The Skeptics' Guide to EM

APRIL 8, 2023

The pre-specified subgroup analyses showed a decrease in in-hospital or 30-day mortality for myocardial infarction, stroke, aortic aneurysm, and major trauma but not for pneumonia, bowel perforation or hip fractures. They found no statistical difference for in-hospital mortality but slightly increased 30-day mortality.

Stroke 56

Stroke Emergency Department COPD Academics 56

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. Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. Two IVs go in, one in each antecubital fossa. Pupils are equal and reactive.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EM SIM Cases

NOVEMBER 12, 2022

The exact moment these orders are completed, a stroke activation will be called for a patient eligible for tPA. Stroke protocol needs to be followed and tPA will need to be given. The trauma will be an open book pelvic fracture with hypotension and a positive FAST.

Resuscitation 40

Resuscitation Stroke EKG/ECG Fractures 40

Taming the SRU

FEBRUARY 12, 2024

CT HEAD Bilateral hemorrhagic contusions, left subdural hematoma with mass effect, scattered subarachnoid hemorrhage, occipital bone fracture and venous thrombosis adjacent to fracture site. Notable diagnostics Point-of-care glucose (initial): 274 PT/INR: 47.4/4.9

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

Taming the SRU

DECEMBER 6, 2023

Occult fractures exist, therefore a high index of suspicion for these injuries is necessary, even in the setting of initially negative plain films. With rare exception, patients with sICH should be admitted to a specialized stroke unit (NSICU). Read your own x-rays - you know the patient’s exam better than the radiologist!

Leadership 57

Leadership Stroke Airway Management Administration 57

Mind The Bleep

JUNE 18, 2023

Risks with antipsychotics -Increased risk of death -Stroke -Falls and fracture -Postural hypotension -Extrapyramidal side effects/ parkinsonian symptoms Risks with Benzodiazepines -Drowsiness -Confusion -Falls and fracture -Memory problems -Dependence risk They are not recommended for longer than 2 weeks.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. A subset of these patients develop an accelerated rate either primarily or due to other factors known as rapid ventricular response.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

Taming the SRU

JULY 31, 2024

Barometric pressure, humidity, and temperature changes may influence stroke and fall incidence (especially in elderly patients with cardiovascular risk factors). Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Pediatric Emergency Playbook

JULY 1, 2016

T – Toddler’s fracture This is usually a torque injury when the wobbling toddler pivots quickly or trips and falls. Toddler’s fractures happen in children 1 to 3 years of age, and occur in the distal 1/3 of the tibia. Sometimes a cast is needed, but currently there is a new trend in foregoing casting in mild cases.

Fractures 52

Fractures Poisoning Wellness Sepsis 52

ACEP Now

MAY 9, 2024

Classically associated with long bone fractures, a PFE may also occur when fat is injected or absorbed into a blood vessel during the reinjection phase of an AFT procedure. The most concerning complication of AFT is the pulmonary fat embolism (PFE).

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Taming the SRU

AUGUST 30, 2023

Identifying serious causes of back pain: cancer, infection, fracture. Cleve Clin J Med. 2008 Aug;75(8):557-66. doi: 10.3949/ccjm.75.8.557. PMID: 18756836.

Infectious Diseases 89

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

EB Medicine

NOVEMBER 1, 2018

CNS dysfunction may be immediate or delayed and can range from strokes to spinal cord injuries. Cerebral salt wasting syndrome, peripheral nerve lesions, spinal cord fracture, and cerebral hemorrhages have all been described. Nachi: From the neurologic standpoint – it’s a bit more complicated.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. 3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck. Br J Neurosurg. 2017;31(2):223–6.

Seizures 98

Seizures Stroke Outcomes EMS 98

Northwestern EM Blog

JANUARY 3, 2022

climbing stairs) Diagnosis: Anterior patella tenderness; pain with patellar grind test , deep knee flexion EM differential: meniscus injury, stress fracture, ligamentous injury Initial treatment: home exercise program or formal physical therapy to strengthen quadriceps, core, and hip abductors.

Fractures 52

Fractures EMS Urgent Care Stroke 52

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. Use soothing sensory measures: speak softly, offer a pacifier, and stroke the skin softly. Pediatr Clin North Am. 2007 Oct;54(5):645-72.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

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. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

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 Fractures Documentation/Coding Administration 95

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

Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EM Literature of Note

FEBRUARY 17, 2025

Reviving High-Dose Oxygen Therapy After Stroke Do Facial Fractures Require Antibiotic Prophylaxis? A Nice Win for Radiology AI Where Endovascular Treatment Fails Even the Best Make Terrible Alerts The Future of AI is FUTURE-AI?

Anaphylaxis 57

Anaphylaxis Radiology Radiology Stroke 57

ACEP Now

FEBRUARY 11, 2025

Proving Cost Savings Our ED is a community Level II Trauma Center, Stroke Center, and STEMI [ST-elevation myocardial infarction] Receiving Center with 4,500 trauma activations, 569 hip fractures, and 450 rib fractures per year. Regional anesthesia has been shown to decrease hospital LOS for hip fractures up to 0.9

Emergency Department 80

Emergency Department Fractures Ultrasounds Hospitals 80

Taming the SRU

JUNE 6, 2023

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

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

EMDocs

FEBRUARY 18, 2025

This can be caused by lead fracture or Oversensing. In residency, the example our chiefs banged into our heads was a painter whos painting a house and every time he paints large brush strokes, his pacemaker interprets his pec firing as his heart firing.

EKG/ECG 63

EKG/ECG Documentation/Coding Wellness CPR 63

Mind The Bleep

NOVEMBER 2, 2024

If you are concerned that the clavicle may be fractured then arrange an x-ray and discuss the findings with the orthopaedics team. If you are easily able to straighten the neonates feet to normal position by stroking the outside of the foot or manipulating the foot then the talipes are ‘positional’.

Dislocations 52

Dislocations Documentation/Coding Ultrasounds Wellness 52