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. ED Physicians are already well-versed in the use of ultrasound.

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Taming the SRU

FEBRUARY 23, 2024

Clinical pathologic case presentation - r1 diagnostics/therapeutics: Lumbar punctures - AIRWAY GROUND ROUNDS- r4 capstone - r3 taming the sru - ultrasound grand rounds Clinical pathologic case presentation WITH Drs. If assessing for SAH, xanthochromia may not appear until 12 hours after onset, though may appear after 2-4 hours.

Pediatrics 74

Pediatrics Ultrasounds Fractures Wellness 74

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EM Curious

JULY 24, 2015

One of our beloved colleagues from the community has recently declared to us his love of ultrasound guided nerve blocks--a skill that is established in the anesthesia world but is quickly gaining traction in our realm. Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures. Sorry we've been out of the loop lately.

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.

Leadership 93

Leadership EMS Pediatrics Stroke 93

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction? Consider an ultrasound guided ulnar nerve block.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

EMDocs

JUNE 6, 2023

High-velocity projectiles or direct blunt trauma to the globe should raise concern for OGI, especially if there are associated facial fractures or injuries to the adnexa. Visual prognosis is determined by the time to surgical intervention.

Fractures 87

Fractures Documentation/Coding Ultrasounds Wellness 87

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.)

EMS 52

EMS Fractures Operations Ultrasounds 52

Taming the SRU

OCTOBER 16, 2024

Pregnant patients are inherently higher risk for VTE, and because of this are excluded from normal clinical decision tools like Wells Criteria that would normally be able to help guidance our clinical decisions. Ultrasound can be used to support the diagnosis by identifying anechoic or hypoechoic fluid within the flexor tendon sheath.

Airway Management 74

Airway Management Fractures CDC Pediatrics 74

ACEP Now

MARCH 15, 2024

3 Tenderness over the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite normal plain radiographs and fluoroscopic images. Children and older adults have weaker long bones than young adults and are more likely to sustain a distal radius fracture after a FOOSH than a carpal bone injury.

Fractures 52

Fractures Dislocations EMS Emergency Department 52

ALiEM

SEPTEMBER 13, 2024

On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. Laboratory Data CT Orbits/Sella w/ IV Contrast : No acute orbital fracture. He had no other complaints and denied any other trauma or loss of consciousness during the event.

Emergency Department 64

Emergency Department Fractures Academics Hospitals 64

Don't Forget the Bubbles

DECEMBER 25, 2023

In the BUCKLED trial that looked at whether ultrasound was non-inferior to X-ray in diagnosing forearm fractures, the primary outcome was physical function of the affected arm at four weeks. How well a patient can use their arm matters greatly to the patient! They are the variables that matter most to the patient. We love POOs.

Research 83

Research Outcomes Fractures Pediatrics 83

Taming the SRU

NOVEMBER 6, 2024

jarrell, leenellett and lafollette Our workforce is changing and our interactions with our colleagues are changing as well. Beyde, artiga, and vaishnav Shoulder Dislocations Shoulder dislocations are easily diagnosed via ultrasound, with high sensitivity and specificity.

Leadership 52

Leadership Dislocations Fractures COPD 52

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 Curious

JULY 1, 2015

ULTRASOUND IN CHEST PAIN: [BLOG]: It is never a bad idea to throw an ultrasound probe on your patient with chest pain. More FOAMed HARDWARE MALFUNCTION PACEMAKER AND AICD MANAGEMENT IN THE ED [BLOG]: EM Docs brings us some well needed cardiac hardware meducation on the patient with AICD/pacemaker issues presenting to the ED.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

He is interested in ultrasound and international emergency medicine. Case: It’s a busy night in the emergency department, your next patient is a well appearing 70-year-old man, presenting after a mechanical fall from standing with loss of consciousness. The CCHR is the most researched CDR in mTBI [3] and ha.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

Broome Docs

APRIL 6, 2023

Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. PMID: 36688507 You can read Justin’s Full write up here. Emerg Med J.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

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). Typically well appearing with normal labs, however, this is a diagnosis of exclusion and a septic joint should be ruled out. Affects ages 3-8, males to females 2:1 [3].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

All Ohio EM

JANUARY 14, 2019

Without palpating, you can already tell that the patient will have many facial fractures. Well, several reasons. Remember, ultrasound can help you identify the thyroid and cricoid cartilage, ideally enabling you to better identify the membrane connecting the two. You notice the patient gargling. It’s that easy.

Pediatrics 52

Pediatrics EMS Fractures Wellness 52

Rural Doctors Net

AUGUST 30, 2013

I’d raise here the concept of his ‘anticipated clinical course’ – he’s going to OT and has airway injury that will likely progress – so you might as well intubate on these grounds alone. Sure he’s got a traumatic amputation – your tourniquet has arrested the bleeding, but there may well be more blood loss.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

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

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Original clinical studies Distribution and pattern of hand fractures in children and adolescents. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. Sethi SK, et al. Pediatr Nephrol. JAMA Pediatr.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. 89% of patients with PTX under this cutoff were successfully observed.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The patient states they were cutting an avocado when the knife pierced through and punctured his hand. Examination reveals the following: What is the diagnosis?

EMS 81

EMS Fractures Operations Ultrasounds 81

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. Jeff: Interestingly, the system I work in has prehospital physicians, who do carry US, but I can’t think of a major trauma where ultrasound changed any of the decisions we made.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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?

CPR 89

CPR Burns Airway Management Wellness 89

Urgent Care Ultrasounds

MAY 15, 2018

The importance of patient positioning, probe position and patience, for the detection of small pneumothoraces Ultrasound to rule out a pneumothorax is easy! Well, maybe. If you are using ultrasound in the primary care setting as a rule out test, you really don’t want to miss any pneumothorax, however small.

Ultrasounds 40

Ultrasounds Academics Fractures Wellness 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 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: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Which is reasonable, as that is the crux of our job as emergency physicians. Jeff: Indeed. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. EM makes a strong push into bedside use of ultrasound sonography.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

OCTOBER 28, 2024

Potential causes include: -Trauma: Blunt or penetrating thoracic injuries, rib fractures, esophageal rupture (Boerhaave syndrome). Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. Pneumomediastinum Diagnosed on Ultrasound in the Emergency Department: A Case Report. West J Emerg Med.

COPD 78

COPD Pediatrics Emergency Department Ultrasounds 78

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

NOVEMBER 1, 2018

Nachi: There is a school of thought out there that victims of electrical injury can have delayed onset arrhythmias and require prolonged cardiac monitoring – however several well-designed observational studies, including 1000s of patients, have demonstrated no such evidence. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. 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.

Infectious Diseases 88

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

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence.

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. This is particularly crucial in younger children who have received a large adult kidney and typically have relatively low creatinine levels when stable and well. An ultrasound scan of the graft is usually sufficient to rule out these complications.

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Don't Forget the Bubbles

OCTOBER 4, 2023

In this issue of the Archives , we read a large retrospective study about gastric acid suppression in infancy and the increased risk of fractures. The intriguing finding of this study was the fact that non-fracture injuries increased, which could suggest that another factor (the temperament of the child rather than gastrin or VitB metabolism?)

Pediatrics 111

Pediatrics Fractures Outcomes Research 111