Cook County EM Blog

JUNE 2, 2022

The Case: A 40-year-old male with no past medical history presented to the emergency department after he was assaulted with closed fists just prior to arrival. Patient Course: Radiographs demonstrated a displaced, comminuted midshaft fracture of the fourth metacarpal. Metacarpal fractures: treatment and complications.

Fractures 52

Fractures Soft Tissue Injuries Operations Emergency Department 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Background During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. The primary outcome was the proportion of patients requiring more than one reduction attempt. to 6.45).

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

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. ED Physicians are already well-versed in the use of ultrasound.

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

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. X-ray (radiography) is the standard imaging technique used in emergency departments. N Engl J Med.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

The Skeptics' Guide to EM

DECEMBER 10, 2022

One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Case: A 32-year-old male construction worker presents to the emergency department (ED) after falling on his right dominant hand.

Operations 52

Operations Fractures Military Emergency Department 52

The Trauma Pro

JULY 5, 2024

Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Improper care during an emergency This situation can occur in the emergency department when the emergency physician calls a specialist to assist with management.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

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

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? 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. Arch Dis Child.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

The Skeptics' Guide to EM

MARCH 27, 2021

He currently serves as Vice-Chair of the Danish Society for Emergency Medicine and Chair of the Young Doctors in Emergency Medicine in Denmark. Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. Reference: Schuster et al.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 40

The Skeptics' Guide to EM

NOVEMBER 2, 2019

Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? Annals of EM 2019 Guest Skeptic: Martha Roberts is a critical and emergency care, triple certified nurse practitioner, currently living and working in western Massachusetts. A Randomized Controlled Trial.

Fractures 40

Fractures EMS Outcomes Emergency Department 40

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

EM Literature of Note

AUGUST 23, 2023

In a world of doors, truck beds, furniture, and other finger-crushing nuisances, emergency department visits for injuries involving the distal digits are common. Injuries range from tuft fractures, to degloving injuries, to all manner of nail and nailbed derangement.

Emergency Department 69

Emergency Department Fractures Outcomes 69

Taming the SRU

MARCH 11, 2024

of all orthopedic injuries and may be difficult to recognize if the dislocation spontaneously reduces prior to care in the Emergency Department, which may occur in upwards of 50% of cases (3). 4) This classification system is more specific but may be impractical to use in an Emergency Department setting.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

The Skeptics' Guide to EM

AUGUST 17, 2019

Opioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain. AEM August 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Opioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain.

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

EB Medicine

MAY 31, 2017

This month's episode of EMplify, a podcast corollary to the Emergency Medicine Practice journal, focuses on management strategies that improve dental emergency outcomes. This podcast is based on the full-length review published in the June 2017 issue of Emergency Medicine Practice.

Outcomes 40

Outcomes Fractures Emergency Department 40

The Skeptics' Guide to EM

MAY 7, 2017

Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med May 2017. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Acad Emerg Med May 2017. Guest Skeptic: Dr. .

Fractures 40

Fractures Pediatrics Ultrasounds Academics 40

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

Pediatric EM Morsels

MAY 24, 2024

Ann Emerg Med. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Cohort of 12,000 children with blunt IAI were prospectively enrolled to determine the number of subjects requiring acute intervention .

Pediatrics 161

Pediatrics Blood Transfusions EMS Fractures 161

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

Don't Forget the Bubbles

JULY 17, 2023

Original clinical studies Distribution and pattern of hand fractures in children and adolescents. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. McClellan JM, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Taming the SRU

MAY 23, 2023

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 of the talar body, talar neck, and calcaneus require high-impact trauma). Gross deformities often suggest fracture or dislocation.

Fractures 57

Fractures Dislocations Operations EMS 57

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

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. None of the physicians in the study believe that the rate of violence has decreased at all.

EKG/ECG 93

EKG/ECG Shock Fractures Emergency Department 93

The Skeptics' Guide to EM

DECEMBER 17, 2022

Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. EMS have already splinted an obvious mid-shaft femoral fracture, but he continues to be tachycardic and hypotensive.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

The Skeptics' Guide to EM

APRIL 8, 2023

There have been many “temporary” rural emergency department closures during the past last year. In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. It was a stepped-wedge reconfiguration of the entire Danish emergency healthcare system.

Stroke 55

Stroke Emergency Department Academics COPD 55

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. Nachi: Perfect, so that sums up treatment, next we have one special circumstance to discuss: sternal fractures. Early defibrillation is linked to better outcomes.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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. Dell KM, et al. Akkaya B et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

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 ). Crit Care Med. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

AUGUST 5, 2023

Computerized tomography (CT) is commonly used in the emergency department in the diagnosis of TBI. Background: Children have big heads proportionally to their body compared to adults which makes them more at risk of traumatic brain injury (TBI). But we’re always trying to balance the potential harms and potential benefits in medicine.

Head Injuries 40

Head Injuries Pediatrics Outcomes Fractures 40

RebelEM

JANUARY 30, 2023

PSA, also referred to as intravenous sedation in this paper, requires considerable resources, including 1:1 nursing observation, and burdens the emergency department (ED). Heterogeneity (I 2 ) for the primary outcome was 69%, representing a moderate value. Paper: Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S.

Dislocations 59

Dislocations Outcomes Emergency Department Research 59

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

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

Don't Forget the Bubbles

OCTOBER 2, 2024

A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. A full primary survey is carried out.

Administration 49

Administration Outcomes Pediatrics Research 49

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

Taming the SRU

OCTOBER 1, 2023

This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department. 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].

Fractures 96

Fractures COPD Hospitals Emergency Department 96

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

She is interested in social determinants of health in the emergency department and health policy. Dr. Ian Holley is also a PGY-3 resident in Emergency Medicine at Washington University School of Medicine in St. He is interested in ultrasound and international emergency medicine.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

Don't Forget the Bubbles

MAY 17, 2023

Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. 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. Eur J Pediatr.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72