Remove Administration Remove Fractures Remove Outcomes
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Neurogenic Shock in Children

Pediatric EM Morsels

Most commonly caused by fracture or dislocation of vertebrae. Crystalloid may help, but neurogenic shock may not respond to fluid administration. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. J Pediatr Surg.

Shock 304
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SGEM#451: I’ve Become So Numb – Serratus Anterior Plane Blocks for Rib Fractures

The Skeptics' Guide to EM

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.

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Low Risk Intra-Abdominal Trauma: Rebaked Morsel

Pediatric EM Morsels

Cohort of 12,000 children with blunt IAI were prospectively enrolled to determine the number of subjects requiring acute intervention . Incorrect interpretation of the recommendations would lead to a very high number of CT scans.

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Trauma Resuscitation Updates

RebelEM

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]

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Grand Rounds 5.8.24

Taming the SRU

For mid-shaft femur fractures, traction appears to may reduce blood loss and pulmonary complications, but the available data is very scarce. 3% HTS appears to be safe for peripheral IV administration and does not require a central line. Usually presents consistent with failure of that organ. Hypertonic saline in TBI Is it safe?

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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

RebelEM

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
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TXA in head injuries

Don't Forget the Bubbles

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.