Trauma

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:…

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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…

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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,…

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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…

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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…

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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…

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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….

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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…

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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…

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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…

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