The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper or lower extremity, but you can’t palpate a dorsalis pedis (DP) or posterior tibialis (PT) pulse! You spend minutes, whisking the doppler probe, attempting to hear a waveform in a busy ED. Unfortunately you can’t seem to hear the “whoosh,” making accurate it nearly impossible for you to measure ankle-brachial indices (ABI). 1–3
A 9-year boy was hit in the head during a soccer game and was out for a few seconds. He regained consciousness quickly, but was repetitive for EMS. By the time the patient arrived at the ED, he was back to his normal self. Did this patient sustain a concussion? If so, what discharge instructions, anticipatory guidance, and resources do you have for your patient and his family? Here’s a quick 170-second animated video tutorial to sum up some thing for you.
Tranexamic acid (TXA) can be used in a wide variety of settings in the Emergency Department for its hemostatic effects. Topical applications of TXA are commonly utilized to control minor bleeding from epistaxis, lacerations, or dental extractions.1–3 More in-depth reviews of topical TXA can be found on R.E.B.E.L EM4 and The Skeptics Guide to Emergency Medicine.5
Older adults are at high risk of poor outcomes from even minor head injuries. We see many older patients in the ED who present after a fall or head injury, and we have good decision rules for which patients need brain imaging.1 However, even patients with mild traumatic brain injuries, who have a negative CT scan, are at risk for mortality and significant long-term sequelae. The CDC has called traumatic brain injuries a ‘silent epidemic’.2,3 The first steps to breaking that silence are awareness and recognition.
Case: 55-year-old restrained driver is reporting severe shortness of breath and right sided chest pain after a high-speed motor vehicle collision. Her respiratory rate is 26 breaths/min and her oxygen saturation is 96% on a 15-liter non-rebreather. She has decreased breath sounds on the right, epigastric tenderness, and an abdominal seatbelt sign. What is the diagnosis?
Below we have listed our selection of the 6 highest quality blog posts related to 4 advanced level questions on trauma topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:
- When to give tranexamic acid in the trauma patient
- The pregnant trauma patient
- Transfusions in the trauma patient
- Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
In this module, we have 6 AIR-Pro’s and we did not include any honorable mentions to prevent redundancy of the topics covered. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.
This year I published a Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries in the Journal of Emergency Medicine 1 — a technique I’ve used in my local ED for several years. In brief, this involves achieving hemostasis over a fingertip skin avulsion by using a tourniquet followed by tissue adhesive glue. After bringing the technique to press and sharing this video, I’ve received great tips from peers and subsequently refined it with some additional ideas. Thus I present for the first time on ALiEM: Dermal Avulsion Injuries 2.0.