The Skeptics' Guide to EM

NOVEMBER 11, 2023

Which clinical features best predict occult scaphoid fractures? He will soon be transitioning out of the US military after […] The post SGEM#420: I get knocked down, but I get up again – do I have a scaphoid fracture? Which clinical features best predict occult scaphoid fractures? Emerg Med J. Emerg Med J. Emerg Med J.

Fractures 96

Fractures Military Radiology Radiology 96

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 118

Dislocations Fractures Soft Tissue Injuries Outcomes 118

Broome Docs

SEPTEMBER 9, 2023

In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. Bottom line: ultrasound appears to be non-inferior to X-ray when used as a first line investigation in terms of functional, patient-oriented outcomes.

Fractures 114

Fractures Ultrasounds Outcomes 114

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. AE and PPP have equivalent outcomes.

Fractures 113

Fractures Documentation/Coding Radiology Radiology 113

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

Pediatric EM Morsels

SEPTEMBER 22, 2023

Most commonly caused by fracture or dislocation of vertebrae. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. This leads to descending sympathetic tracts being disrupted. J Pediatr Surg. 2001;36(2):373. Pediatr Emerg Care.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

AENJ: Current Issue

JULY 31, 2024

Hamate fractures are uncommon, but early and accurate diagnosis is critical to prevent negative outcomes. Hamate fractures may present initially to emergency departments, and diagnosis can be challenging.

Fractures 40

Fractures Emergency Department Outcomes 40

The Skeptics' Guide to EM

AUGUST 24, 2024

Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. He has three left-sided rib fractures on imaging without underlying complications. Background: Rib fractures are a common injury, particularly for those over 65. We have covered rib fractures twice on the SGEM.

Fractures 51

Fractures Emergency Department Ultrasounds Radiology 51

The Trauma Pro

SEPTEMBER 12, 2023

Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture. Bottom line: This is an intriguing abstract, pointing me to the original paper published in NEJM. This multi-center study was performed in conjunction with the research coordinating center at Johns Hopkins, which designs some top-notch research.

Fractures 113

Fractures Head Injuries Research Outcomes 113

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. His CT scan showed extensive cranial fractures, traumatic subarachnoid haemorrhage, and intraparenchymal haemorrhage. Should we aim to prevent fever, or should we cool patients?

Hyperthermia / Hypothermia 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

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. X-rays demonstrate a minimally displaced midwaist fracture of the scaphoid. The LR- to rule out a scaphoid fracture was 0.15

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). In urgent or elective situations, always discuss the procedure completely, and provide realistic information on expected outcomes and possible complications.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

Don't Forget the Bubbles

JUNE 30, 2023

She has a right parietal-occipital region haematoma, and you think you might be able to feel a step – you’re pretty convinced she has a palpable skull fracture. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Two IVs go in, one in each antecubital fossa.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Hospitals 83

RebelEM

JANUARY 29, 2024

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).

Stroke 136

Stroke Outcomes Hospitals Administration 136

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? She […] The post SGEM#273: My Buddy (Tape) for Boxer’s Fractures first appeared on The Skeptics Guide to Emergency Medicine. Background: Boxer’s fractures are common hand injuries. Reference: Pellatt et al.

Fractures 40

Fractures EMS Outcomes Emergency Department 40

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.

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. Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med May 2017.

Fractures 40

Fractures Pediatrics Ultrasounds Academics 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

Emergency Medicine Journal

NOVEMBER 28, 2023

Background There is a high rate of surgical fixation of displaced Colles’ type distal radial wrist fractures despite fracture manipulation in the ED. Point-of-care ultrasound has been used to guide ED manipulations but its effect on the quality of fracture reduction or subsequent need for surgical fixation is unknown.

Fractures 40

Fractures Ultrasounds Outcomes Research 40

The Skeptics' Guide to EM

MARCH 27, 2021

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. Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 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

Low Risk Intra-Abdominal (IAI) Trauma – Derivation of the Rule The PECARN Group first released their derivation of a pediatric prediction rule for intra-abdominal injury in 2013. 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

JULY 25, 2024

More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters! Currently EVT for large core is being looked at and so far the outcomes seem to be favorable

Stroke 97

Stroke Fractures Outcomes Operations 97

RebelEM

MAY 25, 2023

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]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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

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. Abstract 2268 Table 1 Rib-fracture Data Set March 2022 – June 2023

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

We aimed to assess the STRC by reviewing the journey and outcomes of patients who attended the clinic. In total, 56 patients were reviewed with vertebral fractures. Methods A retrospective review of electronic chart data was performed on all patients who attended the clinic over the initial 1-year period.

Operations 75

Operations Fractures Outcomes 75

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

Sensible Medicine

OCTOBER 21, 2024

One of those rules was (and remains) that if differences are observed in outcomes that were not pre-specified these should be regarded merely as generating hypotheses for testing in further studies But then something happened. Our lorcainide study faithfully followed all the rules of clinical trials as they were then understood.

Evidence-Based Practice 115

Evidence-Based Practice Shock Outcomes Fractures 115

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. A 12-year-old male is being transported by ambulance after a road traffic accident.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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

DECEMBER 2, 2024

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?

Documentation/Coding 94

Documentation/Coding Pediatrics Emergency Department Fractures 94

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

Taming the SRU

FEBRUARY 24, 2024

non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 93

Leadership EMS Pediatrics Stroke 93

The Skeptics' Guide to EM

JANUARY 30, 2021

The X-ray demonstrates a fracture of the distal radius that is in an acceptable position and does not require a reduction. You immobilize her in a below elbow splint which provides significant pain relief and refer her to the local orthopedic fracture clinic. J Bone Joint Surg Am. Reference: George et al. J Bone Joint Surg Am.

Fractures 52

Fractures Documentation/Coding Outcomes 52

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 Fractures Administration 95