Blog

Time to Bind…

So you’re working a busy A side shift at Elmhurst and you get an alert from EMS about a polytrauma. The patient rolls through the door alert but moaning in pain with obvious road rash to the bilateral lower extremities. He states he was in a motorcycle accident. He’s tachycardic and hypotensive. After a negativeRead more

Applying the Pelvic Binder: Pearls and Pitfalls

Tl;dr: (1) Never rock the pelvis. Firmly squeeze and hold. (2) Consider quickly assessing for rectal or vaginal bleeding prior to binder application as this would suggest an open fx into the vag / rectal vault. It will be difficult to complete the exam once the binder is on. (3) The binder is applied overRead more

EFAST vs CXR for PTX

Surgical resident X: “We have to get the chest X-ray before we go to CT.” EM resident Y: “Honestly, [surgical colleague X], I don’t think we do. The FAST didn’t have any evidence of pneumothorax, so I think we’re safe to proceed to the CT scanner rather than wait for X-ray right now.” Surgical residentRead more

Topical antibiotics after suture repair?

So, you’ve just finished suturing an uncomplicated laceration and you think to yourself: should I apply antibiotic ointment or just cover with a bandage with good return precautions?   Answer: There is some limited evidence to support antibiotic ointment use.   A study by Dire et al. in 1995 enrolled 465 patients with uncomplicated EDRead more

Oops…is that part important?

There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. This happened to me twice in my PGY2 year. Obviously, this ETT will need to beRead more

52 in 52: A Clinical Predictive Tool for Intra-Abdominal Trauma in Pediatric Patients

Title: Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma Article Citation: Holmes JF, Mao A, Awasthi S, McGahan JP, et al. Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med. 2009 Oct;54(4):528-33. PMID: 19250706 WhatRead more

Burn Baby Burn

Happy 4th of July! I’m taking the day to review a commonly incurred injury on the holiday: burns. Whether it’s from operating a grill after a few too many libations or an unfortunate encounter with fireworks, the incidence of burns seems to go up dramatically on the 4th. While we mostly see minor burns inRead more

Hypertonic Saline or Mannitol for Head Injury?

Traumatic Brain Injury & Neurocritical Care You’ve just intubated your traumatic brain injury patient and the repeat pupil exam shows signs of herniation. In addition to your other interventions (e.g., Reverse Trendelenburg positioning, optimization of sedation/analgesia), do you reach for the hypertonic saline or mannitol as osmotherapy? What risks and benefits come with either therapy?Read more

Fight Bites

  “Dogs never bite me. Just humans.” -Marilyn Monroe   Human bites are the third most common bite after dog and cat bites. They occur more frequently in males, typically between the late teens and in the twenties. Closed fist bites are typically caused by punching another individual in the mouth. The dorsal aspects ofRead more

The 52 in 52 Review: Tap Water for Wound Irrigation

Article Citation: Weiss EA, Oldham G, Lin M, Foster T, Quinn JV. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. BMJ Open. 2013 Jan 16;3(1). PMID: 23325896   What we already know about the topic: Traumatic wounds are a frequentRead more