Article: Elevated INR May Overestimate Coagulopathy in Trauma and Surgical Patients

A 55 year old woman presents as the driver of a motor vehicle collision. She has moderate abdominal tenderness diffusely and a seat belt sign, but has a negative abdominal/pelvis CT. Her INR, however, was noted to be 2.1. She is not on any vitamin K antagonists. The surgeons admit her to the hospital to observe for a potential hollow viscus injury and requests that you order 2 units of FFP for her. Seems reasonable… or is it? What is the logic?

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By William Paolo, MD|2016-11-11T19:19:39-08:00Mar 17, 2014|Heme-Oncology, Trauma|

Head injury in pediatric patients: To CT or not to CT?

Intracranial injury is the leading cause of death and disability in children. It can arise after severe, moderate, or minor head injury. Children with minor head injury present the greatest diagnostic dilemma for emergency physicians, as they appear well but a small number will develop intracranial injuries. The question that often arises in the ED is:

To CT or not to CT?

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By Josh Easter, MD|2017-03-05T14:14:36-08:00Jan 23, 2014|Expert Peer Reviewed (Clinical), Pediatrics, Trauma|

Should We Admit All Patients with Sternal Fractures?

The detection rate of sternal fractures following motor vehicle collisions and blunt trauma to the chest and abdomen has increased over the past decade. The reason for this increase is most likely from the use of seat belts and better imaging modalities such as computed tomography (CT) in trauma patients. I can recall as a resident being told that any patient with a sternal fracture should be admitted to trauma because of the high likelihood of blunt cardiac injury and high mortality rate associated with this injury, but is this always true?

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By Salim Rezaie, MD|2019-09-10T13:34:54-07:00Jan 17, 2014|Cardiovascular, Trauma|

52 Articles in 52 Weeks: Landmark EM Articles 2013

To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.

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By Emily Junck, MD|2017-03-05T14:18:46-08:00Nov 12, 2013|Cardiovascular, Critical Care/ Resus, EMS, Environmental, Gastrointestinal, Infectious Disease, Neurology, Orthopedic, Pediatrics, Pulmonary, Renal, Trauma, Ultrasound|

PV Card: Intimate partner violence

In the Emergency Department, we too often under-estimate our patients’ likelihood for intimate partner violence (IPV). Unfortunately, there is no perfect screening test to detect this. So one must maintain a high index of suspicion. Once you detect it, what questions should you ask to ensure her/his safety and how do you optimize the resources available to her/him?

Created by Trevor Wilson (UCSF medical student) and Dr. Beth Kaplan (UCSF/SFGH), the following PV pocket card reviews how to screen, document, intervene, and provide resources for the patient. Learn the “SAFE” questions.^1,2

PV Card: Intimate Partner Violence

Go to ALiEM (PV) Cards for more resources.

References

Ashur M. Asking about domestic violence: SAFE questions. JAMA. 1993;269(18):2367. [PubMed]
Moyer V, U.S. P. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;158(6):478-486. [PubMed]

By Michelle Lin, MD|2021-10-06T19:50:43-07:00Jul 31, 2013|ALiEM Cards, Trauma|

Mass Casualty Anticipation – An essential, instinctual skill of EM physicians

Emergency medicine is full of surprises, twists, and turns. We don’t know what type of patient we will encounter prior to a shift, but we are ready for any and all. That being said, preparation is essential prior to the arrival of critical patients. This is why the airway cart is checked before starting a shift or the position of the bedside ultrasound machine is always mentally tracked in order to quickly grab if needed.

Unfortunately, individual preparation is not sufficient for large scale disasters. This level of preparation must happen on a hospital and interdepartmental level such as coordination between trauma surgery, orthopedics, and emergency medicine with agreed upon policies.

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By Nikita Joshi, MD|2016-11-11T19:02:31-08:00Jul 12, 2013|Medical Education, Trauma|

Geriatric Blunt Trauma – Respect the Lactate

Which is a better prognostic tool in geriatric trauma, traditional vital signs or lactate level?

Meet Norma Nuance (NN), a 70-year-old woman with CAD, HTN, HLD, DM, and mild dementia. She was involved in an MVC as the restrained driver with questionable LOC. She arrives in your ED and appears confused, but has a history of dementia. There are no family members to tell you her baseline. Her BP is 120/80, and her HR is 90. She is not calling out in pain, but does mumble about her left arm when you ask if she is hurting. You think she may have sprained her wrist.

Now meet Frankie Obvious (FO), a 22-year-old male, who was the helmeted driver of a motorcycle that hit a car. He was thrown from the motorcycle, and arrives combative and yelling with a HR of 130 and a BP of 100/70.

Based on their vital signs, which patient is going to receive more immediate attention? Your lactate level is pending… (more…)

By Christina Shenvi, MD, PhD, MBA|2017-03-05T14:18:36-08:00Jul 1, 2013|Geriatrics, Trauma|

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