Cook County EM Blog

JUNE 2, 2022

Patient Course: Radiographs demonstrated a displaced, comminuted midshaft fracture of the fourth metacarpal. Orthopedic surgery saw the patient in clinic two weeks later, and given the irreducible fracture, the patient underwent open reduction and percutaneous pinning the next day. Metacarpal fractures: treatment and complications.

Fractures 52

Fractures Soft Tissue Injuries Operations Emergency Department 52

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

Taming the SRU

MARCH 11, 2024

Reducing the total ischemic time in patients with vascular injury is the single most important variable in improving outcomes and reducing the risk of amputation; an ischemic time of >8 hours is associated with amputation rates of up to 85%, compared with <20% in those with ischemic time of <8 hours (2).

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. Awake fiberoptic intubation where the patient consents, co-operative AND the airway is prepared with local anaesthesia. The Impact of Prehospital Intubation with and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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. Usually presents consistent with failure of that organ.

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

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.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). 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 Fractures Documentation/Coding Administration 95

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

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.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. Distribution and pattern of hand fractures in children and adolescents. J Pediatr Gastroenterol Nutr. 2023 Apr 24. Cetinkaya PG, et al. Eur J Pediatr.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

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. I’ve heard arguments that frame this discussion in terms of trainee wellness, physician burnout, social contract, and patient outcomes.

Hospitals 97

Hospitals Wellness Fractures Academics 97

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. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

PHEM Cast

APRIL 18, 2016

Spinal fractures occur in 2% of all major trauma. Unstable spinal fractures occur in all major trauma 0.7%. Hauwald, 2002 A co-operative patient does not require immobilization unless their conscious level deteriorates. Remember this when you get on scene – 98% of patients will not have a spinal injury.

Fractures 40

Fractures Operations Administration Shock 40

Taming the SRU

MARCH 14, 2023

Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing. Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. CTH demonstrates acute hydrocephalus despite the presence of a VP shunt. Lancet Neurol.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Rural Doctors Net

AUGUST 30, 2013

Smart retrieval services have a presence in the Emergency Operations Centre and will be ‘on standby’ as the initial ambulance call comes through – a much more proactive approach than the usual sequence of calls from first responder-ambulance-local hospital-doctor-retrieval service. Pull straight any fractures & splint them.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks?

Stroke 97

Stroke Fractures Operations Outcomes 97

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 57

Fractures Resuscitation Operations EMS 57

RebelEM

JANUARY 24, 2024

Schedule follow up with orthopedics within 1 week for discussion of operative management vs early rehab protocols. 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.

Operations 86

Operations Ultrasounds Fractures Outcomes 86

EMDocs

SEPTEMBER 9, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. Open Fracture. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c 0b013e3182a0148c Zhao W, Wang G, Chen B, et al. Medicine (Baltimore). 2019;98(44):e17823.

EMS 90

EMS Fractures Soft Tissue Injuries Ultrasounds 90

EB Medicine

MARCH 1, 2019

In terms of radiography, a chest x-ray should be obtained as rib fractures, hemopneumothorax, and mediastinal free air are all things you wouldn't want to miss and are also associated with blunt cardiac injury. In one RCT, the FAST exam reduced the time from arrival in the ED to operative care by 64% in the setting of trauma.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 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. Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Systematic Review and Outcomes Analysis. Vasc Endovascular Surg. Epub 2016 Feb 11.

Emergency Department 93

Emergency Department Fractures Hospitals Operations 93

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. Labs do not play a significant role Imaging X-ray : Start with plain films to look for fracture near laceration, intra-articular free air, radiopaque foreign body. When in the joint, you’ll obtain synovial fluid.

Soft Tissue Injuries 80

Soft Tissue Injuries Fractures Dislocations Radiology 80

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. The resulting injuries include crush injuries, fractures, avulsions, lacerations and amputations. No bone is exposed.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52

PHEM Cast

SEPTEMBER 14, 2022

secondary to fire or other hazard) These principles have been adopted by national level stakeholders in the UK are being incorporated into national clinical and operational guidance which will reduce entrapment time and may demonstrate morbidity and mortality reductions. A pre-specified analysis of the UK trauma registry (TARN).

Fractures 52

Fractures Operations Outcomes Academics 52

Cook County EM Blog

MARCH 20, 2023

X-rays showed radiopaque foreign bodies confined to the distal thumb without fracture. Latex paint-gun injuries of the hand: are the outcomes better? There were no signs of infection, compartment syndrome, tissue necrosis, or limb ischemia. Orthopedics was consulted and recommended outpatient follow up in several days. PMID: 24382878.

Fractures 52

Fractures Documentation/Coding Operations Research 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 88

EMS Dislocations Fractures Operations 88

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Identifying serious causes of back pain: cancer, infection, fracture. Cleve Clin J Med. 2008 Aug;75(8):557-66.

Infectious Diseases 88

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

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes. Emerg Med J. 2024 Jan 22;41(2):76-82. PMID: 38123983.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EB Medicine

JUNE 6, 2019

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.

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. 2022 May;14(5). 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Don't Forget the Bubbles

SEPTEMBER 23, 2024

Kidney transplant recipients have a higher risk of fractures. suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Obesity: Obesity, whether before or after transplant, is linked to worse outcomes.

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

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. Most cases abate by one year.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 98

Stroke Radiology Radiology Emergency Department 98

Mind The Bleep

JANUARY 24, 2025

Upper limb fractures and dislocations can lead to associated arterial and nerve damage. First aid such as irrigation, tourniquet use, reduction and splinting of fractures/dislocations. Fracture reduction and immobilisation : Fracture and/or dislocation reduction can restore alignment and vascular supply as well as reduce pain.

Dislocations 52

Dislocations Fractures Soft Tissue Injuries Infectious Diseases 52

Advanced Emergency Nursing from AENJ

MARCH 27, 2015

They also proved that only expired air resuscitation guaranteed sufficient inflation volumes; that exhaled air was a suitable resuscitating gas; and that the operator would have continuous feedback from each breath. Intracranial placement of a nasotracheal tube after facial fracture: a rare complication. Cover with antibiotic.

Resuscitation 40

Resuscitation Airway Management EMS CPR 40