Podcast # 435 : UCL Injury

Author: Ryan Circh, MD

Educational Pearls:

  • Ulnar collateral ligament injury is often called gamekeeper’s thumb or skier’s thumb
  • Can results from traumatic deviating the thumb radially (abduction)
  • Poor rabbits
  • Have a low threshold for referral to hand surgery for follow up – treatment for minor injuries can be conservative but more severe require surgery to preserve function
  • This injury should be placed in a thumb spica splint
  • Radiographs are often negative unless an avulsion fracture is present

Editor’s note: to test for UCL injuries, I like this.

References:

Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med. 2015 Jan;34(1):117-26. doi: 10.1016/j.csm.2014.09.004. Epub 2014 Oct 11. Review. PubMed PMID: 25455399.

Madan SS, Pai DR, Kaur A, Dixit R. Injury to ulnar collateral ligament of thumb. Orthop Surg. 2014 Feb;6(1):1-7. doi: 10.1111/os.12084. Review. PubMed PMID: 24590986.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Podcast # 426: Ho Ho – Oh No!

Author: Katrina Iverson, MD

Educational Pearls:

  • The winter holiday months present a unique picture of patient presentations to the emergency department
    • Some of the unique presentations include:
    • Children falling off Santa’s lap
    • Sledding injuries
    • Falling off ladders
    • Lacerations, ingestion, and insertion of broken ornaments (pediatrics)
  • Parents tend to hurt themselves on their children’s toys


References:

Lauche R, et al. (2018). ‘Santa baby, hurry [extra carefully] down the chimney tonight’ – Prevalence of Christmas related injuries 2007–2016 in the United States: Observational study. Advances in Integrative Medicine. https://doi.org/10.1016/j.aimed.2018.11.004

https://areyouawellbeing.texashealth.org/common-winter-injuries/

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Podcast # 423: Blunt Cardiac Injuries

Author: Mike Hunt, MD

Educational Pearls:

 

  • Blunt cardiac injuries most commonly occur in motor vehicle collisions, auto-pedestrian collisions, and from sports injuries
  • The more anterior right ventricle is the most commonly injured structure
  • Look for new EKG changes such as bundle branch blocks, ST changes, or other arrhythmias
  • New EKG abnormalities should prompt consideration of further workup and admission for telemetry
  • Patients may have an elevated troponin – but it is unclear when exactly this should be drawn after the injury

 

References:

Bellister SA, Dennis BM, Guillamondegui OD. Blunt and Penetrating Cardiac Trauma. Surg Clin North Am. 2017 Oct;97(5):1065-1076. doi: 10.1016/j.suc.2017.06.012. Review. PubMed PMID: 28958358.

Marcolini EG, Keegan J. Blunt Cardiac Injury. Emerg Med Clin North Am. 2015 Aug;33(3):519-27. doi: 10.1016/j.emc.2015.04.003. Epub 2015 Jun 10. Review. PubMed PMID: 26226863.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Podcast # 413: Fascia Iliaca Block

Author: Katie Sprinkle, MD

Educational Pearls:

 

  • The fascia iliaca block is useful for hip and proximal femur fractures.
  • Typically involves injecting 40-60 mL of diluted bupivacaine (0.25%) under the fascia iliaca (or other anesthetic)
  • Anesthesia is achieved of the femoral, obturator, and lateral femoral cutaneous nerves.
  • Monitor for signs of bupivacaine toxicity (paresthesias, AMS, seizures, arrhythmias)
  • Intralipid can be an effective treatment for life-threatening toxicity

 

References:

Hoegberg LC, Bania TC, Lavergne V, Bailey B, Turgeon AF, Thomas SH, Morris M, Miller-Nesbitt A, Mégarbane B, Magder S, Gosselin S; Lipid Emulsion Workgroup.. Systematic review of the effect of intravenous lipid emulsion therapy for local anesthetic toxicity. Clin Toxicol (Phila). 2016 Mar;54(3):167-93. doi: 10.3109/15563650.2015.1121270. Epub 2016 Feb 6. Review. PubMed PMID: 26853119.

https://www.acepnow.com/article/control-hip-fracture-pain-without-opioids-using-ultrasound-guided-fascia-iliaca-compartment-block/?singlepage=1&theme=print-friendly

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Podcast #411: Mass Casualty Incident

Author: Dylan Luyten, MD

Educational Pearls:

 

  • Early recognition that the current situation is a mass casualty incident (MCI) is essential with establishing a sole provider/nurse to oversee
  • Team members labeling themselves by name and role is also helpful
  • Practice and prepare for these unfortunate events

 

Editor’s note: This podcast comes at the end of a MCI drill over several days

References:

http://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/

 

Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Podcast #410: FAMbulance

Author: Aaron Lessen, MD

Educational Pearls:

  • Retrospective study looking at type of transportation and mortality outcomes for patients with penetrating trauma
  • Mortality was 2.2 % for those brought in by private vehicle compared to 11.6% by EMS

 

 

Editor’s note: the above is raw mortality – even after risk adjustments the odds ratio of death was statistically significant for penetrating injuries, which held true even over multiple trauma systems. Shout out to Dr Haut as well!

References:

Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services. JAMA Surg. 2018 Feb 1;153(2):107-113. doi: 10.1001/jamasurg.2017.3601. PubMed PMID: 28975247; PubMed Central PMCID: PMC5838586.

Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Check out this episode!

Podcast #397: Pharyngeal Trauma

Author: Aaron Lessen, MD

Educational Pearls:

  • Injuries from penetrating pharyngeal trauma  are often subtle on examination in children
  • Potentially serious complications including carotid artery injury, mediastinitis from spreading infection, or airway compromise from hematoma formation
  • Imaging choice is typically CTA to assess for vascular injuries
  • These injuries may require antibiotics

References:

 

Zonfrillo MR, Roy AD, Walsh SA. Management of pediatric penetrating oropharyngeal trauma. Pediatr Emerg Care. 2008 Mar;24(3):172-5. doi: 10.1097/PEC.0b013e3181669072. PubMed PMID: 18347498.

Sasaki T, Toriumi S, Asakage T, Kaga K, Yamaguchi D, Yahagi N. The toothbrush: a rare but potentially life-threatening cause of penetrating oropharyngeal trauma in children. Pediatrics. 2006 Oct;118(4):e1284-6. PubMed PMID: 17015515.

Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

Podcast # 335: Blunt Head Trauma

Author: Peter Bakes, M.D.

Educational Pearls:

  • Epidural hematomas have a characteristic convex appearance on CT while a subdural hematoma will have a concave appearance.
  • Indications for operative intervention for subdural hematoma may include: >5 mm midline shift, over 10 mm in thickness, comatose with ICP >20, or patient neurologic deterioration.

 

References

Bullock, M. R. et. al. . Surgical management of acute subdural hematomas. 2006. Neurosurgery, 58(SUPPL. 3). DOI: 10.1227/01.NEU.0000210364.29290.C9.

Huang KT, Bi WL, Abd-El-Barr M, Yan SC, Tafel IJ, Dunn IF, Gormley WB. The Neurocritical and Neurosurgical Care of Subdural Hematomas. Neurocrit Care. 2016. 24(2):294-307. doi: 10.1007/s12028-015-0194-x.

Podcast #333: TBI Prognosticators

Author: Michael Hunt, MD

Educational Pearls:

  • Studies have shown that patients with decreasing GCS scores have worse outcomes, however GCS of 4 has worse outcome than GCS 3.
  • Alternative scoring system is the GCS-P score which is GCS score – number of non-reactive pupils.
  • GCS3 50% mortality 70% poor outcome at 6 months; GCS-P of 1 had mortality 74% and poor outcome at about 90% at 6 months.
  • GCS-P score is a better prognostic indicator than GCS score.

 

References:

Han J, et al (2014). External validation of the CRASH and IMPACT prognostic models in severe traumatic brain injury. Journal of Neurotrauma. 31(13):1146-52.

Maas AI, et al. (2007). Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. Journal of Neurotrauma.  24(2):232-8.

The CRASH trial management group, & the CRASH trial collaborators. (2001). The CRASH trial protocol (Corticosteroid randomisation after significant head injury) [ISRCTN74459797]. BMC Emergency Medicine, 1, 1. http://doi.org/10.1186/1471-227X-1-1.

Check out this episode!

Podcast #317: Elbow Dislocation

Author: John Winkler, M.D.

Educational Pearls:

-Lower mechanisms of injury have a lower chance of an associated fracture or major ligament injury.

-One major concern is having a fracture fragment in the joint (can lead to chronic arthritic pain).

 -Evaluation should involve checking the neurovascular status of the arm and reduce the fracture as soon as possible. Immobilize arm in a sling and consult orthopedics if there is intra-articular involvement.

References:

https://orthoinfo.aaos.org/en/diseases–conditions/elbow-dislocation/

Mehta, JA; Bain, GI. (2004). Elbow dislocations in adults and children. ?Clinics in Sports Medicine.? 23(4):609-27.