Podcast #257: Strangulation

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

Podcast #230: Concussive Treatment

Author: Aaron Lessen, M.D.

Educational Pearls

  • 2 studies this past year looked at pediatric and adolescent patients following a concussion. They found people who returned to activity sooner did better than those who went on “brain rest”.  
  • While patients should still follow up with their PCP following a concussion, it is ok for patients to return to physical activity as tolerated.

References: Grool AM, Aglipay M, Momoli F, Meehan WP, Freedman SB, Yeates KO, Gravel J, Gagnon I, Boutis K, Meeuwisse W, Barrowman N, Ledoux A, Osmond MH, Zemek R, for the Pediatric Emergency Research Canada (PERC) Concussion Team. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA. 2016;316(23):2504-2514. doi:10.1001/jama.2016.17396

Podcast #228: BB Guns

Author: Jared Scott, M.D.

Educational Pearls

  • BB gun eye injuries are most common in August and September. They most often happen to males aged 16-17 year old. Around 10% of the BB eye injuries lead to eye loss.
  • Accidental firearm injury is common in children and is a common cause of mortality. One-third of homes with children have a firearm.
  • Most accidental pediatric gun injuries happen to young, male children with guns owned by family members. It is important to educate gun owners about proper gun storage.

References: Childhood Firearm Injuries in the United States Katherine A. Fowler, Linda L. Dahlberg, Tadesse Haileyesus, Carmen Gutierrez, Sarah Bacon. Pediatrics Jun 2017, e20163486; DOI: 10.1542/peds.2016-3486

Podcast #210: Bear Mauling

Author: Jared Scott M.D.

Educational Pearls:

  • Bear mauling is not a common issue in the ED.
  • The Ursus americanus (black bear) is the most common in Colorado, but Ursus arctos horribilis (grizzly bear) attacks are more frequent because they are more aggressive.
  • Head and neck lacerations are the most common injuries. Complications include infection and long term PTSD.
  • Most bear attacks are defensive in nature.
  • If a bear attacks you – lay face down and cover your neck with your hands.

References: Frank RC, Mahabir RC, Magi E, Lindsay RL, de Haas W. Bear maulings treated in Calgary, Alberta: Their management and sequelae. The Canadian Journal of Plastic Surgery. 2006;14(3):158-162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539044/

Podcast #204: Thoracotomy

Author: Aaron Lessen M.D.

Educational Pearls:

 

  • Thoracotomy is a potentially life-saving procedure. However, outcomes are often poor and the procedure itself poses many risks to provider and patient.
  • Chance of surviving a thoracotomy when there is no cardiac activity on ultrasound is 0%.
  • Performing a thoracotomy is unlikely to benefit patients with no cardiac activity on ultrasound or patients that lost vital signs greater than 10 minutes before starting the procedure.
  • A thoracotomy is maximally beneficial in patients with a penetrating chest injury that occurred less than 10 minutes before the procedure.

 

References: K. Inaba et al, “FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation” Ann. of Surgery, 2015. https://www.ncbi.nlm.nih.gov/pubmed/26258320

 

Podcast #192: Back Fat Hernia

Author: Jared Scott M.D.

Educational Pearls:

  • There are two anatomical triangles on the back, the inferior lumbar triangle and the superior lumbar triangle.
  • Herniation occurs whenever something moves to a place where it is not supposed to be, often through a fascial weakness.
  • A “back hernia” can happen when the contents of of the abdominal cavity herniate into the back, usually through the superior lumbar triangle. This is also known as a Grynfeltt-Lesshaft hernia.
  • Back hernias can be traumatic or congenital.
  • These hernias are typically treated surgically.

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959346/

 

Podcast #191: Blunt Cervical Trauma

Author: Chris Holmes M.D.

Educational Pearls:

  • Mechanism of injury involves hyperextension/hyperflexion
  • Pathophysiology: inside of the arteries in the neck becomes disrupted, similar to a dissection. This is thrombogenic and leads to cerebral infarction
  • Neurologic deficit is common.
  • Other risk factors include facial fracture and cervical-spine fracture.
  • Treat with anticoagulation – aspirin or other antiplatelet agents are appropriate.
  • Increase clinical suspicion when patient presents with neurological deficit and has a negative CT.

References: https://www.east.org/education/practice-management-guidelines/blunt-cerebrovascular-injury