19 07, 2017

Management of Major Pelvic Trauma

2017-07-19T21:58:25+00:00

pelvic trauma fracturePelvic trauma frequently is associated with other injuries from the high force required to break the pelvis. Management is focused on stabilizing the pelvis and stopping the bleeding. Due to other injuries requiring emergent surgical stabilization, pelvic trauma is primarily managed surgically with pre-peritoneal packing and external fixation, followed by angioembolization for continued bleeding. Emergency physicians must quickly resuscitate patients while gathering vital information to direct the correct definitive bleeding control strategy. New endovascular techniques such as REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) may change future emergency department strategies and improve mortality in severe pelvic trauma. 
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27 06, 2017

PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians

2017-06-20T14:06:44+00:00

pecarn pediatric head traumaThe Pediatric Emergency Care Applied Research Network (PECARN) collaborative has teamed up with the ALiEM and CanadiEM teams to introduce the official PECARN visual decision rule aid for pediatric blunt head trauma! This has been a 6 month collaboration focused on bringing evidence-based research to the bedside in pediatric emergency medicine (EM).

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29 05, 2017

Traumatic Bleeding in Anticoagulated Patients: 5 Other Sources Beyond the Brain

2017-06-04T15:51:12+00:00

anticoagulated patientsWhen a patient is started on anticoagulant therapy, the purpose is to prevent clot formation or propagation. Anticoagulants can improve morbidity and mortality by maintaining cardiac stent patency, reducing the propagation of pulmonary emboli, or preventing formation of intra-cardiac thrombi.1,2 Unfortunately even after minor trauma, these medications can cause major problems. When a patient on clopidogrel is in a motor vehicle collision (MVC) or an elderly patient on warfarin falls out of their bed, the once life-improving therapy becomes potentially life-threatening. It is important for emergency care providers to maintain a high index of suspicion for life-threatening bleeds in all patients on anticoagulation following even minor injuries. The purpose of this discussion is to look beyond the intracranial hemorrhages (ICH) and to consider 5 other sources of bleeding that can occur in anticoagulated patients.

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13 03, 2017

AIR Series: Trauma Module (2017)

2017-04-04T16:44:36+00:00

air series traumaWelcome to the Trauma Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality procedure content. Below we have listed our selection of the 21 highest quality blog posts within the past 12 months (as of September 2016) related to Trauma emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 5 AIRs and 16 Honorable Mentions. We recommend programs give 7 hours (about 20 minutes per article) of III credit for this module.

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6 03, 2017

PV Card: Laceration Repair and Sutures – A cheat sheet guide

2017-03-09T18:53:55+00:00

laceration repair and suturesLaceration repair and suturing are foundational skills for the Emergency Department. This pocket card serves as a quick reference guide for clinicians, and provides a much-needed update and design upgrade from the 2011 PV card on Sutures. This card covers suture/staple removal times, suture sizes, suture material characteristics, special laceration considerations, and suture techniques.

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7 02, 2017

PEM Pearls: Calming techniques while repairing a laceration

2017-02-16T15:21:36+00:00

Most children who come into the Emergency Department present with pain or experience pain during their ED stay.1,2,3 Pain and distress during a procedure can leave a lasting impact on a child and contribute to mistrust of the medical system and compliance with future procedures.1 ,4,5 Children who use active forms of coping report less pain and distress during a procedure.3 To help with coping, when feasible, involve parents or family, nursing and a child life specialist. If the parents are willing, try to get them involved in all parts of the medical procedure.2,3 This includes positioning the patient with a parent in a secure parental-hugging hold or maintaining close physical contact throughout the procedure.6 This can easily replace immobilization of a child or the use of restraints which can cause increased fear and escalate the degree of anxiety in a child.2

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4 05, 2016

Trick of the Trade: Ultrasound for Pedal Pulse Identification and ABI

ultrasound for pedal pulse PT 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

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