Taming the SRU

NOVEMBER 3, 2023

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,

Fractures 98

Fractures Ultrasounds Research Outcomes 98

The Trauma Pro

MAY 28, 2024

This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. A recent Massachusetts General Hospital study involved a larger group (97 patients with 110 fixators). I’ve covered the problem of performing MRI on patients with external fixators. doi: 10.1097/BOT.0000000000000954.

Fractures 260

Fractures Hospitals 260

The Trauma Pro

APRIL 26, 2024

In this series, I will review the two major techniques for addressing troublesome bleeding from pelvic fractures. In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

The Skeptics' Guide to EM

APRIL 20, 2024

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. His imaging shows mildly displaced rib fractures of ribs four through seven. Reference: Ramesh S, Ayyan SM, Rath DP, Sadanandan DM.

Fractures 85

Fractures Ultrasounds Emergency Department CDC 85

The Trauma Pro

OCTOBER 23, 2023

The trauma group at Stanford paired up with the Chang Gung Memorial Hospital in Taiwan to test the use of AI for interpreting images to identify a specific set of common pelvic fractures. The algorithms generated a “heat map” that showed the areas that were suspicious for fracture. Stay tuned!

Fractures 147

Fractures EKG/ECG Hospitals Wellness 147

Mind The Bleep

MARCH 22, 2023

Introduction Clinical Definition An open fracture is when the broken bone breaks through the skin or any other body cavity that is open to the outside, including those through the rectum or vagina. This is especially vital when addressing the issue of a fracture, adequate soft tissue coverage or blood vessel injury.

Fractures 59

Fractures Documentation/Coding Operations Hospitals 59

The Trauma Pro

JUNE 25, 2024

Readmission of any patient to the hospital is considered a quality indicator. Eight had subdural hematomas that required drainage; 3 had spine fractures that failed nonoperative management. Was the patient discharged too soon for some reason? Were there any missed or undertreated injuries? Two required surgical drainage.

Academics 190

Academics Fractures Hospitals 190

The Trauma Pro

MAY 3, 2024

In the previous post in this series, I described an early review article summarizing several older studies comparing these two hemorrhage control techniques for pelvic fractures. They separated all patients with acetabular and pelvic ring fractures using ICD-10 codes. Bottom line: This is the largest comparison of AE and PPP to date.

Fractures 113

Fractures Radiology Radiology Documentation/Coding 113

Cook County EM Blog

APRIL 7, 2022

He initially presented to an outside hospital where he was told he had an “ankle” fracture and was splinted with a short leg posterior splint. Mildly displaced oblique fracture involving the proximal fibular metaphysis. Pathoanatomy and Injury Mechanism of Typical Maisonneuve Fracture. J Emerg Med. 2013 Feb;44(2):e251-5.

Fractures 52

Fractures Operations Hospitals 52

The Skeptics' Guide to EM

AUGUST 24, 2024

Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. Case: A 67-year-old male presents to your hospital emergency department (ED) after a fall from his bicycle. He has three left-sided rib fractures on imaging without underlying complications.

Fractures 53

Fractures Emergency Department Ultrasounds Radiology 53

EB Medicine

NOVEMBER 1, 2021

and get 20% of all orders at [link] Emergency Department Management of Rib Fractures Author: Patrick Maher, MD Episode Outline: Why rib fractures? and get 20% of all orders at [link] Department Management of Rib FracturesAuthor: Patrick Maher, MDEpisode Outline:* Why rib fractures?* It is in Beta and your feedback is welcome.

Fractures 52

Fractures Documentation/Coding Operations Emergency Department 52

Emergency Medicine Journal

SEPTEMBER 25, 2024

Background Forearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block (HB), Bier’s block (BB) and procedural sedation (PS). Results A total of 226 forearm fractures were included.

Fractures 52

Fractures Hospitals 52

Emergency Medicine Journal

MAY 28, 2024

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. CT scans confirmed the absence of intracranial haemorrhage or orbital fracture. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.

Stroke 98

Stroke Fractures Hospitals 98

The Trauma Pro

DECEMBER 12, 2023

This necessitates an inter-hospital transfer that is subject to scrutiny by the trauma performance improvement program of both trauma centers. The work-up from the referring hospital can be re-evaluated. In some hospitals, orthopedics may choose to place a traction pin to provide initial fracture management.

Emergency Department 124

Emergency Department Operations Hospitals Radiology 124

The Trauma Pro

MAY 19, 2023

Not only trauma professionals, but other in-hospital clinical services as well. In trauma, the most common reason to order is “to monitor for bleeding from that spleen laceration” or some other organ or fracture complex. The serial hemoglobin (Hgb) determination. We’ve all done them. They inflict pain. So why do them?

Fractures 130

Fractures Hospitals Wellness 130

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). But under-prescribing can create problems as well. Always do the math and make sure you are sending the right drug in the right amount home with your patient.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

EMDocs

AUGUST 28, 2023

Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Failure to detect child abuse results in $45 million verdict Femur fracture missed; no imaging follow-up system in place Facts : A 2 ½ month old infant is brought to the ED by his mother because he is not moving his right leg and cries every time it is touched.

Fractures 82

Fractures Seizures Patient Safety Hospitals 82

ETM Course

JUNE 28, 2015

Just over a year ago London HEMS performed the first pre-hospital regtrograde endovascular balloon occlusion of the aorta (REBOA). Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. Martinelli et al.

Hospitals 52

Hospitals Resuscitation Shock Military 52

JournalFeed

DECEMBER 10, 2022

Pre-Hospital C-spine Clearance Spoon Feed In this large, single-center prospective cohort implementation study, paramedics were able to apply a modified* Canadian C-spine rule to assess low risk trauma patients and transport a large proportion of them to a higher level of care without spinal precautions. had an abnormal head CT.

Hospitals 40

Hospitals Fractures 40

The Trauma Pro

MAY 5, 2023

Some trauma centers receive a significant number of transfers from referring hospitals. Much of the time, a portion of the workup has already been done by the outside hospital. long bone or pelvic fractures) do not need a trauma activation unless the patient is beginning to show signs of physiologic compromise.

Hospitals 100

Hospitals Fractures 100

The Trauma Pro

OCTOBER 31, 2023

Many simple fractures and wounds do not need immediate attention. If you believe that harm will occur, here are your options, from least to most damaging to your professional status at the hospital: Contact another consultant in the same or overlapping specialty (if there is one). Are they right? Appeal to a higher authority.

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

The Trauma Pro

APRIL 30, 2024

They performed a systematic search of the literature, analyzing the impact of each procedure on in-hospital mortality. Reference: Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis.

Radiology 113

Radiology Radiology Research Fractures 113

The Trauma Pro

DECEMBER 26, 2023

Everyone knows that venous thromboembolism (VTE) is a potential problem in hospitalized patients, and especially so in trauma patients. Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. And we probably won’t, ever.

Fractures 124

Fractures Documentation/Coding Hospitals Research 124

The Skeptics' Guide to EM

MARCH 27, 2021

Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. J Trauma Acute Care Surg.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 40

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. A retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009 in the US revealed that less than one-half of patients undergoing ETI in the ED received sedative drugs while in the ED.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Pediatric EM Morsels

MAY 24, 2024

IAI Rule – The Validation A multicenter prospective validation was planned at hospitals distinct from those where the initial derivation was performed. If all patients with a score of 1 were scanned, 53% of the study participants would’ve had an abdominal CT. This concerned clinicians.

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

EB Medicine

JUNE 1, 2018

Join hosts Jeff Nusbaum, MD, and Nachi Gupta, MD on this episode of EMplify as they take you through the June 2018 issue of Emergency Medicine Practice: Managing Shoulder Injuries in the Emergency Department Fracture, Dislocation, and Overuse. Conservative interventions for treating middle third clavicle fractures in adolescents and adults.

Dislocations 40

Dislocations Emergency Department Fractures Research 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. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. N Engl J Med.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

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 time, the group asked a different question – does using early high-flow nasal cannula oxygen instead of standard oxygen therapy reduce hospital length of stay? An x-ray confirms a toddler’s fracture.

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

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

RebelEM

MAY 25, 2023

Pelvic Fracture A score ≥2 present, consider MTP Clinical Take Home Point: Use of balanced transfusion (including PRBCs and clotting factors) helps avoid dilutional coagulopathy WHOLE BLOOD VS COMPONENT THERAPY Kronstedt S et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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. In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. to 6.45).

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. PMID: 33350794 10 Meilandt C. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

ACEP Now

MARCH 15, 2024

3 Tenderness over the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite normal plain radiographs and fluoroscopic images. Children and older adults have weaker long bones than young adults and are more likely to sustain a distal radius fracture after a FOOSH than a carpal bone injury.

Fractures 52

Fractures Dislocations EMS Emergency Department 52

RebelEM

JANUARY 29, 2024

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).

Stroke 133

Stroke Outcomes Hospitals Administration 133

Don't Forget the Bubbles

DECEMBER 25, 2023

In the BUCKLED trial that looked at whether ultrasound was non-inferior to X-ray in diagnosing forearm fractures, the primary outcome was physical function of the affected arm at four weeks. A randomized trial of epinephrine in out-of-hospital cardiac arrest. They are the variables that matter most to the patient. We love POOs.

Research 83

Research Outcomes Fractures Pediatrics 83

Taming the SRU

JANUARY 10, 2024

There are 38 states where it currently is a felony of some level to assault a healthcare worker BUT there is currently no federal law that protects hospital employees from assault or intimidation. Current bills in progress: US H.R.2663 2663 & S.1176 1176 focuses on violence prevention (introduced for the 3rd time 4/18/23); US H.R.2584

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93