The Skeptics' Guide to EM

AUGUST 24, 2024

Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. He has three left-sided rib fractures on imaging without underlying complications. Background: Rib fractures are a common injury, particularly for those over 65. We have covered rib fractures twice on the SGEM.

Fractures 54

Fractures Emergency Department Ultrasounds Radiology 54

Cook County EM Blog

MAY 26, 2022

Interpretation: Comminuted mildly displaced tongue-type calcaneal fracture. Why it Matters Calcaneus fractures represent 60% of all tarsal bone fractures and are the most diagnosed tarsal bone fractures in emergency medicine. Tongue-type calcaneus fractures: a threat to skin. Am J Emerg Med. 2013 Jul;31(7):1151.e3-4.

Fractures 52

Fractures Soft Tissue Injuries 52

The Trauma Pro

JANUARY 8, 2024

However, it is at odds with a paper published in 2021 from George Washington University. 2021 Nov;49:393-398. They advise that the chest ultrasound should be used alone with caution. Bottom line: This is an interesting and relatively large study. false negative rate. T hese are very disparate numbers. EAST 2024, Podium paper 21.

Ultrasounds 113

Ultrasounds Fractures 113

EB Medicine

NOVEMBER 1, 2021

EMplify – November 2021 Announcements: The EB Medicine app is live and available for free in the Apple Store. and get 20% of all orders at [link] Emergency Department Management of Rib Fractures Author: Patrick Maher, MD Episode Outline: Why rib fractures? Coming to Google Play soon. It is in Beta and your feedback is welcome.

Fractures 52

Fractures Documentation/Coding Operations Emergency Department 52

Pediatric EM Morsels

JUNE 16, 2023

2021) Morel-Lavallee lesion , Orthobullets. 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. 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

Emergency Medicine Journal

SEPTEMBER 25, 2024

Background Forearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block (HB), Bier’s block (BB) and procedural sedation (PS). Results A total of 226 forearm fractures were included.

Fractures 52

Fractures Hospitals 52

JournalFeed

FEBRUARY 13, 2021

It’s the JournalFeed Podcast for the week of Feb 8-12, 2021. We cover a review of syncope scores, use of CTA for GI bleeding, the new ACEP community acquired pneumonia policy, immobilization of pediatric torus fractures of the radius, and the effectiveness of magnesium for migraine headache.

Fractures 52

Fractures Pediatrics 52

EMDocs

AUGUST 12, 2023

McGraw Hill; 2021. November 9, 2021. The value of ultrasound for detecting hand fractures: A meta-analysis. Rosh Review Website Link References: Park CW, Juliano ML, Woodhall D. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023. In: StatPearls.

EMS 95

EMS Fractures Operations Ultrasounds 95

EMDocs

MARCH 9, 2025

A) Factor VIII deficiency B) Hereditary spherocytosis C) Recently reduced closed long bone fracture D) Sickle cell disease Correct answer: D Osteomyelitis is a bacterial infection of the bone typically caused by hematogenous spread of a bloodborne bacteria. C) is seen in 76.3% CRP >1.0 sensitivity of 91.5%, CRP >2.0 Skeletal Radiol.

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. 2021 May;77(5):532-544. Epub 2021 Jan 21. You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. His name is Ben. While waiting, another call comes in. Burgart, A.M. 2020.10.012.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Dr. Smith's ECG Blog

AUGUST 18, 2024

The patient was found to have a fractured lead, which was replaced successfully without complications and with resolution of symptoms. No P wave and no QRS ever follows any of the regular pacing spikes ( a result of the fractured pacing lead ). He did well. Smith: this can usually be seen on chest x-ray.

EKG/ECG 110

EKG/ECG Fractures Burns Wellness 110

EMDocs

DECEMBER 19, 2023

McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. McGraw Hill; 2021. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed August 25, 2022. link] Zafren K, Thurman R, Jones ID. Marine Dermatitis.

Poisoning 105

Poisoning Seizures Anaphylaxis Burns 105

ALiEM

AUGUST 7, 2023

In patients with suspicion of clavicular fracture or dislocation, the presence of dyspnea, stridor, dysphagia, or hoarseness should raise genuine concern for a compressive mediastinal syndrome that may require emergent closed or surgical relocation attempts. View other cases from this Clinical Image Series on ALiEM.

Dislocations 98

Dislocations Academics Fractures Emergency Department 98

Pediatric EM Morsels

JULY 7, 2023

Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ). Epub 2021 Nov 2. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Am J Emerg Med. 2022 Apr;54:328.e3-328.e4.

Dislocations 143

Dislocations Fractures Pediatrics EMS 143

The Skeptics' Guide to EM

MARCH 27, 2021

Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. J Trauma Acute Care Surg.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 40

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

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. Anesth Analg 2021. NEJM 1994. [2] Richards JE et al. PMID: 7935634 Richards JE et al. JAMA Surgery 2019.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

JournalFeed

JANUARY 30, 2021

It’s the JournalFeed Podcast for the week of Jan 25-29, 2021. We cover Project COVERED, interval likelihood ratios for pediatric UA, sepsis workup for infant otitis media, ARREST RCT - ECMO+CPR, and the best immobilization for dancer’s fractures.

Pediatrics 52

Pediatrics CPR Sepsis Fractures 52

JournalFeed

AUGUST 14, 2021

It’s the JournalFeed Podcast for the week of August 9-13, 2021. We cover frequent epinephrine dosing in pediatric arrest, pressors for trauma patients, CAM boot or cast for toddler’s fracture, why PEM physicians are sued, and emergency cricothyrotomy anatomy and angles.

Fractures 52

Fractures Pediatrics 52

JournalFeed

DECEMBER 18, 2021

It’s the JournalFeed Podcast for the week of December 13-17, 2021. We cover ETCO2 and trauma outcomes, ORIF vs cast for adult distal radius fractures, high or low/ 3 or 7 day treatment for pediatric community acquired pneumonia, a new pediatric CAP severity prediction tool, and how emergency physicians are coping with COVID stress.

Fractures 52

Fractures Pediatrics Outcomes 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

PEMBlog

SEPTEMBER 26, 2024

Healing femur fracture C. Infantile Cortical Hyperostosis The child protection team and orthopedics were consulted due to concern for possible healing femur fracture. A healing femur fracture was a strong consideration in this case however there was no healing fracture line and the callus was longer than would be expected.

Fractures 59

Fractures Pediatrics Wellness 59

Taming the SRU

JANUARY 10, 2024

(ACEP, 2022 available at [link] ) In 2020, the Bureau of Labor Statistics found that health care workers make up for more than three quarters of all workplace violence nationwide, and are almost four times more likely to suffer a serious injury from workplace violence than workers in any other workplace setting Rates of violence against healthcare (..)

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

Cook County EM Blog

MARCH 28, 2023

As the patient was also having facial pain and reported multiple episodes of blunt facial trauma over the past months, CT facial bones was completed which demonstrated chronic fracture deformities of the left inferior orbital wall, a communited chronic nasal bone fracture, and confirmed posterior lens dislocation. 2021, [link]

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 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. That letter received no response.

Leadership 127

Leadership Fractures Wellness 127

The Skeptics' Guide to EM

JANUARY 8, 2022

Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. CT scans reveal multiple right sided rib fractures and a hemothorax estimated to measure 500cc with no additional injuries. November 2021.

Fractures 52

Fractures Emergency Department Wellness 52

RebelEM

APRIL 29, 2024

2021 PMID: 34273470 12 Petitpas F et al. Additional sites such as the sternal, iliac crest, distal femur, and distal tibia have also been utilized, and the use of these alternative sites should be considered based on the clinical presentation. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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. 2021 Oct;76:601.e7-601.e11. Epub 2021 Jun 25. 2021 Jun;36(5):392-400. The remainder of the physical examination is unremarkable.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

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]. 2021 Oct 7. Complications : injuries to assess for when evaluating a patient with suspected traumatic iritis. High risk of re-bleeding and vision loss [7]. and John O.

EMS 98

EMS Allergic Reactions Poisoning Emergency Department 98

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. 2021 Aug 1;94:103086. Evaluation for nephrotic syndrome due to viral hepatitis, endocarditis, venous thromboembolism or other cause of chronic lymphedema is reasonable. I am happy to help how I can.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 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%. 2021 Jul 26;:]. 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. 1999;15(3):218–23.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

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 2021 Jun 24. 89% of patients with PTX under this cutoff were successfully observed. Respir Med. 1998;92(5):757-761. Eur Respir J.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

ACEP Now

MAY 6, 2023

Clavicular and humeral fractures are more common in passengers than in drivers. Drivers frequently sustain hand, wrist, and elbow injuries, while passengers rarely have hand fractures. Updated January 4, 2021. The classic “seat belt sign,” if present, may show in which side of the vehicle the patient was seated. 1988;28:498–501.

Forensics 52

Forensics Documentation/Coding Head Injuries Fractures 52

Broome Docs

APRIL 6, 2023

2022 Dec 16:emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

Mind The Bleep

NOVEMBER 6, 2023

Importance: the medial wall is thin and most easily fractured. 2021) Hyphema. 2021) Ocular trauma: acute evaluation, cataract, glaucoma. Bony orbit Seven bones form the lateral and medial walls, orbital roof and floor. Serrano et al. tetracaine or 0.5% Accessed on 27.09.22 < [link] > Lippincott. Moran Core.

Emergency Department 52

Emergency Department Dislocations Burns Fractures 52

Taming the SRU

AUGUST 30, 2023

Despite these results, the 2021 Surviving Sepsis guidelines recommend against using PCT to guide initiation of antimicrobial therapy due to multiple meta-analyses demonstrating no improvement in outcomes using PCT-guided antibiotic therapy [46,54]. 2021; 93: 4358–4369. 2021 Jan;25(1):466-479. Epub 2021 Oct 1. J Med Virol.

Infectious Diseases 89

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

Don't Forget the Bubbles

SEPTEMBER 30, 2024

The 2021 census revealed an 11.8% Which patients Do Not wait? We collected attendance data for the Leicester Royal Infirmary Children’s Emergency Department (LRI CED) for six months, from 1 October 2023 to 31 March 2024. This resulted in a study population of 1,764, giving a “Did Not Wait” (DNW) rate of 5%.

Emergency Department 89

Emergency Department Research Pediatrics Hospitals 89