The Skeptics' Guide to EM

JULY 29, 2023

Background: We have covered head injuries including concussions multiple times on the SGEM. This has included looking at the Canadian CT Head Rules/Tools ( SGEM#106 , SGEM#266 , and SGEM#272 ). This has evolved due to recognition of some of the adverse effects of immobilization as well as limitations to its benefits.

Head Injuries 79

Head Injuries EMS Research Emergency Department 79

Downeast Emergency Medicine

APRIL 26, 2021

CRASH-3 TRIAL COLLABORATORS This international, multi-center, randomized, placebo-controlled trial looked at the effects of TXA on head injury-related death, disability, and adverse events in adult patients with TBI. The primary outcome was head injury-related death in-hospital within 28 days of injury.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

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 Canadian CT Head Rule [2] is a clinical decision instrument to help you decide if a patient with a mild head injury requires a CT head.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

Emergency Medicine Ireland

MAY 3, 2021

This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. . * Welcome back to the tasty morsels of critical care podcast.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40

The Skeptics' Guide to EM

MAY 22, 2021

The patient is not anticoagulated, has no midline neck pain, and no evidence of other injuries. She is generally well appearing without any deficients on neurological examination, given her minor mechanism, and normal examination no imaging or further testing is required. She was ambulatory on scene.

Head Injuries 52

Head Injuries Research Emergency Department Pediatrics 52

Pediatric EM Morsels

JULY 21, 2023

We have mentioned the Glasgow Coma Scale in multiple delicious morsels: Minor closed head injuries in <3 month olds and in the rebaked morsel , Blunt cerebrovascular injury , Cerebral edema in DKA , Pediatric Trauma Pitfalls , and Carbon monoxide poisoning. Predicting outcome in individual patients after severe head injury.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Pediatric Education

APRIL 7, 2024

The mother was given head injury instructions and asked to monitor for any additional problems that arose for his nose or mouth too. Epistaxis is common but not for every injury. Blood clots may make the internal examination difficult to complete as well. Other drainage should be asked about and inspected for.

Fractures 40

Fractures Head Injuries Pediatrics Wellness 40

Sensible Medicine

NOVEMBER 3, 2023

He is otherwise well, with only hypertension, well-controlled on one medication. Ten years after her husband’s death, MV fell and hit her head. The head injury eventually took her life. .  Sensible Medicine is a reader-supported publication.   They say that there is nothing worse than dying alone.

Hospice 108

Hospice Head Injuries Academics Hospitals 108

EMDocs

JULY 20, 2023

Patient had to be able to be randomized between 6-24 hours after last known well. Exclusion criteria: Medical history of severe head injury with lasting neurologic deficit in past 90 days. Pre-stroke disability had to be insignificant measured by mRS (modified Rankin Scale) of 0 or 1.

Stroke 73

Stroke Outcomes Head Injuries Psychiatric 73

EB Medicine

SEPTEMBER 20, 2019

Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Prospective cohort study; 42,412 patients) Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. 2009;374(9696):1160-1170.

Emergency Department 40

Emergency Department Head Injuries Pediatrics Hospitals 40

Mind The Bleep

MAY 1, 2024

If the limb is pale and pulseless this needs urgent referral to vascular as well as orthopaedics and the fracture needs reducing immediately. Open fractures – these need to be irrigated (where appropriate), ideally photographed, and the patient needs IV antibiotics within 1 hour and a tetanus booster.

Fractures 52

Fractures Documentation/Coding Head Injuries Dislocations 52

ACEP Now

JULY 6, 2023

5 Patients with acute ischemic strokes, STEMIs, and trauma, as well as many other diagnoses, have their workup largely completed, and even sometimes definitive therapy executed, before they leave the emergency department, rather than requiring inpatient units. Risk of brain tumor induction from pediatric head CT procedures.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

The Skeptics' Guide to EM

MARCH 12, 2022

She knows about taking it easy physically for the next couple of days but wonders if she must stay off her computer as well? Background: Concussions or mild traumatic brain injury (mTBI) are commonly diagnosed in the Emergency Department (ED).

Emergency Department 40

Emergency Department Head Injuries Pediatrics Research 40

The Skeptics' Guide to EM

OCTOBER 26, 2019

This study by Iyengar and colleagues examines the impacts of financial incentives, as well as varying levels of risk and benefit, on patient preference for CT imaging in the setting of low risk head injury [3]. Thus, it is important to know what factors influence patients’ decision to undergo CT.

Emergency Department 52

Emergency Department Head Injuries Research Wellness 52

RebelEM

AUGUST 24, 2023

The “usual care intervention” was not well-defined. It is essential to outline a rehabilitation plan which includes clear, well-defined, and sport-specific steps to keep this population motivated throughout their recovery. However, the definition of “social” activities was not well defined.

Pediatrics 98

Pediatrics Outcomes Hospitals Research 98

PHEM Cast

APRIL 19, 2016

Prehospital paediatric RSI We do it less despite similar injury aetiology/patterns Most children’s airways can be managed by basic manoeuvres However, children with a significant head injury deserve best airway care – ventilation, metabolic, haemodynamics, positioning.

Head Injuries 52

Head Injuries Ambulance Services Hospitals Leadership 52

The Injectable Orange

JUNE 20, 2017

While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. How do they do it so well?” Well done”……. Check back. Confirmation. Completion. he thought. This demands more research.” Deep breath. “OK

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

RebelEM

MAY 25, 2023

Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Dr. Smith's ECG Blog

JULY 22, 2012

A 6 yo girl had significant trauma from an MVC, with head injury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries. Inpatient stay : She quickly awoke and was observed for a couple days, treated for minor orthopedic injuries, and recovered well from the head injury.

Head Injuries 52

Head Injuries EKG/ECG Outcomes Ultrasounds 52

Pediatric Emergency Playbook

JANUARY 1, 2016

Abusive head injury is the most common cause of death from child abuse. Up to 30% of infants with abusive head injury may be misdiagnosed on initial presentation. Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. Louwers et al.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric EM Morsels

JULY 5, 2024

risk of C Spine injury) Altered Mental Status (GCS 3-8 or U on AVPU) Abnormal ABCs on exam Focal Neurologic Deficits (paresthesia, numbness, weakness) Not Negligible Risk (2.8% Moral of the Morsel Anatomy Matters: Pediatric patients have unique C-spine anatomy, which predisposes them to different injury patterns than adults.

Pediatrics 161

Pediatrics Head Injuries Dislocations Research 161

Emergency Medicine Journal

NOVEMBER 28, 2023

The data identified pathways with largest impact potential - chest pain, dyspnoea and falls/frailty/head injury. Method and Design Using the model for improvement we defined aims and set measures, including number of patients offered alternatives to ED or admission, with balancing measures of patient reattendance/readmission.

Urgent Care 40

Urgent Care Head Injuries Emergency Department Hospitals 40

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

RebelEM

FEBRUARY 29, 2024

Patient data anonymized when presented to adjudication committee to avoid detection bias Well-balanced patient characteristics between groups. Included traumatic and nontraumatic brain injuries. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. El-Ebiary, M.;

CDC 123

CDC Outcomes Radiology Radiology 123

ACEP Now

MAY 6, 2023

In the case of an unrestrained driver, the most common locations of impact are the steering wheel, the instrument panel, and the windshield (most commonly resulting in head injury). Unrestrained passengers tend to strike the windshield and dashboard, often sustaining trauma to the head, thorax, and legs.

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

The Skeptics' Guide to EM

OCTOBER 17, 2020

However, patients with significant head injury were excluded in this study and it was unclear of the effect of TXA in this group. The authors reported no statistical superiority of TXA compared to placebo for the primary outcome of head injury-related deaths within 28 days.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

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,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Mind The Bleep

JUNE 18, 2023

environmental factors, pain, infection, dehydration, electrolyte disturbance, head injury, medication etc) Does the individual have capacity? In a general hospital there are the dementia and delirium team, as well as Liaison Psychiatry who you can refer to.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

The Skeptics' Guide to EM

MAY 30, 2020

Lancet 2010 ) CRASH-3 was a well-designed, large, multi-centred randomized placebo controlled trial published in October 2019 ( The Lancet ). It asked if TXA had a mortality benefit in patients with isolated head trauma ( SGEM#270 )? It asked if TXA had a mortality benefit in patients with isolated head trauma ( SGEM#270 )?

Head Injuries 52

Head Injuries Academics Outcomes EMS 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Abstract 2086 Table 1 Presentations Total first presentation over 2021 Total deaths (within 30 days ) Admission Admission (%) Percentage of deaths [CI ] INJURY OF SHOULDER/ARM/ELBOW/WRIST/HAND 8416 4 424 5 0.05[0.018 0.018 , 0.12] INJURY OF HIP/LEG/KNEE/ANKLE/FOOT 7427 15 653 8.8 HEAD INJURY 3493 22 382 10.9 0.23 , 6.9]

Documentation/Coding 40

Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

Don't Forget the Bubbles

JUNE 30, 2023

Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. You will be running the show today, and you want to use your preparation time well. They had been enjoying a celebratory dinner following their safe return from a trip to the Amazon rainforest.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

The Skeptics' Guide to EM

APRIL 9, 2022

He remained completely awake and alert and otherwise appeared well. She tells you that he woke up normally this morning, but after breakfast he began asking the same questions repetitively and was amnestic to the answer, seemingly unable to form new memories. There was no history of recent trauma, infectious symptoms, or any other illness.

Head Injuries 52

Head Injuries Emergency Department Seizures Stroke 52