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

Taming the SRU

JULY 25, 2024

Indication - skeletally mature patients with a radiographically documented femur fracture (hip to knee) Contraindications: Patient refusal Allergy to local anesthetic Infection over site of planned injection Obtunded/uncooperative patient Crush injury No available provider or space Medication: 0.5%

Stroke 98

Stroke Fractures Operations Outcomes 98

ACEP Now

FEBRUARY 11, 2024

The clavicle is one of the most commonly fractured bones in the human body. Every year, approximately 332,000 people in the United States suffer from a clavicular fracture. The clinician should note the fracture site (either via palpable landmark or ultrasound visualization). Epidemiology of clavicle fractures.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

ACEP Now

MAY 6, 2023

The emergency physician’s documentation of these injuries may prove to be crucial in law enforcement’s reconstruction of the crash and may have significant implications for subsequent legal proceedings. Clavicular and humeral fractures are more common in passengers than in drivers. Discussion There were over 2.1

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

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.

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 52

ACEP Now

OCTOBER 30, 2023

This makes documentation and communication of the utmost importance for these patients for their health and safety. Communication between providers and nursing regarding indwelling devices, bed sores, cleanliness, or signs of neglect is important, as the thoroughness of each examination may vary.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 136

Stroke Outcomes Hospitals Administration 136

The Injectable Orange

APRIL 4, 2017

Quite simply, document your intended personal learning objective; identify a high quality resource that addresses this (article, workshop, conference); document a reflection on your achieved personal learning outcome. The x-ray of her left shoulder is negative for any fracture.

Emergency Department 52

Emergency Department Evidence-Based Practice Academics Documentation/Coding 52

PEMBlog

OCTOBER 18, 2024

Orthopedic Risks: Watch for Fat Embolism DMD patients are prone to fat embolisms following fractures due to the fatty infiltration of their bone marrow. Any trauma that results in fractures should raise immediate concern for fat embolism syndrome, which can present rapidly and lead to respiratory and cardiovascular complications.

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

PulmCCM

JANUARY 16, 2024

You can read the document for all the caveats. This looks like the major fracture between the two expert panels. Neither document commented on treating ARDS patients with statins, which seemed very likely to have benefited some patients with hyperinflammatory ARDS in past trials. ” What About Statins for ARDS?

Research 87

Research Documentation/Coding Outcomes Fractures 87

Taming the SRU

APRIL 22, 2023

Study design This was a retrospective-IRB approved study evaluating adult patients >18 years of age who had documented heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fractures (HFpEF).

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

RebelEM

MARCH 9, 2023

Assess for blood in the nares or signs of basal skull fracture, including battle signs, raccoon eyes, or hemotympanum. Check that clavicles are intact and that there are no obvious rib fractures or spinal step-offs. As always, document clinical sobriety before discharge. Remove all clothing and do a full skin exam.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

EMDocs

JULY 11, 2023

Fractures and dislocations are indications for full dose factor replacement. PMID: 7382250 MASAC Document 257 – Guidelines for Emergency Department Management of Individuals with Hemophilia and Other Bleeding Disorders. If LP is absolutely necessary, pretreat with clotting factors and speak with hematology. PMID: 23968747.

Head Injuries 75

Head Injuries Pediatrics Dislocations CDC 75

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. This is usually caused by blunt trauma and is most commonly seen in wrestlers, mixed martial artists, or boxers. A) on LEFT: Auricular hematoma with overlying tattoos.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

Northwestern EM Blog

APRIL 25, 2022

X - ray : Many times, next step will be to get an X-ray to look for associated fractures. Ideally your exploration should be in a bloodless, painless field and documented as such. It provides additional information about any associated fractures. This may bring the wound tract into your field of view. CT is painless.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

PulmCCM

FEBRUARY 8, 2024

You can read the document for all the caveats. This looks like the major fracture between the two expert panels. Neither document commented on treating ARDS patients with statins, which seemed very likely to have benefited some patients with hyperinflammatory ARDS in past trials. ” What About Statins for ARDS?

Research 52

Research Documentation/Coding Fractures Outcomes 52

Don't Forget the Bubbles

OCTOBER 10, 2024

The study excluded complex nail bed injuries, including those with distal phalanx fractures, germinal matrix injury or pulp lacerations, meaning outcomes are only relevant to simple nail bed injuries. However, in the secondary outcome of parental assessment, nail discard patients had higher median scores.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Cook County EM Blog

MARCH 20, 2023

Further document handedness, occupation, site of injury, and thorough review of systems to evaluate for potential complications ○ Complications as distant as pneumomediastinum following air injection of the hand have been reported5,6. ➢ X-rays showed radiopaque foreign bodies confined to the distal thumb without fracture.

Fractures 52

Fractures Documentation/Coding Operations Research 52

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records. All deaths involving hip fractures if the attending physician believes the fracture caused or contributed to the cause of death. . ·

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

ACEP Now

MARCH 14, 2024

In our case, the patient had a CT of the head, cervical spine, and chest, abdomen, and pelvis with intravenous contrast demonstrated a C2, C7 compression fracture with significant bowel edema (Figure 4), and was taken to the operating room for left arm disarticulation, left below knee amputation and right above knee amputation. Am J Cardiol.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

EB Medicine

MARCH 1, 2019

Post opiate hypotension in prehospital trauma patients is a rare but documented complication. In terms of radiography, a chest x-ray should be obtained as rib fractures, hemopneumothorax, and mediastinal free air are all things you wouldn't want to miss and are also associated with blunt cardiac injury. Nachi: Definitely.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EMDocs

NOVEMBER 16, 2024

6 Periprosthetic fracture Occurs at an estimated rate of 3.5-4.1%. Posterior – Shortened, adducted, internally rotated 5,6 Anterior – Shortened, abducted, externally rotated 5,6 As with all dislocations, perform and document distal neurovascular exam before and after management. 5 CT if concern for occult fracture.

EMS 98

EMS Dislocations Fractures Operations 98

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. EMS in America: The Foundation Documents. Still no pain medicine.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EB Medicine

JUNE 6, 2019

Nachi: And as a brief aside, before we continue… Missed appendicitis is one of the three most common causes of emergency medicine malpractice lawsuits - with MI and fractures being the other two. Nachi: Few things are more important prior to discharge of an abdominal pain patient than documenting repeat exams and a PO trial.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS.

Seizures 98

Seizures Stroke Outcomes EMS 98

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

Mind The Bleep

JANUARY 28, 2025

Enquire about any associated trauma such as head injuries and fractures. First Aid Measures : Document if any initial care has been done, such as cleaning or dressing the wound. Documentation Clearly record findings, including measurements and descriptions of the wound, and consider photographic documentation if appropriate.

Documentation/Coding 52

Documentation/Coding Head Injuries Fractures Emergency Department 52

EMDocs

JUNE 6, 2023

Literature suggests we should avoid evaluating ocular pressure, though there are no case reports or peer reviewed data documenting extrusion of ocular contents from ocular pressure evaluation in the ED setting. No need for Seidel test if there’s obvious globe rupture. Visual prognosis is determined by the time to surgical intervention.

Fractures 98

Fractures Documentation/Coding Ultrasounds Wellness 98

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

Mind The Bleep

NOVEMBER 21, 2023

It is important to be accurate when assessing and documenting wounds as it can have medico-legal implications, should your assessment later come up in a court case. Open fractures that need to be seen by orthopaedics. Wounds are a very common presentation to A&E and minor injuries departments.

Fractures 40

Fractures Burns Documentation/Coding Hospitals 40

Don't Forget the Bubbles

AUGUST 10, 2023

This is partly because the hands (including fingers) of children & young people have a tendency to fracture without as much compressive force being applied to the bones when compared with adult hands. The resulting injuries include crush injuries, fractures, avulsions, lacerations and amputations.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52

American Medical Compliance

JANUARY 8, 2025

Recognizing the Signs of Abuse Healthcare providers must remain vigilant for signs of abuse, which can include: Physical Signs : Unexplained bruises, burns, or fractures, along with frequent hospitalizations for preventable issues. Documentation : Detailed documentation is crucial.

Incident Reporting 105

Incident Reporting Documentation/Coding Dehydration Burns 105

American Medical Compliance

MARCH 3, 2025

Common Cal/Osha Violations No formal workplace violence prevention plan Lack of staff training on de-escalation techniques Failure to report and document violent incidents Inadequate security measures in high-risk areas How to Avoid This Violation Develop a Workplace Violence Prevention Plan as required by Cal/OSHA.

PPE 103

PPE Legal Issues Head Injuries Burns 103

PEMBlog

DECEMBER 4, 2024

Um, with the first documented epidemic occurring in Paris in 1578. And the mechanical complications can include rib fractures, subconjunctival hemorrhage, and even rectal prolapse due to intense coughing and valsalva. Pertussis has been recognized since the 16th century. I was not practicing medicine back then.

Pediatrics 52

Pediatrics PPE Wellness Infectious Diseases 52

Pediatric Education

JANUARY 12, 2025

Other therapy to address side effects also includes treatment for hypertension, glucose management, bone fractures and psychological treatment. Cognitive and emotional regulation has been disrupted by the CS, and therefore it can take a long time for the brain to resolve it (cerebral atrophy has been documented in pediatric patients).

Pediatrics 40

Pediatrics Fractures Academics Wellness 40

Dr. Smith's ECG Blog

MARCH 8, 2025

She sustained a large scalp hematoma along with several rib and vertebral fractures, but with CT scanning of chest/abdomen/pelvis/C-T-L-spine and head, no life threatening injuries were found. International expert consensus document on takotsubo syndrome (part I): Clinical characteristics, diagnostic criteria, and pathophysiology.

EKG/ECG 75

EKG/ECG CPR Resuscitation Wellness 75

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. Document clearly: The location of all wounds Medical photography or drawn labelled diagrams can aid in explaining the exact location. Assess neurovascular status distal to the bite.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52