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. Otherwise, most cases require operative repair. The patient was sent for radiographs. J Emerg Med.

Fractures 52

Fractures Operations Hospitals 52

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?*

Fractures 52

Fractures Documentation/Coding Operations Emergency Department 52

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

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 secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair).

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

Taming the SRU

MAY 11, 2024

For mid-shaft femur fractures, traction appears to may reduce blood loss and pulmonary complications, but the available data is very scarce. Guidelines also support not administering HTS in the pre-hospital setting, yet the available data is weak. What do we do at UC?

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

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 Fractures Hospitals 64

ACEP Now

MAY 4, 2023

Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). The chest X-ray showed multiple displaced right rib fractures and chest wall subcutaneous emphysema without definitive evidence of a pneumothorax, as well as right lower lobe atelectasis versus contusion (Figure 1). Click to enlarge.) Click to enlarge.) Click to enlarge.)

EMS 52

EMS Fractures Operations Ultrasounds 52

Don't Forget the Bubbles

MAY 17, 2023

The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. Post-operative pain in children: Comparison of pain scores between parents and children. Can’t get enough of Bubble Wrap? 2023 Apr 24. Eur J Pediatr.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

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

Sensible Medicine

MARCH 14, 2024

A more inquisitive approach would seek to understand why the educational bargain feels more fractured now despite ACGME work hours being more “protective” than ever before. The analogy of a physical hospital expanding from its original isolated ward to become an interconnected quaternary care center may help.

Hospitals 96

Hospitals Wellness Academics Fractures 96

ACEP Now

OCTOBER 15, 2023

Laryngotracheal trauma has been cited as accounting for less than one in 100,000 hospital admissions. 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

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. 1 The Rise of the Miami BBL An entire industry has emerged around gluteal AFTs in Miami.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

The Skeptics' Guide to EM

MARCH 25, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Do they need surgery, an ERCP or just analgesia and non-operative care? He is also now a fully-fledged “sonologist”. He has been on the SGEM#369 , SGEM#326 and SGEM#217.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

PHEM Cast

APRIL 18, 2016

All things Pre Hospital Ketamine – Minh Le Cong Key point: patients remember if you manage their pain well. Spinal fractures occur in 2% of all major trauma. Unstable spinal fractures occur in all major trauma 0.7%. We have also recorded a three interviews already which will feature in future podcasts.

Fractures 40

Fractures Operations Administration Shock 40

Taming the SRU

JANUARY 29, 2024

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. Hospital Course The patient was initiated on a therapeutic heparin drip in the emergency department with vascular surgery consultation.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

Mind The Bleep

OCTOBER 17, 2024

Scottish Mountain Rescue (SMR) is an umbrella organisation, with teams the final decider of how they operate. Your skills as a doctor need to be different to your hospital role or abilities. Team equipment, procedures, training schedules/frequency, and skill mix vary between teams greatly. What illnesses or injuries do we see?

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

PEMBlog

JUNE 5, 2024

The most common injuries seen in these younger patients are growth plate fractures and ligamentous injuries. You more often will see vertebral body and arch fractures as opposed to the growth plate fractures and ligamentous injuries in the younger children. Axial load can cause burst fracture, so someone that dives into a pool.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

RebelEM

MARCH 9, 2023

Assess for head and neck trauma : A 2014 study out of NYU/Bellevue Hospital found that 39% of patients who frequented the emergency department with acute alcohol intoxication had a moderate to severe brain injury over a three-year period. Check that clavicles are intact and that there are no obvious rib fractures or spinal step-offs.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

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.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

" [Coroners Society] King Richard I (the Lionheart) needed vast sums of money for the Third Crusade, operation of the kingdom, and for his ransom fro m Duke Leopold of Austria. All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Still, except for the public hospital, other hospitals did little emergency work and would have unattended first aid or treatment room in which one could meet one's physician or have an intern provide care in the meanwhile. Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Northwestern EM Blog

APRIL 25, 2022

X - ray : Many times, next step will be to get an X-ray to look for associated fractures. Definitive treatment is joint wash out in the Operating Room. It provides additional information about any associated fractures. It is important to note that the absence of these findings does not rule out a traumatic arthrotomy.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

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. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. Pediatrics. 2014 Apr;133(4):e1104-16.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Rural Doctors Net

AUGUST 30, 2013

James and Casey are used to this kind of stuff (although Casey’s mostly in-hospital and has even got a CT scanner…James is used to working out of a tent wearing just rabbit skins). Allocate someone to activate ambulance, other clinical personnel, notify local hospital and give retrieval services a head’s up. The CAT will hurt.

Burns 52

Burns Hospitals Ambulance Services Wellness 52

Northwestern EM Blog

DECEMBER 20, 2021

Physical examination should always include an attempt to ambulate the child unless there is an obvious contraindication noted immediately (eg open fracture). Management is orthopedic consultation for operative stabilization [12]. Strength and range of motion of both lower extremities should also be examined [2]. 2012;97(5):185-193.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Taming the SRU

MARCH 14, 2023

After a several week NICU stay for prematurity, the infant has been generally healthy and this is his first trip back to the hospital since discharge. Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

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 96

EMS Dislocations Fractures Operations 96

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. This finding was not significantly different among operators with different levels of experience, or between adults and children.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

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 hospital is the Paediatric Major Trauma Centre for the South-West. It’s a great idea and maybe something for other centres to copy!) in lower-resource settings.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. 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.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care. Clinical impact: The patient’s DVT ultrasounds were negative. J Am Psychiatr Nurses Assoc. 2023;29(6):470-476.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

EMDocs

JUNE 3, 2023

Her Glasgow Coma Scale (GCS) is 14 (3E-5V-6M), and she arrives in a cervical collar placed pre-hospital. 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. 2 Vertical shear fractures are also unstable.

Fractures 61

Fractures Resuscitation Operations EMS 61

Taming the SRU

MARCH 11, 2024

Reports of a pre-hospital deformity, “popping” sensation, or reduction attempts should raise suspicion for a spontaneously reduced knee dislocation. CTAs have the added benefit of also further evaluating the surrounding osseus structures for associated fracture.

Dislocations 108

Dislocations Emergency Department Fractures Operations 108

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

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95