The Trauma Pro

OCTOBER 31, 2023

Many simple fractures and wounds do not need immediate attention. Contact the trauma medical director, service chief, or hospital administrator and see if they can intervene. Here are some tips: The patient is in the ED and the consultant won’t come in to see the patient. Are they right? Appeal to a higher authority.

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

RebelEM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. Intravenous vs intraosseous adrenaline administration in cardiac arrest: A protocol for systematic review and meta-analysis. Resuscitation. 2012 PMID: 21893125. 9 Zhang W et al. Medicine (Baltimore). PMID: 33350794 10 Meilandt C.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Emergency Medicine Cases

MAY 5, 2020

The post EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors appeared first on Emergency Medicine Cases.

Sepsis 52

Sepsis Pediatrics EMS Fractures 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. The decision was made to proceed with decompressive hemicraniectomy immediately following andexanet alfa administration.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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. Intensive Care Med 2020. [13] Intensive Care Med 2020. PMID: 33048195 Bouzat P et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

JUNE 25, 2024

Most common traumatic injuries are fractures, TBIs, and thoracic or abdominal injuries. For large burns, consider albumin to lower total volume administration and improve urine output. It may interfere with lab tests (obtain labs prior to administration). Immediate goals are addressing the airway and hemodynamic instability.

Burns 92

Burns Fluid Resuscitation Resuscitation Poisoning 92

Taming the SRU

JANUARY 1, 2024

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. IOs can be used both for resuscitation, medication administration, and for laboratory testing, but there are a few important considerations. 2016 Dec 14;20(1):102. Li Y, editor.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. Clin Exp Emerg Med 2023. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 133

Stroke Outcomes Hospitals Administration 133

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. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). Pupils are equal and reactive.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Don't Forget the Bubbles

DECEMBER 25, 2023

In the BUCKLED trial that looked at whether ultrasound was non-inferior to X-ray in diagnosing forearm fractures, the primary outcome was physical function of the affected arm at four weeks. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% We love POOs. vs. 2.4% ). vs. 1.9% ).

Research 83

Research Outcomes Fractures Pediatrics 83

Don't Forget the Bubbles

MAY 17, 2023

Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative. Distribution and pattern of hand fractures in children and adolescents. Increased fracture risk among children diagnosed with attention- deficit/hyperactivity disorder: a large matched cohort study. Strane D, et al. Pediatrics.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

FEBRUARY 24, 2024

Early recognition and prompt treatment is key. non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 94

Leadership EMS Pediatrics Stroke 94

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. Moderate-quality evidence is available for bolus administration of hypertonic saline, while only low-quality evidence supports continuous administration. The study additionally only measures ICP one hour after bolus administration.

Administration 49

Administration Pediatrics Outcomes Research 49

Taming the SRU

DECEMBER 6, 2023

ems grand rounds: southwest ohio protocol updates WITH dr. weekley Ideally, medications will be administered IV or IO, therefore endotracheal tube drug administration will be de-emphasized. Occult fractures exist, therefore a high index of suspicion for these injuries is necessary, even in the setting of initially negative plain films.

Leadership 57

Leadership Stroke Airway Management Administration 57

PHEM Cast

APRIL 18, 2016

Following the lecture I found this on Minh’s PHARM website: a review of prehospital ketamine administrations. Spinal fractures occur in 2% of all major trauma. Unstable spinal fractures occur in all major trauma 0.7%. Remember this when you get on scene – 98% of patients will not have a spinal injury.

Fractures 40

Fractures Operations Administration Shock 40

PulmCCM

FEBRUARY 12, 2024

In mechanically ventilated patients with septic shock, randomized trials have not shown improved survival with steroid administration , even among those who were “cosyntropin responders” (although hemodynamics were improved with steroids ). Critically ill patients with low cortisol (e.g.,

Shock 52

Shock Administration Sepsis Fractures 52

Broome Docs

APRIL 6, 2023

Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Am J Emerg Med. 2023 Feb;64:206.e1-206.e3. 2022.11.027.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

ACEP Now

AUGUST 9, 2024

7 Depending on velocity of contact, this action can fracture the spike and leave foreign body fragments of the spine within the tissue. Unlike the keratin spines found in porcupines, hedgehogs, and echidnas, these central, needle-sharp, hard spikes are made of hydroxyapatite and collagen.

Poisoning 52

Poisoning Burns Seizures Fractures 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

This appears to be immediately beneath the sternal fracture. However, his cardiac MRI shows scar that is also possibly associated with his sternal fracture given his location. At this point, recommend a short-term follow-up cardiac MRI tailored to evaluation of the right ventricle, in a few days after patient recovery.

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

Don't Forget the Bubbles

SEPTEMBER 5, 2024

Children with complex medical conditions are at higher risk of morbidity and mortality, and this may be compounded by inaccurate weight estimation and leading to inaccurate medication dose administration. Therefore, it is important that the method used gives the most accurate weight estimate.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

In fact, one of my surgeon grandfather's ortho buddies (perhaps with the help of some lunchtime martinis) took a look at the x-rays of my Boxer's Fracture and snapped it back into place without any analgesia or procedural sedation, casted me, and sent me home. Still no pain medicine.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

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

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

DECEMBER 2, 2024

IN administration offers a noninvasive way to bypass the blood-brain barrier, allowing drugs to rapidly enter the brain. However, IN administration was faster and more comfortable for patients without any significant difference in potency among the three routes. Why does it matter? Paediatric elbow X-rays are challenging to interpret.

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

RebelEM

MAY 22, 2023

In 2010, the United States Food and Drug Administration (FDA) granted approval for intravenous (IV) acetaminophen as a pain management option. Undoubtedly, some patients cannot tolerate oral medications and may benefit from parenteral administration.

Emergency Department 82

Emergency Department Administration Dislocations Hospitals 82

Pediatric Emergency Playbook

JANUARY 1, 2017

CRIES is a 10-point scale, using a physiologic basis similar to APGAR: Crying; Requires increased oxygen administration (distress and breath-holding); Increased vital signs; Expression; and Sleeplessness ( Krechel 1995 ). Once the pain is controlled, less frequent administration of medications, with frequent reassessments, are indicated.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Taming the SRU

SEPTEMBER 1, 2023

These were adult trauma patients with compromised vitals, clinical suspicion for life-threatening injuries, and/or presence of a severe injury Negative study for this primary outcome, but potentially an under-powered study Also, study involved mortality of all trauma patients, lumping together patients with polytrauma and those with TBI’s Secondary (..)

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

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

23 Blunt carotid injury is more likely in patients with at least one of the following: Glasgow Coma Scale (GCS) ≤ 6, fracture of petrous bone, presence of diffuse axonal brain injury, and LeFort II/III fractures. 23 BCVI should be suspected with any high-energy trauma or any fractures of the maxilla or mandible. 24) Kelts, G.;

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Don't Forget the Bubbles

OCTOBER 4, 2023

In this issue of the Archives , we read a large retrospective study about gastric acid suppression in infancy and the increased risk of fractures. The intriguing finding of this study was the fact that non-fracture injuries increased, which could suggest that another factor (the temperament of the child rather than gastrin or VitB metabolism?)

Pediatrics 111

Pediatrics Fractures Outcomes Research 111

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64