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. As children, we were often the ones who did not play well with others.

Leadership 128

Leadership Fractures Wellness 128

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. 89% of patients with PTX under this cutoff were successfully observed.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

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Resuscitation Administration Emergency Department Ultrasounds 105

ACEP Now

OCTOBER 30, 2023

Remove all braces, prosthetics, and clothing, check the undersurfaces and intertriginous areas, look for bruising or fractures, evaluate all indwelling devices (tracheostomy sites, gastrostomy-jejunostomy tubes, foleys, peripherally-inserted central catheter lines and ports), and inspect nail beds, ears, and teeth. Accessed October 10, 2023.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Intensive Care Med 2020. [13] Intensive Care Med 2020. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

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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]. McGraw Hill, 2020. Complications : injuries to assess for when evaluating a patient with suspected traumatic iritis. High risk of re-bleeding and vision loss [7].

EMS 96

EMS Allergic Reactions Poisoning Emergency Department 96

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.

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Fractures Research Wellness 40

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. Therefore, both of these should be important considerations as well when evaluating swollen ears in the emergency department. A) on LEFT: Auricular hematoma with overlying tattoos.

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Emergency Department Pediatrics Wellness Fractures 94

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). 2020 Aug;76(2):134–42. IO kit (image left - courtesy of wiki commons under CC attribution SA 4.0 Ann Emerg Med.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

ACEP Now

MAY 6, 2023

million ED visits for injuries from motor vehicle accidents (MVAs) in 2020. Vehicle occupants wearing seatbelts may sustain injury to the cervical spine as a result of abrupt deceleration as well as blunt trauma to the chest, abdomen, and pelvis. Clavicular and humeral fractures are more common in passengers than in drivers.

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology. 4, 2020, pp.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

PEMBlog

SEPTEMBER 13, 2023

This harm can manifest through the discomfort of blood draws and urine catheterizations, as well as the radiation exposure involved in head CT scans. Fever First, is there a fever in a previously well child between the ages of 6 months and 5 years? Occult trauma Any trauma that is not seen on your physical (e.g. 2000; 55(5):616-623.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

Dr. Smith's ECG Blog

JULY 3, 2020

She had multiple rib fractures as well as serious hemorrhage and underwent massive transfusion. It presents on the ECG as a long ST segment with resultant long QT == MY Comment by K EN G RAUER, MD ( 7/3/2020 ): == The patient in today’s case is a middle-aged woman who was brought to the ED following a motor vehicle accident.

Blood Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Pneumonia A 2020 meta-analysis of 8 studies including 2,215 adults with confirmed community acquired pneumonia in different settings found PCT with a cutoff of 0.5 2020 Nov 20;99(47):e23315. J Med Virol. 2021; 93: 4358–4369.

Infectious Diseases 89

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

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. Fluids and Barriers of the CNS.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. Microdosing Methods Help, 2020. J Addict Med.

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Emergency Department Operations Psychiatric Hospitals 64

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

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%. As well as nonpharmacological treatments included physiotherapy and psychological therapy, 79% were also prescribed medication, most commonly gabapentin. Published 2020 Nov 20. More recently, Mesaroli et al.

Psychiatric 98

Psychiatric Pediatrics Outcomes Fractures 98

EMDocs

JULY 3, 2023

3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck. All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient.

Seizures 98

Seizures Stroke Outcomes EMS 98

Northwestern EM Blog

JANUARY 3, 2022

climbing stairs) Diagnosis: Anterior patella tenderness; pain with patellar grind test , deep knee flexion EM differential: meniscus injury, stress fracture, ligamentous injury Initial treatment: home exercise program or formal physical therapy to strengthen quadriceps, core, and hip abductors.

Fractures 52

Fractures EMS Urgent Care Stroke 52

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. Seven provided individual participant data (1728 children between 12-71 months) for the IPD meta-analysis.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. 23 BCVI should be suspected with any high-energy trauma or any fractures of the maxilla or mandible.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Don't Forget the Bubbles

JULY 17, 2023

Original clinical studies Distribution and pattern of hand fractures in children and adolescents. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. Trends in Reasons for Human Papillomavirus Vaccine Hesitancy: 2010-2020. McClellan JM, et al. JAMA Pediatr. Arneitz C, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Dr. Smith's ECG Blog

JANUARY 21, 2023

CT head showed traumatic SAH and small SDH with a traumatic occipital fracture. Internat J Arrhyth 2020 Uesako H, Fukikawa H, Hashimoto S, et al. El-Baba, Dell and McLaren to be intriguing for a series of important concepts that it raises — as well as for a number of equally intriguing unanswered questions. What happened first?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

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

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

Digital Detox and Well-Being. 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. Catassi G, et al. Eur J Pediatr. Marciano L, 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. This is particularly crucial in younger children who have received a large adult kidney and typically have relatively low creatinine levels when stable and well. Kidney transplant recipients are at higher risk of rickets and fractures. (13) Any history of injury?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

Feel: Palpate the area of the bite to feel for areas of tenderness as this could indicate a fracture or infection. There should be a minimum of 2 views in the plain film, or 3 in the hands if there is a suspicion of a fracture. Comorbidities Diabetes and immunosuppression increase infection risk and severity 11. Regular medications.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

PulmCCM

MARCH 7, 2025

The Weekend Effect in Other Countries The weekend effect has been observed in multinational studies as well. Liu et al JAMA Surgery 2020 ) Hospitals with lower adherence rates had more overworked nurses. Sayers et al (BMC Medicine 2017) concluded weekends did not affect outcomes in hip fracture repair in the U.K.

Hospitals 116

Hospitals Outcomes Operations Radiology 116

Don't Forget the Bubbles

NOVEMBER 6, 2024

Digital Detox and Well-Being. 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. Catassi G, et al. Eur J Pediatr. Marciano L, et al.

Pediatrics 59

Pediatrics Sepsis Fractures Hospitals 59