A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.1
Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.
Welcome to Leg Day #2 of the SplintER Series. Following up with the Leg Day #1’s primer on tibial plateau fractures, another key orthopedic injury of the leg is hip dislocation. A hip dislocation occurs when there is separation of the head of the femur from the acetabulum of the pelvis in either an anterior or posterior direction.1
Drowning cases peak this time of year and represent a leading cause of mortality in children. For example, drowning represents the leading cause of death in boys ages 5-14 years old, and worldwide, there are 500,000 annual deaths from drowning.1 Hypoxic injury and subsequent respiratory failure represent the primary causes of morbidity and mortality. Although providers are typically taught to be aware of possible trauma (e.g. cervical spine fracture) when evaluating a drowning case, less than 0.5% of drownings are traumatic.2 The duration of immersion, volume of aspirated fluid, and water temperature dictate clinical outcomes.1 We review the presentation, pathophysiology, and management of drowning to raise awareness about this important public health issue.
Ever wonder what would happen if you were working in the emergency department (ED) when a nuclear attack happens? We’ve all had questions on boards or inservice exams about the long-term effect of radiation exposure, but would you know what to ACTUALLY DO if a nuclear attack happened? What do you do in the first few minutes? First few hours? We know that if you are in the immediate bomb vicinity, there is not much you can do. But what if you are 5 miles away? Or 10 miles?
If you look for information regarding nuclear attacks, there are no great summary resources on what to do in the immediate aftermath if you are in the ED. In order to bring this to you in an easily digestible format, we have broken this post up into a few topic areas: This blog post will cover (1) what physically happens in a nuclear attack and (2) what this means in the ED.
Tranexamic acid (TXA) is a synthetic form of the amino acid lysine that binds to receptors on plasmin and prevents it from breaking down fibrin clots. Numerous studies have investigated its utility in preventing or treating traumatic hemorrhage, and the World Health Organization now includes TXA on its list of Essential Medicines. In addition to trauma, TXA may be effective in other clinical scenarios relevant to Emergency Medicine, including gynecological hemorrhage and epistaxis. ALiEM Cards: TXA, written by Dr. Sam Ashoo, reviews the dosing and potential indications for TXA use in the ED.
Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”
Intracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and key learning points.