Taming the SRU

MARCH 11, 2024

Acute knee dislocations are rare orthopedic injuries that have high morbidity and need to be recognized quickly by the emergency physician; if unrecognized or inadequately treated, these injuries can lead to vascular and limb compromise (1,2). Knee dislocations make up less than 0.5%

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. Laboratory Data CT Orbits/Sella w/ IV Contrast : No acute orbital fracture.

Emergency Department 64

Emergency Department Academics Hospitals Fractures 64

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

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]. traumatic axial loading with calcaneal fractures, pilons, and vertebral compression fractures) [5]. Gross deformities often suggest fracture or dislocation [Image 2].

Fractures 77

Fractures Dislocations Operations Radiology 77

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. A 41-year-old male with no significant past medical history presents with a deep hand laceration. Examination reveals the following: What is the diagnosis?

EMS 69

EMS Fractures Operations Ultrasounds 69

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Taming the SRU

MAY 23, 2023

fractures of the talar body, talar neck, and calcaneus require high-impact trauma). Stress fractures are caused by repetitive microtrauma and stress on the bone, and therefore present with more subacute or chronic symptoms. Gross deformities often suggest fracture or dislocation. RICE), and symptomatic management (e.g.,

Fractures 57

Fractures Dislocations Operations EMS 57

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. Arch Dis Child. Epub ahead of print.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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). Click to enlarge.) for the ED clinician.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

ACEP Now

MAY 4, 2023

Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. On hospital day 2, he was taken to the operating room for surgical rib fixation. Click to enlarge.)

EMS 52

EMS Fractures Operations Radiology 52

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 54

Fractures Resuscitation Operations EMS 54

ACEP Now

OCTOBER 15, 2023

On arrival to the emergency department (ED) she was awake and breathing with stridor. Fracturing the larynx requires considerable force, and the great majority of fractures are from blunt high-velocity trauma. Is there an open neck wound or palpable cartilage fracture?

Fractures 52

Fractures Dislocations Airway Management Operations 52

The Skeptics' Guide to EM

MARCH 25, 2023

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Date: March 22, 2023 Reference: Hilsden et al.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

EMDocs

SEPTEMBER 9, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. 2021.0052 Emergency Department Management of Extensor Tendon Lacerations – Page 3 of 4. Ann Emerg Med. Open Fracture. Emergency Medicine Residents’ Association; 2022:10-11. Extensor tendon repair in the emergency department.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. The data is strong that in the hands of trained Emergency Clinicians, when parasternal, apical, and subcostal views are obtained, US has an accuracy of 97.5%

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Downeast Emergency Medicine

FEBRUARY 9, 2022

He had an operative repair of his patellar fracture 10 days after his initial visit. ULTRASOUND PEARLS This case highlights an excellent use of musculoskeletal ultrasound for the diagnosis of patellar fracture. Make sure you always scan the opposite extremity to get a sense of your patient’s baseline/normal anatomy.

Ultrasounds 52

Ultrasounds Fractures Operations Emergency Department 52

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. Crit Care Med.

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

Mind The Bleep

SEPTEMBER 17, 2024

Introduction Patients regularly present to the emergency department with animal bites. Feel: Palpate the area of the bite to feel for areas of tenderness as this could indicate a fracture or infection. There should be a minimum of 2 views in the plain film, or 3 in the hands if there is a suspicion of a fracture.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. Distribution and pattern of hand fractures in children and adolescents. 2023 Apr 24.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. In the operating room, there was minimal urinary output and the bladder pressures were 35 mmHg under sedation and analgesia.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Assess for blood in the nares or signs of basal skull fracture, including battle signs, raccoon eyes, or hemotympanum. Annals of Emergency Medicine. J Emerg Med. 2018 Mar;71(3):279-288.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

PEMBlog

JUNE 5, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane).

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Taming the SRU

JANUARY 29, 2024

She was concerned that this was not improving and decided to come to the emergency department (ED). 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. She had not had any blood clots previously.

Emergency Department 93

Emergency Department Fractures Hospitals Operations 93

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 68

EMS Dislocations Fractures Operations 68

Northwestern EM Blog

DECEMBER 20, 2021

Written by: Tommy Ng, MD (NUEM ‘24) Edited by: Patricia Bigach, MD (NUEM ‘22) Expert review by : Terese Whipple, MD '20 So your kid won’t walk One of the most common complaints in a pediatric Emergency Department is a child refusing or inability to ambulate. Management is orthopedic consultation for operative stabilization [12].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Emerg Med J. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Evaluation of fever in the emergency department. ng/mL (strongly recommended against antibiotics), 0.1-0.25

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Depending on the height of the child and the height of the car, the initial impact will cause a femur fracture, a pelvic fracture, or direct abdominal trauma. Pediatric emergency department thoracotomy: a large case series and systematic review. Pediatric emergency department thoracotomy: A 40-year review.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

Act V, scene I [Text from Folger Shakespeare Library] [Audio recording of Dramatic Reading; Chapter Vox] [Video recording of Act V, scene1] Most deaths that are brought to, or occur in, an emergency department will require, at least, discussion with the local Coroner or Medical Examiner.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. Journal of general internal medicine. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Don't Forget the Bubbles

SEPTEMBER 23, 2024

You are working in the paediatric emergency department of a busy District General Hospital. These centres have a close relationship with their patients, but this does not mean they may not turn up at your emergency department! Kidney transplant recipients have a higher risk of fractures. Any history of injury?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

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. We will focus on the most important structures when assessing paediatric hands in the emergency department.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. Emerg Med Clin North Am. Talk to you next month! Abdom Imaging. Review) 83.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. J Emerg Med. Acad Emerg Med.

Emergency Department 98

Emergency Department Fractures Burns EMS 98