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Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures. Today, we want to focus on a couple of our good friends, buckle and greenstick forearm fractures. Pediatric patients have unique bony anatomy and physiology compared to the skeletally mature.
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 (..)
This places a significant responsibility on the EM physician to diagnose and treat fractures. Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture.
To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Most commonly caused by fracture or dislocation of vertebrae. Never fear. J Pediatr Surg. 2001;36(2):373. Pediatr Emerg Care.
Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. This topic is important because of the high incidence of rib fractures in trauma patients and their association with increased morbidity and mortality. Ultrasound Med. 41, 2695–2701 (2022). Why do we care? SD 3.28) and 6.5,
Evaluation of unintentional injury and trauma is one of the hallmarks of the EM and PEM physician. Low Risk Inta-Adbominal Trauma: Just Light ‘Em Up? The post Low Risk Intra-Abdominal Trauma: Rebaked Morsel appeared first on Pediatric EM Morsels. J Am Coll Surg. 2017;224:449-460. doi:10.1016/j.jamcollsurg.2016.12.041.
Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. The X-ray shows a buckle fracture of his right distal radius. Reference: Perry et al.
ENRICH Trial - the leadership journey - EMS grand rounds - r4 capstone - r1 clinical knowledge - pediatric lecture ENRICH Trial WITH visiting professor Dr. david wright ICH makes up only 10-15% of all strokes yet has a higher mortality than ischemic strokes and SAH Current 2022 AHA/ASA guidelines for spontaneous ICH (prior to ENRICH Trial) minimally-invasive (..)
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.
r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery.
in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).
He has a passion for FOAMed and is the creator of the […] The post SGEM#324: Blow Away, Blow Away, Blow Away – Spirometry for Discharging Older Patients with Rib Fractures first appeared on The Skeptics Guide to Emergency Medicine. He has a passion for FOAMed and is the creator of the Danish EM platform www.akutmedicineren.dk.
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]
(Table 3) Prehospital Care What do our EMS colleagues need to keep in mind when transporting a child with an ocular injury? Orbital fractures: What should we be looking for? Table 3)Prehospital Care* What do our EMS colleagues need to keep in mind when transporting a child with an ocular injury?* How can they help us in the ED?
Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al. Orthop J Sports Med. 2015; 3(4): PMID: 26665055 Post Peer Reviewed By: Salim R.
The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. Part 1 here.
One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. With this model, there will hopefully be improved patient satisfaction and better outcomes. EM Resident. Open Access Emerg Med. 2023;50(1):58–59.
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.
Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Their back has worsened significantly over the past 24 hours with radiation down the left leg. 2022 May;14(5).
Hegeman EM, et al. Schwindt EM, et al. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. Distribution and pattern of hand fractures in children and adolescents. Osteomyelitis in Sickle Cell Anemia: Does Age Predict Risk of Salmonella Infection? Pediatr Infect Dis J. 2023 Apr 18.
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 ).
The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. I would definitely give it a read.
The Sonosite website has some excellent resources, which you can filter according to specialty, including prehospital using ‘EMS/Air Med/Ambulance’. The radiopaedia website is an amazing resource for all things imaging. Their section on POCUS is here. Kenji Inaba.
Amputations Distal to DIP may require revision amputation, which is in the purview of EM physicians. Patients are unable to actively flex their DIP and x-ray imaging often will reveal and avulsion fracture. X-ray imaging should be obtained to evaluate for avulsion fracture. Antibiotics are not indicated.
Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. Trauma CTs showed a "mildly displaced sternal fracture and a small retrosternal hematoma." He was intubated for altered mental status.
He is also the CME editor for Academic Emergency Medicine Case: You’re working in a small rural emergency department when a seven-year-old girl comes in by EMS with a head injury. Corey Heitz is an emergency physician in Roanoke, Virginia. Her father was teaching her how to bike and he got a little ambitious and sent her down a small hill.
In an attempt to improve resource utilization, emergency department length of stay, limit cost and improve outcomes, there have been multiple Clinical Decision Rules (CDRs) created to help guide clinicians in their decision-making process. We have covered the CCHR on the SGEM with the EM Swami and Dr. Emily Junck back on SGEM#106.
Case by Sean Dyer PGY-3 EM Resident; Peer Reviewed by Dr. Christopher Hogrefe, Assistant Professor in Emergency Medicine at Northwestern University Feinberg School of Medicine The Case A 32 y/o male presents with wrist pain after being involved in a motor vehicle collision this afternoon. References: Sherman, S.
The main outcome was the adjusted odds ratio for in-hospital mortality and hazard ratio for 30-day mortality with some pre-specified subgroups. The reconfiguration included the centralisation of hospitals and the establishment of emergency departments with specialists present around the clock.
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. If there is no improvement in 20 minutes, EMS will call medical control regarding further decisions. Remember who you are and who you represent.
Heterogeneity (I 2 ) for the primary outcome was 69%, representing a moderate value. Of particular note, subjective outcomes are particularly prone to bias in an open-label trial. vs. 91.4%; RR 0.93; 95% CI 0.86–1.01, 1.01, I2 = 69%, low certainty) Fewer adverse events occurred in the IAL group compared to the PSA group.
Talk Trauma is a two-day conference for nurses, allied health and EMS professionals involved in providing care for the adult and paediatric trauma patient. Case: A 52-year-old man presents to the emergency department via EMS after a motor vehicle collision while driving home from the city. You suspect he has been drinking.
We’ll keep it short, while you keep that EM brain sharp. 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. Initial vital signs include T 36.8,
The cause is felt to be repetitive overload of the patella, knee and tibial structures, along with potential alignment problems, tight tissue and muscle imbalances, which may cause strain and small avulsion fractures of the tibial tuberosity. The outcomes of cushioning devices such as shoe inserts are inconclusive. Curr Opin Pediatr.
Jeff: And don’t forget to get the crash details from the EMS crew before they depart! As a side note, for anyone taking oral boards in a few months, don’t forget to ask the EMS crew for the details!!! Nachi: Perfect, so that sums up treatment, next we have one special circumstance to discuss: sternal fractures.
Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing. The seizure abated with rectal diazepam given by the squad.
doing the little things right, with the understanding that small gains are additive, and that details can be the difference between a good outcome and a poor one. Lesson 11 Find what you love to do and surround yourself with people who make you better at doing it.
It is important that we identify eating disorders in the ED, as the earlier treatment is started, the better the long-term outcomes (similar to schizophrenia), the lower the mortality rate, and the less likely they are to develop serious medical complications. Comorbidity and outcome in eating disorders. Int J Eat Disord.
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: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic.
How should pelvic fractures be identified in unstable trauma patients? What is the EM physician’s role in the stabilization of unstable pelvic injuries? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. While single-bone fractures can occur, they are far less common.
The majority of them focused on the care process (86.8%), while a smaller percentage focused on care outcomes (9.3%) and structural aspects (3.9%). Most QIs focus on the care process; however, there is a lack of QIs that assess clinical outcomes. Expert panel studies and observational studies proposed 129 QIs. Why does it matter?
Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Introduction SAH has the potential for rapid progression and devastating outcomes.
saline Outcomes: Primary: Improvement in pain, measured on a 0 to 10 pain scale from baseline to 60 minutes later Secondary: Use of additional medication for the treatment of pain at any time during the ED course Percentage of patients who failed to achieve clinically important improvement in pain (<1.3)
Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. Authors: Nikhil B. Most cases abate by one year.
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