Resuscitation of a Drowning Victim: A Literature Review

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.
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By Evan Kuhl, MD|2021-05-13T09:19:37-07:00Sep 3, 2018|Critical Care/ Resus, Environmental, Trauma|

Nuclear Attack: What Emergency Physicians Working in the ED Need to Know

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.

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By Andrea G. Tenner, MD|2018-06-01T14:16:29-07:00Jun 4, 2018|EMS, Trauma|

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.
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By Debbie Yi Madhok, MD|2020-04-20T19:37:59-07:00Apr 6, 2018|Neurology, Podcasts, Tox & Medications, Trauma|

Infographic: Compartment Syndrome

Compartment syndrome is a true orthopedic emergency, and if you don’t consider it in your differential diagnosis, it can be missed easily! Dr. Katelyn Hanson, a combined EM-IM resident at Jefferson Health, packs the presenting symptoms, causes, and definitions into this flashy infographic. (more…)

By Katelyn Hanson, DO|2018-01-31T00:28:29-08:00Jan 24, 2018|Orthopedic, Trauma|

Trick of the Trade: Fishhook Removal Techniques

Penetrating fishhook injuries can be a common occurrence during the warm weather months. Initially, it is important to evaluate what type of fishhook was being used. How many and where are the barbs? What shape is it (treble hook, single hook)? The physical examination requires a thorough neurovascular exam and, if penetration depth is difficult to assess, radiographs should be utilized for further evaluation.

What approach do you use to remove these barbed fishhooks?

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By Toni Riveros, MD|2021-05-15T09:30:49-07:00Jan 8, 2018|Trauma, Tricks of the Trade|

Pediatric Trick of the Trade: Finger Immobilization Technique

A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair?

Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.

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By Josh Bukowski, MD|2017-11-13T10:18:47-08:00Nov 13, 2017|Orthopedic, PEM Pearls, Trauma, Tricks of the Trade|

Extensor Tendon Lacerations to the Foot

A young man is brought into an emergency department after an electric lawn edger cut through his work boot and into the dorsum of his right foot. He has a clearly contaminated 5 cm x 1 cm laceration on the lateral side, and an underlying tendon is exposed. Sensation is diminished around the wound and he is unable to actively extend his 5th toe past a neutral position. How would you diagnose and repair his extensor tendon injury?

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By James Powell, MD|2017-09-11T03:28:42-07:00Sep 11, 2017|Orthopedic, Trauma|

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