EM SIM Cases

DECEMBER 15, 2023

Sophie Ramsden (Emergency Medicine Resident, McMaster University, Hamilton, Ontario) Why it Matters Major trauma patients sometimes decompensate after initial resuscitation. A detailed re-examination is important as the decline can be caused by an injury that was identified or missed in the initial stabilization phase.

Fractures 40

Fractures Resuscitation Academics Shock 40

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Dr. Smith's ECG Blog

JULY 3, 2020

She had multiple rib fractures as well as serious hemorrhage and underwent massive transfusion. She sustained chest wall trauma, including rib fractures with serious bleeding. The patient was in shock on arrival in the ED — and multiple blood transfusions were needed.

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Blood Transfusions EKG/ECG Shock Fractures 52

Pediatric Emergency Playbook

OCTOBER 1, 2015

The two most common complications of VP shunts are malfunction (due to obstruction, fracture, or kinking) or infection. He is in compensated shock. The Huber needle is not a resuscitative line. Vascular Devices: assume the line is not functional, and use another to resuscitate, especially in port-a-caths.

Pediatrics 40

Pediatrics Fractures Resuscitation Burns 40

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2]

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

JUNE 25, 2024

Most common traumatic injuries are fractures, TBIs, and thoracic or abdominal injuries. Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Always consider trauma and toxic exposure in the burn patient.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

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. Resuscitative Thoracotomy in Children In a 40-year review of ED thoracotomy, Moore et al. Resuscitative thoracotomy for blunt trauma has a dismal prognosis in children.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

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]. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. J Emerg Trauma Shock. Resuscitation. Ann Emerg Med.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Pediatric Emergency Playbook

MARCH 1, 2016

He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in compensated shock, with tachycardia. Resuscitative Pearls Our goal here is damage control. We should not allow children to become hypotensive – severe tachycardia alone should prompt us to resuscitate.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

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. You should also consider the possibility of quote unquote spinal shock.

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Fractures Pediatrics Radiology Radiology 52

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015.

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Emergency Department Burns EKG/ECG Shock 40

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Click to enlarge.) His ECG was unremarkable.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 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. 1950s & 1960s Resuscitation Research. Still no pain medicine.

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Emergency Nursing EMS Resuscitation Military 40

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. The latter also recommend ED thoracotomy in those with refractory shock.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 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. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. In one study, a SI > 0.7

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Ultrasounds Radiology Radiology Sepsis 40

Rural Doctors Net

AUGUST 30, 2013

Pull straight any fractures & splint them. Whilst we’ve ‘re-discovered’ balanced resuscitation (first described by Cannon back after WWI), there remains some limited controversy – listen to this 2013 take from Simon Carley at St. For the spontaneously breathing patient, there can be significant differences in FiO2.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

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 64

Fractures Resuscitation Operations EMS 64

Pediatric Emergency Playbook

JANUARY 1, 2017

Some are simple comfort measures such as splinting (fracture or sprain), applying cold (acute soft tissue injury) or heat (non-traumatic, non-specific pain), or other targeted non-pharmacology. Long-bone injuries Fracture pain should be addressed immediately with splinting and analgesia. Pediatr Clin North Am. 2007 Oct;54(5):645-72.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Dr. Smith's ECG Blog

MARCH 8, 2025

She sustained a large scalp hematoma along with several rib and vertebral fractures, but with CT scanning of chest/abdomen/pelvis/C-T-L-spine and head, no life threatening injuries were found. Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J.

EKG/ECG 75

EKG/ECG CPR Resuscitation Wellness 75

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

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Documentation/Coding Seizures Psychiatric Wellness 64