The Trauma Pro

SEPTEMBER 20, 2024

Getting there includes an obvious problem: what happens when the physician leaves the hospital? Other surgeons may be available in the hospital during the daytime, although they may have other responsibilities keeping them busy. For emergency physicians, there are generally several on duty, so one will not be missed too much.

Hospitals 187

Hospitals EMS Wellness 187

Ken Grauer, MD

DECEMBER 8, 2023

Instead, he left the hospital — only to be found dead at home 36 hours later. For full discussion of this case — See ECG Blog #292 — == The 2 ECGs shown in Figure-1 were obtained from a man in his 30s — who presented to the ED ( E mergency D epartment ) with chest pain that began several hours earlier. ECG #2 was recorded 1 hour after ECG #1.

EKG/ECG 412

EKG/ECG Hospitals 412

Ken Grauer, MD

DECEMBER 29, 2023

The "good news" — is that after an extended hospitalization, the patient was finally discharged home, and doing well. = . = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.

EKG/ECG 438

EKG/ECG Resuscitation Hospitals Wellness 438

The Trauma Pro

FEBRUARY 23, 2024

Unfortunately, they were very conservative, recommending days of bedrest, extended NPO status, very frequent blood draws, and a lengthy hospital stay. Many hospitals, including mine, developed less conservative management routines, noting that children nearly always tolerate liver and spleen injury better than adults.

Pediatrics 199

Pediatrics Hospitals Resuscitation 199

Dr. Smith's ECG Blog

OCTOBER 6, 2024

An ECG was recorded immediately at triage and, at this hospital, the Queen of Hearts is routinely used to determine cath lab activation. This patient had the onset of chest pain 24 hours before arrival to the ED. Here is that ECG: Original ECG What do you think? There is ST depression maximal in V1-V4, which is diagnostic of posterior OMI.

Hospitals 82

Hospitals EKG/ECG 82

Mount Sinai EM

AUGUST 7, 2024

Rapidly intervened-upon cardiac tamponade in PEA during cardiac arrest has significantly higher hospital discharge rates. survival to hospital discharge rate. Evidence of right heart strain is important but the evidence of fibrinolysis during arrest is mixed with many studies showing no 30-day mortality benefit to lysing during a code.

Ultrasounds 235

Ultrasounds CPR Documentation/Coding COPD 235

The Trauma Pro

SEPTEMBER 24, 2024

I would discourage the use of propofol because it is difficult to titrate outside the hospital and may contribute to hypotension. Finally, don’t assume that you will accompany the patient (and possibly their limb) back to the hospital. Paralytics, sedatives and analgesics are essential.

Hospitals 203

Hospitals 203

The Trauma Pro

JULY 9, 2024

This problem was associated with a significantly longer ICU stay and a somewhat longer overall hospital stay. They studied a series of 79 of their patients who were treated with a halo. A full 66% had problems with their swallowing evaluation. Bottom line: Suspect dysphagia in all patients with cervical fractures, especially the elderly.

Head Injuries 264

Head Injuries Fractures Hospitals Wellness 264

The Trauma Pro

SEPTEMBER 17, 2024

Getting them to the scene will always take extra time since they are typically hospital-based. Look at your local resources and the logistics imposed by the environment, traffic, hospital, and other factors. In contrast, the prehospital providers are already present and are used to working in an austere environment.

Airway Management 199

Airway Management Operations Hospitals Wellness 199

The Trauma Pro

MAY 28, 2024

A recent Massachusetts General Hospital study involved a larger group (97 patients with 110 fixators). Consult your radiologists and physicists to develop a policy that is specific to the scanners used at your hospital. Most MRIs were performed to evaluate the cervical spine. There were no adverse events. Most were performed on a 1.5T

Fractures 261

Fractures Hospitals 261

The Trauma Pro

JUNE 21, 2024

References: “ The VIP Syndrome”: A Clinical Study in Hospital Psychiatry. Order the same tests you usually would, use the same consultants, and take control of all of their recommendations, trying to do things your usual way. This will provide the VIP with the best care possible, which is actually the same as what everybody else gets.

Documentation/Coding 290

Documentation/Coding Outcomes Hospitals Wellness 290

The Trauma Pro

NOVEMBER 8, 2024

Another disadvantage is that if the patient moves away or presents to another hospital for flap replacement, the logistics of transferring a frozen piece of bone are very challenging. There are reports of some mineral loss from the flap after replacement, and occasional infection. And occasionally the entire piece is misplaced.

Hospitals 260

Hospitals 260

The Trauma Pro

MARCH 1, 2024

The US military has adopted its routine use at forward combat hospitals. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury. It’s typically given as a rapid IV infusion, followed by a slower followup infusion.

Military 279

Military Resuscitation Administration Hospitals 279

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria. June 28, 2023. J Travel Med.

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

The Trauma Pro

NOVEMBER 17, 2023

My previous statements were based on the way that we organize our trauma team and trauma activations at this hospital. At our hospital, we have 8 people clustered immediately around the patient, with half of them being surgery or emergency medicine residents. In principle, I agree.

Resuscitation 214

Resuscitation Ultrasounds Hospitals Wellness 214

The Trauma Pro

JUNE 27, 2023

Since I last published the series, I’ve visited numerous hospitals that use the eTFS and a diminishing number that have stuck with the paper trauma flow sheet. I’ll kick off the series with my next post, which describes why your hospital wants you to switch to some newfangled eTFS. But alas, that is not the case.

Hospitals 185

Hospitals 185

The Trauma Pro

SEPTEMBER 1, 2023

more likely In-hospital cardiac arrest – 5x The authors concluded that even if your patient does not have injuries that might limit their daily activities, it is still important to discuss goals of care with our elderly trauma patients. The point is that injuries limiting daily activities are a predictable factor for withdrawal of care.

Hospitals 198

Hospitals Wellness 198

St. Emlyn

NOVEMBER 14, 2023

St.Emlyn's - Emergency Medicine #FOAMed Simplifying urgent care data translation is essential for hospital flow improvement. This post provides a perspective on how to achieve this. The post Speaking urgent care flow fluently appeared first on St.Emlyn's.

Urgent Care 133

Urgent Care Hospitals Teamwork Leadership 133

Intensive Blog

MARCH 13, 2024

Other logistical factors that will influence outcomes of ECPR trials outside the provision of ECMO itself include time to ambulance arrival and transport times to hospital. Pre-hospital initiation vs transport to ECMO centre The optimal location of where ECMO should be initiated is yet to be determined. J Am Heart Assoc.

CPR 130

CPR Resuscitation Outcomes Hospitals 130

Pediatric EM Morsels

JULY 19, 2024

If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. Even those that are no longer bleeding on arrival, will often require observation in the hospital. Is there active bleeding, clot, or no bleeding ?

Airway Management 286

Airway Management Pediatrics Wellness Administration 286

The Trauma Pro

MAY 17, 2024

This is a major reason for the relative lack of availability, especially at smaller hospitals. However, it can be frozen and used only when needed. Platelets are another short-lifespan product, typically lasting only five days. Unfortunately, freezing them or attempting cold storage renders them less active.

Resuscitation 263

Resuscitation Research Hospitals 263

Ken Grauer, MD

SEPTEMBER 15, 2024

For full discussion of the case — CLICK HERE — ECG Rhythm Overview: A 12-year-old boy was admitted to our hospital with severe myocardial dysfunction and chaotic rhythm with tachy- and bradycardic arrhythmias. ECG #2: Figure-2: ECG #2 is from the 4th hospital day.

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

RebelEM

FEBRUARY 15, 2024

PMID: 38019968 Clinical Question: In patients with suspected acute poisoning and GCS <9, is a conservative airway strategy of withholding intubation associated with a reduction in death, ICU LOS, and hospital LOS compared with routine practice of intubation?

Poisoning 141

Poisoning Airway Management Seizures Shock 141

Ken Grauer, MD

DECEMBER 15, 2023

About 20 minutes later ( on the way to the hospital ) — the patient's CP resolved, and ECG #1 was recorded. ECG #2 was actually done first, at the time the EMS unit arrived on the scene ( at which time the patient was having severe chest pain ).

EKG/ECG 381

EKG/ECG EMS Hospitals 381

Ken Grauer, MD

JUNE 22, 2024

During my decades of working with residents when hospital Attending — by far, the most commonly overlooked vital sign was respiratory rate. . = PEARL # 3: An Often Forgotten Clinical NOTE. Initial assessment of the patient for possible acute PE begins by counting the respiratory rate.

EKG/ECG 433

EKG/ECG Stroke Documentation/Coding Wellness 433

Sensible Medicine

OCTOBER 15, 2024

It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. The State of Maryland reinstated a health care mask mandate last winter based on the state reaching a threshold of 10 RSV/flu/covid hospitalizations per 100,000 population.

Hospitals 136

Hospitals Wellness 136

The Trauma Pro

AUGUST 9, 2024

He spent his career at the Charity Hospital there, weathering multiple political storms over the years, as well as the big one, Hurricane Katrina. He was instrumental in achieving Level I Trauma Center status for its replacement, Interim LSU Hospital.

EMS 147

EMS Hospitals Wellness 147

Pediatric EM Morsels

MARCH 29, 2024

Then please put IEM on your differential for critically ill newborns and infants Kids should be Sweet!

Dehydration 294

Dehydration Pediatrics Sepsis EMS 294

The Trauma Pro

JANUARY 2, 2024

They entered 222 patients, but only 164 had pre- and post-ASIA scores for comparison.

Outcomes 264

Outcomes Hospitals 264

EM Ottawa

MAY 30, 2024

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE.

Hospitals 108

Hospitals Ultrasounds 108

Sensible Medicine

FEBRUARY 9, 2024

This had been my sixth and longest hospital stay in as many months. After hospital stay number four, I had to quit my job as an Off-Broadway house manager. I had been in and out of ERs and hospital beds so often that there was no projecting who I might be after I survived all this. As my health declined, so did my independence.

Hospitals 142

Hospitals 142

The Trauma Pro

JANUARY 5, 2024

The study excluded patients with chest tubes placed in other hospitals, tubes placed late (after 24 hours), or patients who had a chest procedure within 6 hours. They noted a decrease in hospital, ICU, and ventilator days. The only prior study I could find was published in 2022 by a group at the University of Nevada at Las Vegas.

Hospitals 133

Hospitals Wellness Outcomes 133

The Trauma Pro

JUNE 14, 2024

Patients with no other injuries could potentially be discharged from the hospital before they become overtly symptomatic, leading to delayed treatment. The authors suggested that if such patients had no other injuries requiring hospitalization, they could potentially be discharged home.

Operations 147

Operations Radiology Radiology Hospitals 147

Pediatric EM Morsels

FEBRUARY 2, 2024

Hospitalization for travel-related illness are around 10% for both VFR and tourists (Leuthard 2015) Multiple studies have reported the most common travel infections in various countries. Infectious Disease Acquisition in Pediatric International Travelers: A 10-Year Review at a Canadian Tertiary Care Hospital. Pediatr Emerg Care.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

The Trauma Pro

DECEMBER 12, 2023

This necessitates an inter-hospital transfer that is subject to scrutiny by the trauma performance improvement program of both trauma centers. The work-up from the referring hospital can be re-evaluated. In some hospitals, orthopedics may choose to place a traction pin to provide initial fracture management.

Emergency Department 124

Emergency Department Operations Hospitals Radiology 124

Pediatric EM Morsels

APRIL 19, 2024

Hospital versus home management of children with buckle fractures of the distal radius. Buckle fractures of the distal radius are safely treated in a soft bandage: a randomized prospective trial of bandage versus plaster cast. J Pediatr Orthop. 2005;25:322–325. Symons S, Rowsell M, Bhowal B, et al. A prospective, randomised trial.

Fractures 286

Fractures Pediatrics Best Practices Outcomes 286

The Trauma Pro

JUNE 25, 2024

Readmission of any patient to the hospital is considered a quality indicator. Was the patient discharged too soon for some reason? Were there any missed or undertreated injuries?

Academics 194

Academics Fractures Hospitals 194