Emergency Medicine Journal

NOVEMBER 28, 2023

Background During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. The primary outcome was the proportion of patients requiring more than one reduction attempt. to 6.45).

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

The Skeptics' Guide to EM

DECEMBER 10, 2022

One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. X-rays demonstrate a minimally displaced midwaist fracture of the scaphoid. The LR- to rule out a scaphoid fracture was 0.15

Operations 52

Operations Fractures Military Emergency Department 52

Broome Docs

SEPTEMBER 9, 2023

In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. Bottom line: ultrasound appears to be non-inferior to X-ray when used as a first line investigation in terms of functional, patient-oriented outcomes.

Fractures 120

Fractures Ultrasounds Outcomes 120

Pediatric EM Morsels

APRIL 19, 2024

Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures. Today, we want to focus on a couple of our good friends, buckle and greenstick forearm fractures. Pediatric patients have unique bony anatomy and physiology compared to the skeletally mature.

Fractures 251

Fractures Pediatrics Best Practices Outcomes 251

Don't Forget the Bubbles

NOVEMBER 13, 2023

Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? Distal forearm fractures are common in children and adolescents, but the best method for diagnosing them is still debatable. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. N Engl J Med.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

The Skeptics' Guide to EM

MARCH 27, 2021

He has a passion for FOAMed and is the creator of the […] The post SGEM#324: Blow Away, Blow Away, Blow Away – Spirometry for Discharging Older Patients with Rib Fractures first appeared on The Skeptics Guide to Emergency Medicine. Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 40

The Trauma Pro

SEPTEMBER 12, 2023

Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture. Bottom line: This is an intriguing abstract, pointing me to the original paper published in NEJM. This multi-center study was performed in conjunction with the research coordinating center at Johns Hopkins, which designs some top-notch research.

Fractures 147

Fractures Head Injuries Research Outcomes 147

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Hospitals 83

Don't Forget the Bubbles

OCTOBER 4, 2023

In this issue of the Archives , we read a large retrospective study about gastric acid suppression in infancy and the increased risk of fractures. The intriguing finding of this study was the fact that non-fracture injuries increased, which could suggest that another factor (the temperament of the child rather than gastrin or VitB metabolism?)

Pediatrics 111

Pediatrics Fractures Outcomes Research 111

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

EB Medicine

MAY 31, 2017

This month's episode of EMplify, a podcast corollary to the Emergency Medicine Practice journal, focuses on management strategies that improve dental emergency outcomes.

Outcomes 40

Outcomes Fractures Emergency Department 40

The Skeptics' Guide to EM

MAY 7, 2017

Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med May 2017.

Fractures 40

Fractures Pediatrics Ultrasounds Academics 40

Emergency Medicine Journal

SEPTEMBER 27, 2023

We aimed to assess the STRC by reviewing the journey and outcomes of patients who attended the clinic. In total, 56 patients were reviewed with vertebral fractures. Methods A retrospective review of electronic chart data was performed on all patients who attended the clinic over the initial 1-year period.

Operations 75

Operations Fractures Outcomes 75

Taming the SRU

MAY 11, 2024

For mid-shaft femur fractures, traction appears to may reduce blood loss and pulmonary complications, but the available data is very scarce. Usually presents consistent with failure of that organ.

Administration 81

Administration Resuscitation Research Fluid Resuscitation 81

Taming the SRU

MAY 22, 2023

Ankle fractures are the third most common fracture in the ED [2] and more than 20,000 patients are seen in the ED for ankle sprains each day [3]. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED.

Fractures 69

Fractures Dislocations Operations Radiology 69

EM Literature of Note

AUGUST 23, 2023

Injuries range from tuft fractures, to degloving injuries, to all manner of nail and nailbed derangement. The “c0-primary” outcomes were cosmetic appearance of the nail (using the Oxford Fingernail Appearance Score) and surgical-site infection at 1 week follow-up.

Emergency Department 75

Emergency Department Fractures Outcomes 75

Taming the SRU

MAY 23, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. fractures of the talar body, talar neck, and calcaneus require high-impact trauma). Gross deformities often suggest fracture or dislocation.

Fractures 55

Fractures Dislocations Operations EMS 55

Emergency Medicine Journal

JULY 24, 2023

Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. No restrictions were applied for date and language.

Ultrasounds 40

Ultrasounds Fractures Outcomes 40

Emergency Medicine Journal

JULY 24, 2023

Not just a minor injury The term minor in the vernacular of emergency medicine is relative, often a misnomer can serve to downplay and underestimate the complexity of some injuries and the potential adverse ramifications and outcomes for patients with some minor injuries.

Fractures 53

Fractures Outcomes 53

JournalFeed

DECEMBER 18, 2021

We cover ETCO2 and trauma outcomes, ORIF vs cast for adult distal radius fractures, high or low/ 3 or 7 day treatment for pediatric community acquired pneumonia, a new pediatric CAP severity prediction tool, and how emergency physicians are coping with COVID stress. It’s the JournalFeed Podcast for the week of December 13-17, 2021.

Fractures 52

Fractures Pediatrics Outcomes 52

The Skeptics' Guide to EM

JANUARY 30, 2021

The X-ray demonstrates a fracture of the distal radius that is in an acceptable position and does not require a reduction. You immobilize her in a below elbow splint which provides significant pain relief and refer her to the local orthopedic fracture clinic. J Bone Joint Surg Am. Reference: George et al. J Bone Joint Surg Am.

Fractures 52

Fractures Documentation/Coding Outcomes 52

EB Medicine

NOVEMBER 3, 2022

Orbital fractures: What should we be looking for? Orbital fractures: What should we be looking for? Physical: Visual acuity and eye exam Diagnostics: Slit lamp, ocular pressure, US, CT, MRI Treatment Lid lacerations: Who repairs and when? Why is it different in children? When does repair typically occur?

Pediatrics 52

Pediatrics Fractures EMS Outcomes 52

Don't Forget the Bubbles

JUNE 30, 2023

She has a right parietal-occipital region haematoma, and you think you might be able to feel a step – you’re pretty convinced she has a palpable skull fracture. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Two IVs go in, one in each antecubital fossa.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

EMDocs

SEPTEMBER 9, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. Open Fracture. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c 0b013e3182a0148c Zhao W, Wang G, Chen B, et al. Medicine (Baltimore). 2019;98(44):e17823.

EMS 77

EMS Fractures Soft Tissue Injuries Ultrasounds 77

The Skeptics' Guide to EM

FEBRUARY 20, 2021

Myth #1: The use of non-selective NSAIDs will cause a nonunion in long bone fractures When bones break, they usually heal with either surgical or non-surgical management. Non-union is defined as “a failure of the fracture-healing process” and occurs in up to 1 in 10 fractures.

Fractures 52

Fractures Outcomes Hospitals 52

Pediatric EM Morsels

SEPTEMBER 22, 2023

Most commonly caused by fracture or dislocation of vertebrae. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. This leads to descending sympathetic tracts being disrupted. J Pediatr Surg. 2001;36(2):373. Pediatr Emerg Care.

Shock 273

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 273

Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 66

Seizures Fractures EKG/ECG Resuscitation 66

Taming the SRU

APRIL 22, 2023

Currently, there is limited data investigating outcome differences between beta blockers and calcium channel blockers for atrial fibrillation with rapid ventricular response in a patient diagnosed with heart failure. There were similar lengths of say overall and no significant difference in safety outcomes.

Outcomes 52

Outcomes Documentation/Coding Stroke Wellness 52

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 84

Sepsis Administration Documentation/Coding Fractures 84

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. With this model, there will hopefully be improved patient satisfaction and better outcomes.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Koenis MM et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

RebelEM

JANUARY 24, 2024

Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al.

Operations 74

Operations Ultrasounds Outcomes Fractures 74

Pediatric Education

OCTOBER 22, 2023

Discussion The main outcome of any delivery is to have a healthy mother and healthy child. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children. The radiologic evaluation confirmed that these were subcutaneous fat necrosis. Br J Dermatol.

Radiology 52

Radiology Radiology Fractures Pediatrics 52

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ).

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. 89% of patients with PTX under this cutoff were successfully observed.

Fractures 85

Fractures COPD Hospitals Emergency Department 85

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Classically associated with long bone fractures, a PFE may also occur when fat is injected or absorbed into a blood vessel during the reinjection phase of an AFT procedure. The most concerning complication of AFT is the pulmonary fat embolism (PFE).

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

RebelEM

JANUARY 30, 2023

Heterogeneity (I 2 ) for the primary outcome was 69%, representing a moderate value. Of particular note, subjective outcomes are particularly prone to bias in an open-label trial. vs. 91.4%; RR 0.93; 95% CI 0.86–1.01, 1.01, I2 = 69%, low certainty) Fewer adverse events occurred in the IAL group compared to the PSA group.

Dislocations 57

Dislocations Outcomes Emergency Department Research 57