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52 in 52: POCUS in Trauma

Article Citation: Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006 Sep;48(3):227-35. PMID: 16934640 Resident Reviewer: Courtney Cassella What we already know about the topic Trauma is anRead more

52 in 52: Emergency Department Thoracotomy

Article Citation: Moore EE, Knudson MM, Burlew CC, Inaba K, et al; WTA Study Group. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011 Feb;70(2):334-9. PMID: 21307731 Resident Reviewer: Courtney Cassella What we already know about the topic: Resuscitative ED thoracotomy (EDT) is a resource intense procedure withRead more

Unstable Cervical Fractures

Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.   Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures   Jefferson Fracture A burst fracture of the ring of C1 Typically caused by an axial loading force to the occiput (think diving injury) TypicallyRead more

Neck flexion injury

A diver shows up to your trauma bay in a c-collar and with complete motor paralysis of legs, torso, hands and weakness of shoulder muscles. He has no sensation to pain or temperature below his clavicles. His proprioception is intact. Which level spinal cord lesion is this? What is the diagnosis?   ANSWER: Anterior cord syndromeRead more

Knee Immobilizer Pearl

53 yo F was walking in high-heeled boots on the cobblestones of the west village. She slipped and suffered a knee twisting injury. On exam, she has an effusion but her plain film is negative for fracture/dislocation. She is in too much pain to bear weight but there is no appreciable laxity in the kneeRead more

Is It Time to End Routine C-spine Immobilization?

  Cervical spine immobilization is a routine precaution taken by both EMS and Emergency Departments for patient who experience oftentimes minimal trauma. The purpose of maintaining immobilization of the cervical spine with suspected bony injury is to prevent secondary injury.  Other than patient discomfort, maintaining cervical spine immobilization is oftentimes resource-heavy and can complicate essentialRead more

Mtp Pearls

32M BIBEMS s/p SW to abdomen. He becomes hypotensive/tachycardic, becomes less responsive. Massive transfusion protocol is initiated. What electrolyte abnormality is caused by massive transfusion? In the 1:1:1 ratio, are we talking about a single dose of platelets or a single unit of platelets?Read more

Eye Trauma & Bradycardia

A 3yo M comes into your ED around midnight after a fall off a stool onto his face. He has been vomiting, is bradycardic in triage to the 50s so is brought into your pediatric RESUS bay. Mom states that his eyes “look weird”. On exam, pt is scared but awake and alert, with fullRead more

Pharmacologic Intervention for Prevention of Post-traumatic Stress Disorder After Trauma

In the ED we often provide first line care for patients as the result of traumatic events.  Beyond attending to clinically apparent injuries, pain, and distress, we would be in a position to apply prophylactic treatment to attempt to prevent PTSD, a debilitating sequela of trauma, if such treatment were to exist and founded inRead more

Face off

A 29 y/o M presents to your ED after a head-on MVC at moderate speed.  The patient was driving an older automobile without airbags, and smashed his face hard against the steering wheel.  He has significant facial ecchymoses and swelling, and you note clear fluid continuing to drain from his nose.  What injury will likelyRead more