52

Fractures 52

Taming the SRU

APRIL 22, 2023

For treatment, the American Heart Association’s 2019 guidelines recommend limiting use of non-dihydropyridiine CCB due to potential for negative inotropic effects. Concomitant atrial fibrillation and heart failure makes treatment more difficult and increases the odds of mortality up to 57% compared to isolated heart failure.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

Don't Forget the Bubbles

OCTOBER 2, 2024

He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. 2019 Mar;20(3S) The Question Which hyperosmolar agent – 3% Hypertonic Saline or Mannitol – is more effective at reducing intracranial pressure (ICP) and increasing cerebral perfusion pressure (CPP) in paediatric traumatic brain injury (TBI)?

Administration 49

Administration Pediatrics Outcomes Research 49

Pediatric Education

MARCH 17, 2024

If there is any concern for significant trauma including potential fracture, the elbow should be stablized and radiographs obtained, before attempting RHS reduction maneuvers. If there is a fracture or it is unclear if there is a fracture, then the elbow should be stabilized and orthopaedics consulted. had 2 relapses, 4.4%

Dislocations 40

Dislocations Fractures Pediatrics Urgent Care 40

Don't Forget the Bubbles

SEPTEMBER 30, 2024

Patients were excluded from the total if it was clearly noted that they had made another appointment (like seeing an out-of-hours GP), had an upcoming outpatient appointment (such as a fracture clinic visit for a known injury), or if the issue had already been resolved (for example, a foreign object removed by the patient or parent while waiting).

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). 2019 May 31;14(5):e0217629. Schindler P, Helfen A, Wildgruber M, Heindel W, Schülke C, Masthoff M. Li Y, editor.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92