Podcast #294: Rhabdomyolysis

Author: Michael Hunt, M.D.

Educational Pearls

  • Rhabdomyolysis is caused by the destruction of skeletal muscle that leads to the release of myoglobin, which causes renal failure. It presents with pain and weakness in the affected muscle, as well as dark urine.
  • Diagnosis is made with creatinine kinase levels
  • It can happen to extreme athletes after competition, but the most common presentation is in people who fall and are immobilized for long periods of time.
  • Other causes include burns, crush injuries, viral infections (influenza), bacterial infections (Legionella), and medications (statins in adults, propofol in kids)
  • Treatment is aggressive fluids

References: Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis ? an overview for clinicians. Critical Care. 2005;9(2):158-169. doi:10.1186/cc2978.

Podcast #281: Intracranial Hemorrhage Treatment

Podcast #281: Intracranial Hemorrhage Treatment

Author: Don Stader, M.D.

Educational Pearls

  • Types of traumatic bleeds include subdural, epidural, and subarachnoid.
  • Treatment for a traumatic bleed includes maintenance of systolic BP above 120 and seizure prophylaxis with phenytoin.
  • In atraumatic bleeds, treatment should focus on lowering  blood pressure to reduce bleeding.

References: https://www.aliem.com/2017/09/intracranial-hemorrhage-management/

Podcast #278: Subdural Hematomas

Author: Jared Scott, M.D.

Educational Pearls

  • Subdural hematomas can happen in the elderly because of brain atrophy, and can manifest with neurological deficit.
  • Subdural hematomas are caused by rupture of the bridging veins of the brain. This can be caused by trauma, brain atrophy, or possibly by anticoagulant use. They are crescent-shaped on head CT.  
  • Epidural hematomas, in contrast, are caused by rupture of meningeal arteries secondary to trauma. They are usually lens-shaped on head CT.
  • Subdurals are difficult to pick up on head CT because they may be isodense to brain tissue.

References: Management of Recurrent Subdural Hematomas Desai, Virendra R. et al. Neurosurgery Clinics , Volume 28 , Issue 2 , 279 – 286

Podcast #271: Nexus Chest CT Scan Guidelines

Author: Chris Holmes, M.D.

Educational Pearls

  • The nexus chest CT scan rule is based on an 11,000 subject, multicenter study that looked for signs following a trauma that predicted significant findings on subsequent chest CT.
  • Findings that were associated with abnormal chest CT included: abnormal CXR, distracting injury, chest wall, sternal, thoracic spine or scapular tenderness. Furthermore, a mechanism of injury that includes rapid deceleration was also associated.
  • If a patient has none of the above findings, then there is only a small chance that there will be an abnormal chest CT.

References: https://www.mdcalc.com/nexus-chest-ct-decision-instrument-ct-imaging

Podcast #267: Causes of Very High Lactate

Author: Dylan Luyten, M.D.

Educational Pearls

  • Lactate is a byproduct of anaerobic metabolism, a sign of dying tissue. Dangerous causes of high lactates will not normalize with repeat labs.
  • Crush injuries, seizures, bowel necrosis,  end-stage liver disease, and metformin toxicity are common causes of highly elevated lactate.

References: https://lifeinthefastlane.com/ccc/lactic-acidosis/

Podcast #257: Strangulation

Author: Jennifer Wright – BSN, RN

Educational Pearls

  • Strangulation is common in cases of domestic violence and sexual assault, and it is associated with higher mortality.
  • People who have been strangled have a higher rate of stroke due to vascular damage to carotid artery.
  • Only 50% of people who die from strangulation show external signs of trauma
  • CTA should be done in all those who experience LOC or incontinence from strangulation.
  • 50-60sec of strangulation is all that is required to produce LOC.

References: http://epmonthly.com/article/clinical-focus-strangulation-and-hanging-injuries/

Podcast #252: Mandible Fractures

Author: Sam Killian, M.D.

Educational Pearls

  • The tongue blade test is done for mandible fractures, which make up 40-60% of facial fractures.
  • The test is done by having the patient bite down on a tongue depressor on one side of the mouth. The provider then tries to snap the tongue depressor. This is repeated on the other side of the mouth. The test is positive if the patient complains of pain before the depressor can be broken on either side.  
  • It has been compared to CT and X-ray and has a similar sensitivity and specificity (95% and 65%, respectively).

References: J. Neiner, et al. Tongue Blade Bite Test Predicts Mandible Fractures. Craniomaxillofac Trauma Reconstr. 2016

Podcast #242: Clavicle Fracture Review

Author: Nick Hatch, M.D.

Educational Pearls

  • The force required to break a clavicle is significant, so clavicle fracture may be associated with other injury (pneumothorax, vascular injury).
  • Most fractures occur in the middle 1/3 of the clavicle.
  • Traditionally, clavicle fractures have been managed without surgery. However, recent studies have shown that surgery may be beneficial in a larger population than previously thought.

References: http://emedicine.medscape.com/article/398799-overview