MIA 2012: Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012 Jun;59(6):460-8.e1-7.

230px-Intracerebral_heamorrageBottom Line 1

CREST study: Patients presenting to the emergency room with blunt head trauma and preinjury warfarin or clopidogrel use have a high incidence of immediate intracranial hemorrhage, but a very low incidence delayed intracranial hemorrhage. Thus, if the initial head CT is negative, you should be able to discharge the patient home…

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By |2016-11-11T18:42:23-08:00Jan 1, 2013|Tox & Medications, Trauma|

Tricks of the Trade: Calcium gel for hydrofluoric acid burns

HydrofluoricAcidA 41 y/o m presents to your ED after an occupational exposure to 30% hydrofluoric acid (HF). The thumb and index finger of his right hand were affected. Upon visual examination, the site of exposure looks relatively benign but the patient is complaining of extreme pain. Beyond giving opioids, what can you do?

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Paucis Verbis: Blunt cardiac injury

blunt cardiac injuryDo you always get a troponin for patients who sustain blunt chest trauma?

Hopefully your answer is no. Of note, it is also NOT indicated as a screening test for those in whom you suspect a blunt cardiac injury (BCI). It can be normal in the setting of arrhythmias and it can be falsely elevated in the setting of catecholamine release or reperfusion injury from hypovolemic shock.

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By |2019-01-28T22:18:42-08:00Jun 29, 2012|ALiEM Cards, Cardiovascular, Trauma|

Paucis Verbis: Blunt Abdominal Injury, Likelihood Ratios

blunt abdominal injuryThis month’s issue of JAMA addresses the question “Does this patient have a blunt intra-abdominal injury?” as part of the always-popular Rational Clinical Examination series.

The systematic review of the literature summarizes the accuracy of findings for your blunt trauma patient in diagnosing intra-abdominal injuries. Specifically, likelihood ratios (LR) are summarized. These LRs can be used to plot on the Bayes nomogram below. You draw a straight line connecting your pretest probability and the LR. This yields your posttest probability.

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By |2019-01-28T22:22:31-08:00Apr 20, 2012|ALiEM Cards, Gastrointestinal, Trauma|

Paucis Verbis: Distracting injuries in c-spine injuries

CervicalCollar

“Distracting injury” is a frequent cited reason for imaging the cervical spine in blunt trauma patients, per the NEXUS study. In the Journal of Trauma in 2005 and 2011, studies aimed to narrow the definition of “distracting injury”. Although both are studies at different sites, both conclude the same:

  • Chest injuries may be considered “distracting injuries” because of their proximity to the cervical spine.

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By |2019-02-19T18:42:18-08:00Sep 9, 2011|ALiEM Cards, Orthopedic, Trauma|

Trick of the Trade: Splinting the ear

EarHematomaDressing

One of the hardest bandages to apply well is one for auricular hematomas. After drainage, how would you apply a bandage to prevent the re-accumulation of blood in the perichondrial space?

Traditionally, one can wedge xeroform gauze or a moistened ribbon (used for I&D’s) in the antihelical fold. Behind the ear, insert several layers of gauze, which have been slit half way to allow for easier molding around the ear. Anterior to the ear, apply several layers of gauze to complete the “ear sandwich”. Finally, secure the sandwich in place with an ACE wrap, which ends up being quite challenging because of the shape of the head.

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By |2016-11-11T19:59:20-08:00Aug 10, 2011|ENT, Trauma, Tricks of the Trade|

Paucis Verbis: Blunt cerebrovascular injuries

CerebrovascularAnatomyIn the setting of blunt trauma, it is easily to overlook a patient’s risk for blunt cerebrovascular injuries (BCVI). These are injuries to the carotid and vertebral arteries. Often they are asymptomatic with the initial injury, but the goal is to detect them before they develop a delayed stroke.

  • Who are at risk for these injuries?
  • What kind of imaging should I order to rule these injuries out?
  • Do I really treat these patients with antithrombotic agents even in the setting of trauma to reduce the incidence of CVA?

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By |2019-01-28T22:41:59-08:00Jul 1, 2011|ALiEM Cards, Cardiovascular, Radiology, Trauma|