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

APRIL 30, 2024

Angioembolization requires the presence of a special interventional radiology team and a reasonably stable patient. 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

Mount Sinai EM

DECEMBER 27, 2022

Illustration by Yvonne Chow The Lisfranc Injury The lisfranc injury is any disruption of the joint and is a spectrum including ligamentous injury, dislocations and fractures. High energy mechanisms, such as MVCs or falls, are more likely to cause fracture-dislocations. Normal Lisfranc joint and ligament.

Dislocations 130

Dislocations Fractures Operations Radiology 130

The Trauma Pro

DECEMBER 12, 2023

In some hospitals, orthopedics may choose to place a traction pin to provide initial fracture management. A patient may be more rapidly taken to the operating room or interventional radiology if the patient is in the emergency department. They may choose to use sedation, which may not be as readily available on a surgery ward.

Emergency Department 124

Emergency Department Operations Hospitals Radiology 124

EMergucate

MAY 12, 2016

Anatomy Features Radiology Classification Weber A = Supination Adduction (Lauge Hansen) Weber B = Supination Exorotation (Lauge Hansen) Weber C … Continue reading →

Fractures 40

Fractures Radiology Radiology EMS 40

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]. traumatic axial loading with calcaneal fractures, pilons, and vertebral compression fractures) [5]. Gross deformities often suggest fracture or dislocation [Image 2].

Fractures 77

Fractures Dislocations Operations Radiology 77

Cook County EM Blog

APRIL 24, 2023

He was initially seen in triage and right hand radiographs were obtained and read by the radiology resident as negative (Figure 1). Based on the exam and suspicion of a fracture seen on the hand radiographs, the patient was sent back to get dedicated radiographs of the involved digit (Figure 2).

Radiology 52

Radiology Radiology Fractures 52

RebelEM

AUGUST 30, 2023

Diagnostic Radiology: Musculoskeletal and Breast Imaging. Vertebral Osteomyelitis and Spinal Epidural Abscess: An Evidence-based Review. J Spinal Disord Tech. 2015 Jul;28(6):E316-27 PMID: 26079841 Chowdhury V, Gupta A, Khandelwal N. New Delhi: JP Brothers Medical Ltd; 2012 Della-Guistina, D.

Infectious Diseases 104

Infectious Diseases Fractures Radiology Radiology 104

ALiEM

DECEMBER 22, 2023

The patient reported a history of falls resulting in shoulder, rib, and left hip fractures in the past. Occult femur fracture Occult fractures are defined as fractures that cannot be detected by standard radiographic examination until weeks after the injury either due to lack of displacement or limitations of the imaging study.

Fractures 64

Fractures Dislocations Academics Radiology 64

Mind The Bleep

NOVEMBER 6, 2023

In this injury, there is a fracture of the orbital floor and the inferior orbital rim remains intact. The “teardrop sign” is a radiological sign of inferior orbital wall fractures in which intraorbital fat +/- inferior rectus muscle herniates through the fracture. Teardrop sign (inferior orbital wall fracture).

Fractures 52

Fractures Radiology Radiology Emergency Department 52

ALiEM

FEBRUARY 28, 2024

We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. Photographs, ECGs, Radiology Images These fall into the category of “other multimedia” in the AMA Manual of Style, and here is my best attempt to interpret this to clinical media. Apps App Title app. Version number.

Radiology 52

Radiology Radiology Academics Fractures 52

ALiEM

JUNE 10, 2024

High Risk (>12.1% risk of injury) -> Consider CT Altered mental status (GCS 3-8 or AVPU = U) Abnormal airway Breathing Circulation findings Focal neurological deficits Intermediate Risk (2.8% sensitivity and 99.9%

Pediatrics 126

Pediatrics Emergency Department Research Fractures 126

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 54

Fractures Resuscitation Operations EMS 54

American Medical Compliance

FEBRUARY 28, 2024

Orthopedic surgery to guide joint replacements and treatment of fractures. Radiation Protection in Interventional Radiology Over the last decade there has been a rapid increase in the number of interventional radiology (IR) procedures performed. The radiation dose that the patient receives varies on the type of procedure.

Radiology 52

Radiology Radiology Fractures Operations 52

Don't Forget the Bubbles

DECEMBER 2, 2024

This may lead to either missing potential fractures or overcall injuries, leading to increased use of hospital resources and increased morbidity. Missing potential fractures or overcall injuries may lead to increased use of hospital resources and increased morbidity. Why does it matter?

Documentation/Coding 94

Documentation/Coding Pediatrics Emergency Department Fractures 94

Pediatric Emergency Playbook

NOVEMBER 1, 2016

What am I seeing -- or not seeing -- here? First a refresher on radiographic anatomy of the elbow -- Images courtesy of Radioglypics (Open Access Radiology Education). If you don't see the obvious fracture, you can be "saved" by the sail sign and/or a posterior fat pad. Position of comfort, analgesia, xrays, and now what?

Pediatrics 52

Pediatrics Fractures Dislocations Radiology 52

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. She’s wheeled to radiology. Two IVs go in, one in each antecubital fossa. D – here, we have a problem. Polly’s drowsy, and a formal GCS is 12 – E3, V4, M5.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

The Skeptics' Guide to EM

NOVEMBER 9, 2019

You do not have an ultrasound tech available at night and you are thinking of using your point of care ultrasound (POCUS) skills to look for a possible appendicitis, but you are unsure how accurate this test would be especially compared to other modalities such as radiology performed ultrasound.

Ultrasounds 52

Ultrasounds Fractures Pediatrics Radiology 52

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

Taming the SRU

OCTOBER 1, 2023

Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. PPV, rib fractures, and decreased GCS were predictive of conservative management failure [23]. doi:10.1148/radiology.144.4.7111716 89% of patients with PTX under this cutoff were successfully observed. AJR Am J Roentgenol. doi:10.2214/ajr.165.5.7572489

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Cook County EM Blog

MARCH 28, 2023

As the patient was also having facial pain and reported multiple episodes of blunt facial trauma over the past months, CT facial bones was completed which demonstrated chronic fracture deformities of the left inferior orbital wall, a communited chronic nasal bone fracture, and confirmed posterior lens dislocation.

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 52

Pediatric Education

OCTOBER 22, 2023

The radiologic evaluation confirmed that these were subcutaneous fat necrosis. The pediatrician thought that given the history, location and texture of the masses, that this was most likely fat necrosis secondary to the forceps delivery. Other considerations included hematoma or congenital malformation or deformation.

Radiology 52

Radiology Radiology Fractures Pediatrics 52

The Skeptics' Guide to EM

MARCH 25, 2023

Many small trials have compared the accuracy of POCUS to the “gold standard” of “Radiology-performed ultrasound”. One use of POCUS we have not covered yet is for diagnosing acute biliary disease. As demonstrated in the list of SGEM episodes, ED clinician performed POCUS has been increasing in popularity over the years.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 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

RCEM Learning

NOVEMBER 28, 2022

Introduction Immediate management Control of haemorrhage Use of pelvic binder REBOA Management of stable VS unstable fracture Management of closed VS open fracture Other injuries Immediate management Coordinated and structured approach (eg. Learning bite Nearly 90% of pelvic fracture bleeding is venous in origin.

Fractures 40

Fractures Blood Transfusions Sepsis Operations 40

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.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Emergency Medicine Cases

OCTOBER 25, 2022

In this main episode podcast, Dr. Arun Sayal creator of the CASTED course and Dr. Yatin Chadha a radiologist with a fellowship in MSK radiology, join Anton for Part 1 of 2 podcasts on Emergency Orthopedic Injuries.

Radiology 52

Radiology Radiology Fractures EMS 52

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.

CPR 89

CPR Burns Airway Management Wellness 89

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. After balloon occlusion, blood pressure improved sufficiently to take the patient either to interventional radiology or to the OR. Four patients lived, two died.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

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). Commonly hematogenous spread from bacteremia; clinical suspicion should prompt radiologic evaluation.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Pediatric Emergency Playbook

MARCH 1, 2016

He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. Rib fractures on CXR predict pulmonary contusions. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Unstable patients do not belong in a radiology suite - they belong in the ED resus bay to be resuscitated first. Nachi: All valid points, but let’s dive in too some actual detail.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

PEMBlog

SEPTEMBER 13, 2023

battle sign bruises around the mastoid, raccoon eyes, or other bruising and lacerations) or reported by history – but could be identified (later) with a bleed or fracture on a head CT scan if your index of suspicion is high or the seizure is going well beyond the expected duration and not responding well to antiepileptics.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

In fact, one of my surgeon grandfather's ortho buddies (perhaps with the help of some lunchtime martinis) took a look at the x-rays of my Boxer's Fracture and snapped it back into place without any analgesia or procedural sedation, casted me, and sent me home. Still no pain medicine. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Life in the Fast Lane

MAY 16, 2024

Michael Gibbs MD Adult Ortho Cases 003 Sternal. Adult Orthopedic case interpretation with Carrie Bissell, Aaron Fox, Stephanie Jensen, Kendrick Lim and Olivia Rice

Dislocations 52

Dislocations Radiology Radiology Fractures 52

Life in the Fast Lane

DECEMBER 10, 2023

Michael Gibbs MD Pediatric Ortho Cases 007 December 2022; Elbow injuries. Pediatric Orthopedic case interpretation with Haley Dusek, Danielle Sutton, and Virginia Casey

Pediatrics 52

Pediatrics Dislocations Radiology Radiology 52

Don't Forget the Bubbles

MARCH 4, 2024

Reviewed by: Kieran McDonnell Article 4: Diagnosing Paediatric Distal Forearm Fractures with Ultrasound Snelling PJ, Jones P, Bade D, Bindra R, Davison M, Gillespie A, et al. Diagnostic accuracy of point-of-care ultrasound versus radiographic imaging for pediatric distal forearm fractures: A randomized controlled trial.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78