Mind The Bleep

MAY 1, 2024

Whether you’re interested in orthopaedics or not, knowledge of basic fracture management can be useful in any ED. Examination of a fractured limb Most patients will be in a lot of pain. If the limb is pale and pulseless this needs urgent referral to vascular as well as orthopaedics and the fracture needs reducing immediately.

Fractures 52

Fractures Head Injuries Documentation/Coding Dislocations 52

Pediatric EM Morsels

MARCH 31, 2023

They like to pretend to be well when they are truly sick ( remember to check that Cap Refill and to never trust a Neonate! ) Children love to trick us! Sometimes it is all in good fun and other times it is quite serious! and they often show us “odd” findings that are really normal (ex, Growth Plates, Primitive Reflexes ).

Fractures 130

Fractures Dislocations Pediatrics Radiology 130

Ultrasound Gel

DECEMBER 10, 2018

The FAST exam is tried and true for trauma, but in the past it hasn't been super useful for patients with isolated pelvic fractures. This study teases out a very sick subset of this population - patient who have significant hemorrhage associated with their fracture.

Fractures 52

Fractures Wellness 52

Board Bombs

APRIL 4, 2021

well its time to close some books to save lives. The GOAT, Dr. Mary Claire O'Brien joins us to tell you ALL what you need to know about pelvic fractures. well its time to close some books to save lives. well its time to close some books to save lives. Oh and don't rock the pelvis! Oh and don't rock the pelvis!

Fractures 52

Fractures Wellness 52

Emergency Medicine Cases

AUGUST 28, 2018

In this EM Cases Journal Jam podcast with Anton Helman, Justin Morgenstern, Rory Spiegel, and special guest Jacques Lee we explore the evidence for femoral nerve blocks and fascia iliaca blocks as well as discuss the practical implementation of them in your ED. Do they decrease opioid use? Are they safe compared to standard pain management?

Fractures 52

Fractures EMS Wellness 52

Emergency Live

JUNE 7, 2023

What is the cortex made up of?

Fractures 116

Fractures Wellness 116

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. Most commonly caused by fracture or dislocation of vertebrae. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.”

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Emergency Medicine Journal

AUGUST 21, 2024

A recent study based on Royal College of Emergency Medicine (RCEM) audit data concluded that it was not possible to identify an ED in the UK that performed consistently well in the assessment and management of pain. Regional analgesic techniques have been demonstrated to provide superior pain relief; however, in the older adult with.

Fractures 52

Fractures Wellness 52

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

Mind The Bleep

AUGUST 18, 2024

Patients with orbital fractures will present with swelling and periorbital bruising. Examination of possible orbital floor fracture: Presence of proptosis/exophthalmos, enophthalmos or hypoglobus Visual acuity in both eyes Check eye movements Presence of diplopia and in which gaze? This normally resolves once the swelling improves.

Fractures 91

Fractures Soft Tissue Injuries Burns Emergency Department 91

Taming the SRU

JANUARY 24, 2024

The case highlights how we as providers can grieve the loss of our patients, as well as the profound relationships with can make with their family members. Orthopedic Injuries Quick Hits Upper Extremity Injuries Galeazzi Fracture How? fracture of distal 1/3 of radial shaft w/ distal radioulnar joint injury Management?

Fractures 88

Fractures Leadership Dislocations Resuscitation 88

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

Pediatric Education

APRIL 7, 2024

The mother was counseled about how to manage the lip laceration, and was relieved to hear that a nasal fracture was very unlikely in his case. Nasal fractures are fewer in younger ages but increase in incidence as children age because of increased opportunity for trauma (e.g. playing, sports, car accidents, etc.).

Fractures 40

Fractures Head Injuries Pediatrics Wellness 40

The Trauma Pro

MAY 19, 2023

Not only trauma professionals, but other in-hospital clinical services as well. In trauma, the most common reason to order is “to monitor for bleeding from that spleen laceration” or some other organ or fracture complex. The serial hemoglobin (Hgb) determination. We’ve all done them. They inflict pain. So why do them?

Fractures 130

Fractures Hospitals Wellness 130

Taming the SRU

MARCH 11, 2024

It is also important for the emergency physician to ask about previous surgeries on the affected knee, as well as anticoagulation status. CTAs have the added benefit of also further evaluating the surrounding osseus structures for associated fracture.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

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 Emergency Department Outcomes 40

Dr. Smith's ECG Blog

AUGUST 18, 2024

The patient was found to have a fractured lead, which was replaced successfully without complications and with resolution of symptoms. He did well. No P wave and no QRS ever follows any of the regular pacing spikes ( a result of the fractured pacing lead ). Smith: this can usually be seen on chest x-ray.

EKG/ECG 113

EKG/ECG Fractures Burns Wellness 113

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

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

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

The Trauma Pro

SEPTEMBER 15, 2023

Typical ones include hemorrhagic injuries to the brain, pelvic and spine fractures, and solid organ injuries. Bottom line: Seeing such a well-designed and nicely executed study is refreshing. These guidelines typically recognize specific injuries that increase the risk of bleeding if anticoagulants are given.

Administration 113

Administration Fractures Wellness 113

Pediatric EM Morsels

JULY 7, 2023

Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ). Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma.

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

PEMBlog

SEPTEMBER 26, 2024

She denies any associated redness, warmth, or bruising to the area as well as any trauma or falls. He has been doing well since discharge. On exam, the child has normal vital signs and is generally well appearing. Healing femur fracture C. No recent illnesses or any other symptoms. Labs Calcium 10.6 [Reference Range 8.7-10.7

Fractures 59

Fractures Pediatrics Wellness 59

Emergency Medicine Cases

JANUARY 2, 2024

Triquetrum chip fractures, scapholunate injuries, hook of the hamate fractures, and of course, scaphoid fractures can be easily missed with serious consequences for our patients. The post Ep 190 Carpal Bone Injuries – The Big 4 appeared first on Emergency Medicine Cases.

Fractures 52

Fractures Wellness Dislocations EMS 52

The Trauma Pro

APRIL 30, 2024

In the next post, I’ll look at a brand new paper that includes a cost analysis as well. Reference: Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. Interestingly, the use of AE and PPP vary geographically.

Radiology 113

Radiology Radiology Research Fractures 113

EMergucate

OCTOBER 9, 2022

The pelvic x-ray shows right inferior pubic ramus fracture as well as right acetabular fracture. There is buckling of arcuate … Continue reading →

Fractures 52

Fractures Wellness EMS 52

The Trauma Pro

DECEMBER 26, 2023

Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility.

Fractures 124

Fractures Documentation/Coding Hospitals Research 124

The Trauma Pro

OCTOBER 31, 2023

Many simple fractures and wounds do not need immediate attention. Explain to the consultant that you truly believe that harm will occur, and you will have to document that fact in the medical record as well as their failure to respond. Are they right? Does that problem really need to be dealt with in the ED in the middle of the night?

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

Taming the SRU

MAY 23, 2023

BACKGROUND Foot injuries are common and can have significant implications for a patient’s well-being, functional capacity, and finances. fractures of the talar body, talar neck, and calcaneus require high-impact trauma). Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis.

Fractures 57

Fractures Dislocations Operations EMS 57

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

Taming the SRU

SEPTEMBER 1, 2023

These were adult trauma patients with compromised vitals, clinical suspicion for life-threatening injuries, and/or presence of a severe injury Negative study for this primary outcome, but potentially an under-powered study Also, study involved mortality of all trauma patients, lumping together patients with polytrauma and those with TBI’s Secondary (..)

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

Sensible Medicine

JANUARY 2, 2024

If the health and wellness of one system is askew, there will be an impact on the other systems as well. While trauma, fractures, and crystalline diseases can influence OA, metabolic- disease-associated osteoarthritis is becoming far more prevalent. The cause of OA is far more complicated than we could imagine.

Fractures 140

Fractures Wellness Research 140

The Trauma Pro

MAY 2, 2023

Splint to reduce fracture bleeding. Pack well, close and re-establish normal physiology before doing all the final repairs. We are not always as fastidious as we should be because of the universal availability of blood products. Use direct pressure or direct suture ligation for external bleeding. Always watch the temperature.

Blood Transfusions 100

Blood Transfusions Fractures Wellness Resuscitation 100

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. 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

Taming the SRU

AUGUST 6, 2023

Kletsel Pustular psoriasis Psoriasis is characterized by discrete plaques of erythema, scales, and fissures of the extremities It is associated with significant morbidity & treatment consists of topical steroids, along with referral to establish with dermatology Use caution with systemic steroids as they can potentially worsen flares While rare, (..)

Infectious Diseases 84

Infectious Diseases Pediatrics Fractures Wellness 84

Taming the SRU

FEBRUARY 23, 2024

Total RBC count (<500 RBCs in last tube), as well as clearance by the last tube (decrease in RBC count by at least 70% by the last tube), can be used to differentiate between traumatic taps and a SAH. 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

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