The Skeptics' Guide to EM

FEBRUARY 20, 2021

Myth #1: The use of non-selective NSAIDs will cause a nonunion in long bone fractures When bones break, they usually heal with either surgical or non-surgical management. Non-union is defined as “a failure of the fracture-healing process” and occurs in up to 1 in 10 fractures. J Bone Joint Surg Am.

Fractures 52

Fractures Outcomes Hospitals 52

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. Published 2020 Jul 23. Published 2020 Jan 21.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. With this model, there will hopefully be improved patient satisfaction and better outcomes. Published September 16, 2020. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Taming the SRU

JANUARY 10, 2024

Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. Physicians believe the biggest factors contributing to ED violence are a lack of adequate punitive consequences toward the attacker and the absence of adequate protective mechanisms for staff.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). Resuscitation. Resusc Plus.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

JANUARY 30, 2023

Heterogeneity (I 2 ) for the primary outcome was 69%, representing a moderate value. Of particular note, subjective outcomes are particularly prone to bias in an open-label trial. vs. 91.4%; RR 0.93; 95% CI 0.86–1.01, 1.01, I2 = 69%, low certainty) Fewer adverse events occurred in the IAL group compared to the PSA group.

Dislocations 58

Dislocations Emergency Department Outcomes Research 58

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Classically associated with long bone fractures, a PFE may also occur when fat is injected or absorbed into a blood vessel during the reinjection phase of an AFT procedure. Aesthetic Plastic Surgery National Databank Statistics 2020–2021. Accessed March 6, 2024.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Taming the SRU

JANUARY 29, 2024

Notable Diagnostics CBC : unremarkable, BMP : unremarkable X-ray imaging of the left hand, wrist, and forearm: chronic degenerative changes without acute fracture or bony abnormality. Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Systematic Review and Outcomes Analysis. Epub 2020 Nov 25. Epub 2016 Feb 11.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

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. Complications of auricular hematoma drainage include pain, paresthesia, bleeding, infection, poor cosmetic outcome, scar formation, and re-accumulation of hematoma after the procedure.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. 2020 Nov 20;99(47):e23315. Compared to CRP, FC has similar sensitivity but nearly double the specificity [42-43].

Infectious Diseases 89

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

Cook County EM Blog

MARCH 20, 2023

X-rays showed radiopaque foreign bodies confined to the distal thumb without fracture. 2020 Nov;26(6):899-904. Latex paint-gun injuries of the hand: are the outcomes better? There were no signs of infection, compartment syndrome, tissue necrosis, or limb ischemia. Ulus Travma Acil Cerrahi Derg. doi: 10.14744/tjtes.2020.26751.

Fractures 52

Fractures Documentation/Coding Operations Research 52

Pediatric Education

APRIL 16, 2023

The cause is felt to be repetitive overload of the patella, knee and tibial structures, along with potential alignment problems, tight tissue and muscle imbalances, which may cause strain and small avulsion fractures of the tibial tuberosity. The outcomes of cushioning devices such as shoe inserts are inconclusive. J Knee Surg.

Pediatrics 40

Pediatrics Fractures Outcomes EMS 40

PEMBlog

SEPTEMBER 13, 2023

battle sign bruises around the mastoid, raccoon eyes, or other bruising and lacerations) or reported by history – but could be identified (later) with a bleed or fracture on a head CT scan if your index of suspicion is high or the seizure is going well beyond the expected duration and not responding well to antiepileptics.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

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. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Fluids and Barriers of the CNS. Neuroanatomy. Lancet Neurol.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

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

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. Microdosing Methods Help, 2020. 2022 May;14(5). J Addict Med.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

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%. Early management leads to better outcomes. That being said, younger patients tend to have better outcomes with a multidisciplinary team approach leading to remission in approximately 90% of children. Pain Res Manag.

Psychiatric 98

Psychiatric Pediatrics Outcomes Fractures 98

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. 3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck. What are the next steps in the management of this patient?

Seizures 98

Seizures Stroke Outcomes EMS 98

EMDocs

JUNE 3, 2023

How should pelvic fractures be identified in unstable trauma patients? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently. 2 Vertical shear fractures are also unstable.

Fractures 60

Fractures Resuscitation Operations EMS 60

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. 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. Curr Orthop Pract, 31 (5) (2020 Sept), pp.

Soft Tissue Injuries 88

Soft Tissue Injuries Fractures Dislocations Radiology 88

The Skeptics' Guide to EM

JANUARY 30, 2021

2020 Case: A healthy 55-year-old woman was out for a walk and had a FOOSH (fall on outstretched hand) of her dominant arm. The X-ray demonstrates a fracture of the distal radius that is in an acceptable position and does not require a reduction. Reference: George et al. J Bone Joint Surg Am. Reference: George et al.

Fractures 52

Fractures Documentation/Coding Outcomes 52

Don't Forget the Bubbles

JULY 17, 2023

Original clinical studies Distribution and pattern of hand fractures in children and adolescents. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. McClellan JM, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

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]. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED.

Fractures 77

Fractures Dislocations Operations Radiology 77

EMDocs

SEPTEMBER 9, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. Open Fracture. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c 0b013e3182a0148c Zhao W, Wang G, Chen B, et al. Medicine (Baltimore). 2019;98(44):e17823.

EMS 97

EMS Fractures Soft Tissue Injuries Ultrasounds 97

Don't Forget the Bubbles

NOVEMBER 6, 2024

Survival of Infants Born at 22 to 25 Weeks’ Gestation Receiving Care in the NICU: 2020-2022. Palpable signs of skull fractures on physical examination and depressed skull fractures or traumatic brain injuries on CT in children. Pediatrics. Synnes A, et al. Pediatrics. 2024 Oct 1;154(4):e2024067390. Edwards EM, et al.

Pediatrics 52

Pediatrics Sepsis Fractures Hospitals 52

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

Don't Forget the Bubbles

SEPTEMBER 23, 2024

Kidney transplant recipients have a higher risk of fractures. Consider CMV, EBV and BK-polyoma virus infections: Patients are often on prophylaxis for a variable length of time, with differing outcomes. Obesity: Obesity, whether before or after transplant, is linked to worse outcomes. Any history of injury? Aydin, A.M.,

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

PulmCCM

MARCH 7, 2025

Ranganathan et al reviewed the outcomes for 429,691 patients undergoing commonly performed surgeries on Friday or Monday (or Tuesday after a holiday weekend) in multiple hospitals in Ontario, Canada, from 2007 to 2019. Liu et al JAMA Surgery 2020 ) Hospitals with lower adherence rates had more overworked nurses.

Outcomes 116

Outcomes Hospitals Operations Radiology 116

Don't Forget the Bubbles

NOVEMBER 6, 2024

Survival of Infants Born at 22 to 25 Weeks’ Gestation Receiving Care in the NICU: 2020-2022. Palpable signs of skull fractures on physical examination and depressed skull fractures or traumatic brain injuries on CT in children. Pediatrics. Synnes A, et al. Pediatrics. 2024 Oct 1;154(4):e2024067390. Edwards EM, et al.

Pediatrics 59

Pediatrics Sepsis Fractures Hospitals 59