The Trauma Pro

SEPTEMBER 12, 2023

AAST 2023 Plenary Paper 3. Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture. N Engl J Med 2023; 388:203-213. Bottom line: This is an intriguing abstract, pointing me to the original paper published in NEJM.

Fractures 113

Fractures Head Injuries Research Outcomes 113

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. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Two IVs go in, one in each antecubital fossa.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. 2023 Jan 1;53(1):140-2. 2022; 06/26/2023. 2023 Jun 1;36:89-91. This month in JAAD Case Reports: August 2023: Xylazine and skin necrosis. 2023 Aug 1;89(2):231. 2023 [book].

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

Broome Docs

APRIL 6, 2023

2023 Jan 21. 2023 Feb;64:206.e1-206.e3. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2023 Jan 30. 2023 Jan 13;76(2):185-191. 2023 Feb;30(2):144-146. N Engl J Med. doi: 10.1056/NEJMoa2212663.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7%

Stroke 136

Stroke Outcomes Hospitals Administration 136

Don't Forget the Bubbles

NOVEMBER 13, 2023

Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? Distal forearm fractures are common in children and adolescents, but the best method for diagnosing them is still debatable. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. 2023 Jun 1;388(22):2049-2057.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes. 2023 Nov; doi:10.1016/j.annemergmed.2023.10.008

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. Abstract 2268 Table 1 Rib-fracture Data Set March 2022 – June 2023

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Don't Forget the Bubbles

OCTOBER 19, 2023

Dani gave this talk at the Irish Association of Emergency Medicine Annual Scientific Conference in October 2023 Once upon a time, there were two beautiful people, Barbie and Ken. Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. days compared to 1.50

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

PulmCCM

FEBRUARY 8, 2024

ATS and ESICM each separately issued its own updated ARDS guideline in 2023, and SCCM did not lend its name to either. This looks like the major fracture between the two expert panels. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated.

Research 52

Research Documentation/Coding Fractures Outcomes 52

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 ). Healthcare. Resusc Plus.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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. Accessed October 10, 2023. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Don't Forget the Bubbles

OCTOBER 10, 2024

Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? 2023 Mar 30;110(4):432-438. Children with nail bed injuries were randomly assigned to nail replacement or discarding , with the primary outcomes being secondary infection in 7 days and cosmetic outcome in four months.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Taming the SRU

JANUARY 10, 2024

2768 aka the SAVE act (introduced for the 3rd time 9/12/2023) which establishes a new criminal offense for knowingly assaulting or intimidating hospital personnel during the performance of their official duties in a manner that interferes with their performance of the duties or limits their ability to perform the duties. 2663 & S.1176

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. 2024 Apr 25:archdischild-2023-326533.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

The Skeptics' Guide to EM

APRIL 8, 2023

Date: April 4th, 2023 Reference: Vaughan and Browne. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare. Date: April 4th, 2023 Reference: Vaughan and Browne. BMJ Qual Saf.

Stroke 56

Stroke Emergency Department COPD Academics 56

Taming the SRU

OCTOBER 16, 2024

Patients are unable to actively flex their DIP and x-ray imaging often will reveal and avulsion fracture. X-ray imaging should be obtained to evaluate for avulsion fracture. Major contributing factors for poor outcomes in this patient population (Dalton et.

Airway Management 74

Airway Management Fractures CDC Pediatrics 74

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. 89% of patients with PTX under this cutoff were successfully observed.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

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

PulmCCM

JANUARY 16, 2024

ATS and ESICU each separately issued its own updated ARDS guideline in 2023, and SCCM did not lend its name to either. This looks like the major fracture between the two expert panels. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated.

Research 87

Research Documentation/Coding Outcomes Fractures 87

Taming the SRU

APRIL 22, 2023

Currently, there is limited data investigating outcome differences between beta blockers and calcium channel blockers for atrial fibrillation with rapid ventricular response in a patient diagnosed with heart failure. There were similar lengths of say overall and no significant difference in safety outcomes.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

The Skeptics' Guide to EM

AUGUST 5, 2023

Date: July 10, 2023 Guest Skeptic: Dr. Joe Mullally is a paediatric trainee in the Welsh paediatric training program and interested in Paediatric Emergency Medicine. Date: July 10, 2023 Guest Skeptic: Dr. Joe Mullally is a paediatric trainee in the Welsh paediatric training program and interested in Paediatric Emergency Medicine.

Head Injuries 40

Head Injuries Pediatrics Fractures Outcomes 40

Taming the SRU

AUGUST 30, 2023

Specific Evidence: Septic arthritis: According to the European Journal of Bone and Joint Infection’s 2023 guidelines for septic arthritis of native joints (SANJO), no blood tests have adequate sensitivity or specificity to either diagnose or exclude SANJO. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. 2023 Jul 10.

Infectious Diseases 89

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

Sensible Medicine

MARCH 14, 2024

These suspicions are not baseless as a 2023 Elsevier survey suggests a majority of trainees are struggling to imagine themselves shouldering a career in direct patient care. I’ve heard arguments that frame this discussion in terms of trainee wellness, physician burnout, social contract, and patient outcomes.

Hospitals 100

Hospitals Wellness Fractures Academics 100

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. Significantly, it should be noted that the study does not cover long-term outcomes, including survival. Results: The pooled data showed no statistical difference in survival or neurological outcomes. 2023 [cited 2024 Apr 10].

Administration 49

Administration Pediatrics Outcomes Research 49

Don't Forget the Bubbles

SEPTEMBER 5, 2024

doi: 10.1136/archdischild-2023-326407. Obesity is considered a contributing factor for some musculoskeletal outcomes. A recent systematic review found that children with obesity at school entry are more likely to experience back pain, slipped capital femoral epiphysis or fractures during childhood. 2023 Aug 23;11:1225087.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

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. The most concerning complication of AFT is the pulmonary fat embolism (PFE).

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

PulmCCM

FEBRUARY 12, 2024

Recent studies, though, have shown steroids’ benefit in Covid pneumonia with ARDS, and for steroids improving outcomes in severe community-acquired pneumonia. Then in 2023, ATS and ESICM released separate, conflicting ARDS guidelines: ESICM did not recommend steroids for ARDS in its guidance, while ATS did.

Shock 52

Shock Administration Sepsis Fractures 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 98

EMS Dislocations Fractures Operations 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 64

Fractures Resuscitation Operations EMS 64

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

Taming the SRU

MARCH 11, 2024

Reducing the total ischemic time in patients with vascular injury is the single most important variable in improving outcomes and reducing the risk of amputation; an ischemic time of >8 hours is associated with amputation rates of up to 85%, compared with <20% in those with ischemic time of <8 hours (2). JBJS Reviews. StatPearls.

Dislocations 108

Dislocations Emergency Department Fractures Operations 108

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. Original clinical studies Distribution and pattern of hand fractures in children and adolescents. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 1.

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 105

Stroke Radiology Radiology Emergency Department 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

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