Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis

Traneamic-newTranexamic 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

(more…)

2016-11-11T19:40:06-07:00

Traumatic Brain Injuries in Older Adults

Fall Risk - canstockphoto14757614Older 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.

(more…)

2016-12-20T12:28:08-07:00

Diagnose on Sight: Shortness of Breath

shortness of breathCase: 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?

(more…)

AIR-Pro Series: Trauma (2015)

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:

  1. When to give tranexamic acid in the trauma patient
  2. The pregnant trauma patient
  3. Transfusions in the trauma patient
  4. 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.

(more…)

Trick of the Trade: Dermal Avulsion Injuries 2.0

Take a shortened, piece of rubber tourniquet and encircle the finger, then clamp it with a needle driver.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.

 

 

(more…)

2016-11-11T19:39:55-07:00

NEXUS Chest CT Decision Instruments in Blunt Trauma

ct_cat_scanner_angled_400_wht_5332One of the five 2014 American College of Surgeons’ Choosing Wisely recommendations is to avoid routing whole-body CT imaging of trauma patents, also known as the ‘pan-CT’. Until now, no validated decision instrument existed to help guide clinicians decide whether to obtain a chest CT in the setting of blunt trauma. This month, Dr. Robert Rodriguez and the multi-institutional NEXUS Chest CT research team published a paper describing the derivation and validation of 2 decision instruments in PLOS Medicine [1].

(more…)

2019-01-28T21:43:56-07:00

60-Second Soapbox: New podcast series featuring Drs. Lin, Riddell, Shaikh

aliem_soapboxWe are excited to announce our new podcast series, 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 whole minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. Don’t worry if your are microphone-shy. We will carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own!

(more…)