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SOBRE EL AUTOR **

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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

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jueves, 27 de julio de 2017

Sistemas de trauma

AnestesiaR -
AnestesiaR - Por Vizuete - 17 Julio 2017
"El trauma grave sigue siendo la principal causa de muerte en gente joven en nuestro medio y siguen siendo los accidentes de tráfico la causa fundamental. Para algunos autores el sistema de trauma es el sistema “gold estandar” para prestar la atención sanitaria adecuada al paciente traumático. En esta revisión, dividida en dos partes, se pretende definir que es un sistema de trauma, sus componentes, resaltar la importancia, la situación y desarrollo a nivel internacional y nacional y los requisitos necesarios para su puesta en marcha."
*
AnestesiaR - Por Vizuete - 26 Julio 2017
"En esta segunda parte, pretendemos comentar los componentes básicos de un sistema de trauma, así como otros que también son necesarios para la puesta en marcha del mismo. Queremos resaltar aspectos fundamentales como la coordinación entre los diferentes profesionales que atienden al paciente, la existencia de un Código Trauma o aquellos requerimientos que deben cumplir los hospitales que atienden a pacientes traumáticos, estando entre ellos la presencia del equipo de trauma. También resaltaremos el papel que debe jugar la administración sanitaria, para que la creación de esta estructura asistencial tenga éxito y cumpla sus funciones."

martes, 25 de julio de 2017

Dexamethasone for Acute Pharyngitis

R.E.B.E.L. EM - Emergency Medicine Blog
REBEL Cast Episode 39 –  - July 24, 2017 24
Background: Sore throat is a common presentation to the emergency department as well as primary care clinics. Corticosteroids inhibit transcription of pro-inflammatory mediators in airway endothelial cells responsible for pharyngeal inflammation and symptoms of pain. They have been used in other upper respiratory tract infections such as acute sinusitis and croup. In adults, previous studies with dexamethasone are in combination with antibiotics but studies of children have included dexamethasone without antibiotics. This study is unique as it is evaluating the benefits of oral corticosteroids for acute sore throat in primary care in the absence of antibiotics..
Author Conclusion: “Among adults presenting to primary care with acute sore throat, a single dose of oral dexamethasone compared with placebo did not increase the proportion of patients with resolution of symptoms at 24 hours. However, there was a significant difference at 48 hours.”
Clinical Take Home Point: Corticosteroids may play a beneficial role in sore throat just like in other upper respiratory infections but the effect is more likely to be beneficial in those with more severe symptoms.

Recurrent VTE

Emergency Physicians Monthly
EP Monthly - By Hatfield L - July 21, 2017
"While recurrent venous thromboembolism is rare, it presents a unique challenge to emergency physicians seeking to understand the breadth of available anticoagulants. Here’s an essential run-down."

Cannabinoid Hyperemesis Syndrome

Gastroenterology & Endoscopy News - July 19, 2017 - By Kate O’Rourke
"The incidence of cannabinoid hyperemesis syndrome has increased with the loosening of marijuana laws in the United States, according to a new study presented at the 2017 Digestive Disease Week (abstract Tu1688).
Cannabinoid hyperemesis syndrome and cyclic vomiting syndrome are barely known to physicians and characterized by recurrent episodes of heavy nausea, vomiting and frequent abdominal pain. Complete and persistent resolution of all symptoms of the disease following cannabis cessation is the only reliable criterion applicable to distinguish cannabinoid hyperemesis syndrome from cyclic vomiting syndrome (Ger Med Sci 2017;15:Doc06).
Researchers said raising awareness of some of the medical problems that can occur with the use of cannabis is critical..."

lunes, 17 de julio de 2017

Apneic Oxygenation (ApOx)

R.E.B.E.L.EM - Jul 17, 2017
"Background: 
Apneic oxygenation (ApOx) is the passive flow of oxygen into the alveoli during apnea. This passive movement occurs due to the differential rate between alveolar oxygen absorption and carbon dioxide excretion producing a mass flow of gas from the upper respiratory tract into the lungs. Another important component of this maneuver is maintaining a patent airway so that supplemental oxygen administered through the nares is able to be delivered to the alveoli. This practice has been a game changer in emergency airway management for many providers. However, there are still some naysayers that believe in the sickest patients ApOx may not be so beneficial. This post is a review of two recent systematic reviews/meta-analyses published in the critical care and ED/retrieval settings on the use of ApOx..."

CVO saturation

PulmCrit (EMCrit)
PulmCrit – July 17, 2017 - By Josh Farkas
Summary: The Bullet
  • It is impossible to estimate the cardiac output merely by looking at the central venous oxygen saturation.
  • Even if a Fick calculation is performed which takes other variables into account (e.g. hemoglobin concentration), the central venous oxygen saturation cannot be used to accurately calculate the cardiac output.
  • A normal or high central venous oxygen saturation cannot be used to reassure us that the patient has adequate tissue oxygen delivery.
  • The central venous oxygen saturation probably cannot contribute useful information for patient evaluation (i.e. information which is more accurate than what could be otherwise surmised based on other clinical parameters)."

sábado, 15 de julio de 2017

Lidocaine

Emergency Physicians Monthly
EP Monthly - By Shenvi C & Serrano K - July 10, 2017
"Lidocaine is used routinely in the ED to numb up lacerations before repair and abscesses before I&D, or to perform digital blocks, hematoma blocks, nerve blocks, or intra-articular analgesia. Every medical student is taught how to infiltrate the skin with a thin needle, producing a blanching skin wheal. Lidocaine is also one of the ACLS 2015 antiarrhythmics for VF or pulseless VT. However, there are numerous other ways in which lidocaine can be used. The data supporting them is variable, and many of the uses are off-label. However, given the subjectivity inherent in the experience of pain, and the myriad mechanisms by which pain and noxious stimuli are sensed and transmitted, it is not surprising that there is some variability in the clinical response to lidocaine from patient to patient. Here we will outline a few of the interesting ways that lidocaine can be used. Personally, we have used it successfully basis for NG tube placement, urethral catheterization, in lower cervical muscular injections for headaches, atomized before nasal scope, and nebulized for cough or for ENT..."

Prehospital Emergency Procedures

MEDEST - LUG 13 2017
"In Emergency Medicine “Simplicity” is synonymous of efficiency, efficacy and reproducibility.
More the time frame is stressful more we need procedures that are efficient, efficacious and standardised, in one word SIMPLE.
Critcothyrodotomy and chest drain are procedures usually performed in high stressing scenarios and more simply they are more chance of success they have.
I don’t like complicate kits. They need training of course but even a calm and protected environment, and the middle of a street or a busy ER room aren’t nothing like that. 
I don’t like blindly performed procedures but prefer trusting my own senses and sensibility when performing high invasive procedures that, mostly of the times, are a lifesaving last chance.
So this is the best way I know to perform a surgical access to the airway and to drain a highly unstable tense pneumo: using simple instruments, always present in every emergency pack, and trusting my own tactile sensitivity."

BP in Neurological Emergencies

EMOttawa - July 13, 2017 - By Rob Suttie
"Objectives:
  • Explore the data for safety and efficacy of urgent BP lowering in hemorrhagic stroke.
  • Is there any benefit from management of elevated BP in acute ischemic stroke that is not a candidate for tPA?
  • What is the data for BP target in aSAH awaiting definitive management?"

Non-Response to Vasopressors

R.E.B.E.L. EM - Emergency Medicine Blog
R.E.B.E.L.EM - July 13, 2017
"Intro: Vasoactive substances are powerful therapeutic medications that can boost a patient’s blood pressure and perfusion to target organs. They are often used in resuscitation to support tissue perfusion though their benefits are mostly unproven and may be harmful in certain circumstances (i.e. hypovolemia, hemorrhage). The cognitive response to hypotension should not be reaching for a pressor. The primary therapy for any sick hypotensive patient is treatment of the underlying pathology..."

martes, 11 de julio de 2017

Interventional therapy for AIS

A summary of the evidence for endovascular therapy in stroke
First10EM - By Justin Morgenstern - July 11, 2017
"In part 2 of our EM Cases Journal Jam, we explored the literature looking at endovascular therapy for acute ischemic stroke. The studies of interventional therapy for stroke tend to get broken down into the early (negative) studies and the later (positive) studies. For consistency, I’ll use the same break down...
Summary
The studies here have to be rated as low quality. I would like to see at least 1 properly blinded study, and we clearly need more research to determine which patients are best managed with endovascular treatment, the harms of screening, and the societal impacts of this strategy. However, the recent studies are consistent and demonstrate an important benefit. Based on what we know today, I would want this therapy for myself."

June 2017 EM Articles

EM Topics
EMTopics - June 30, 2017
*NNR THIS MONTH = 56
You'd have to read 2533 articles to find these 45 marvels of modern statistics.
*NNR - number needed to read

domingo, 9 de julio de 2017

IVC / IVF

EMCrit
EMCrit - July 8, 2017 by Scott Weingart
"So on the ISepsis section of the blog, Paul just posted on the uselessness of IVC ultrasound for fluid assessment. Now since I don't really believe in large volume repletion anymore, I don't really care about fluid responsiveness all that much either. But I never let a good opportunity for debate pass me by, so it was a delightful happenstance that one of the authors of a negative trial on IVC ultrasound for fluid responsiveness sent me an email a few weeks ago. It seems Dr. Keith Corl, who was lead author of a 2002 trial mentioned in Paul's post, did not let the matter go. He just published a repeated, and in his estimation, much better trial:


I'll be posting a wee about it and Paul's post very soon; EMNerd tells me he is working on one as well. In the meanwhile, why don't you read through the trial and tell us what you think in the comments section."

Intubation during CPR

PulmCCM
Pulm CCM - July 8, 2017
..."There was serious concern that prioritizing airway and breathing led to inadequate circulation, sacrificing precious brain and other organs' health for the sake of an unneeded advanced airway. The 2015 AHA guidelines (and their European counterparts) further downplayed any advantage of endotracheal intubation over bag-mask ventilation during CPR...

Anyway, don't sacrifice immediacy or quality of chest compressions to intubate during CPR, is what I think this paper (and AHA) are trying to tell us. 

viernes, 7 de julio de 2017

The Thessaly Test for Meniscal Injury

An online community of practice for Canadian EM physicians
CanadiEM - By Maeghan Fu - July 7, 2017
meniscal injury
..."Summary
The Thessaly test is a relatively new physical examination technique for the detection of meniscal injury (both medial and lateral) in the emergency department. Clinical research has demonstrated high sensitivity and specificity for this test, especially when performed at 20° knee flexion. Moreover, compared to the more commonly taught McMurray test, the Thessaly test is much easier to perform and similarly easy to learn and teach.10 The general consensus among recent studies is that the Thessaly test should be the preferred method for detection of meniscal injury and is a useful clinical tool..."

Thrombolytics for stroke

A summary of the evidence for (or against) thrombolytics for stroke
First10EM - Justin Morgenstern - May 26, 2017
"Thrombolytics for stroke: undoubtedly the biggest controversy in emergency medicine. Also, the topic of this week’s Emergency Medicine Cases Journal Jam podcast. Rory Spiegel, Anton Helman, and I take a deep dive into the evidence. Why would we do this? No, it isn’t just that we have too much time on our hands. The journal jam podcast exists because we truly believe it is important to understand why we do what we do, both to ensure we are always providing the best care for our patients, but also so that we can explain that care to our patients. The evidence for (or against) thrombolytics is important precisely because the topic is so controversial. You will hear arguments on both sides. So will your patients. It is only through a familiarity with the studies, their strengths, and their weaknesses, that you will be able to decide for yourself what the evidence really shows and guide your patients to the best decision for their circumstances..."

martes, 4 de julio de 2017

The gag reflex

PulmCrit (EMCrit)
PulmCrit - July 4, 2017 -  ::By Josh Farkas 
"Summary: The Bullet
  • The gag reflex is a traditional component of the neurologic examination, but isn't evidence-based.
  • The reproducibility of the gag reflex is poor, due to variation in the techniques used to elicit it.
  • The specificity of the gag reflex is poor, being absent in ~20% of younger patients and ~40% of elderly patients.
  • The gag reflex is an unreliable predictor of aspiration, because it tests only a small fraction of the nerves and muscles required to control secretions via swallowing.
  • The gag reflex should not be used to assess whether patients can protect their airways.
  • The only rational use of the gag reflex appears to be certification of brain death."

ED Medication Errors

Logo
emDocs - July 3, 2017 - Author: Fontes K - Edited by: Koyfman A & Long B
"Take home points
  1. Avoid using the serum creatinine value to make decisions about drug dosing in older patients. Use GFR or calculate creatinine clearance (CrCl).
  2. When prescribing to older adults, minimize the number of CNS medications and their cumulative anticholinergic burden as much as possible.
  3. Use caution when prescribing new medications to elderly patients already taking antidiabetic agents, calcium channel blockers, and selective serotonin reuptake inhibitors, as drug-drug interactions with these agents can lead to falls and delirium.
  4. Consider using a validated screening tool to identify and avoid potentially inappropriate medications and drug combinations in older patients (MAI and STOPP/START may be more appropriate to the ED setting)."

Fall Prevention in Geriatric Patients

R.E.B.E.L.EM - July 3, 2017 - By Pescatore R
Post Peer Reviewed By: Anand Swaminathan and Salim Rezaie
"Background: 
Falls are the most common cause of traumatic mortality in geriatric patients. Each year, about 1/3 of community-dwelling adults over the age of 65 suffer standing-level falls. Over age 80, the incidence rises to nearly half (Carpenter 2014). Of the patients admitted to the hospital for injuries resulting from a fall, 33% will be dead within the year (Masud 2001). The emergency physician is tasked with the rapid evaluation and management of these patients, as well as the simultaneous responsibility of identifying those patients at risk for recurrent fall and intervening on modifiable risk factors. The American Geriatrics Society, Centers for Disease Control, and American College of Emergency Physicians all recommend that acute care providers screen for the risk of recurrent fall..."

PE: YEARS Study

EM Topics
EM Topics - July 3, 217
One size fits all
The YEARS study was a simplified way to work up patients for possible PE. Here was the method used in picture form.
From cited article
Source
Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017 May 23. pii: S0140-6736(17)30885-1. doi: 10.1016/S0140-6736(17)30885-1. [Epub ahead of print]

Trombosis venosa superficial

EMpills - Carlo D'Apuzzo - 6 Giu 2017
"E l’una. La prossima paziente che ci apprestiamo a visitare è una donna di quasi 90 anni.
Nella scheda di triage leggo: inviata dal medico curante per sospetta trombosi venosa gamba destra.
L’attesa per Miriam è stata lunga, quasi 6 ore. Quando la vedo vengo preso dallo sconforto.
E’ presente una tumefazione cordoniforme bluastra su un terreno varicoso, non dolente alla palpazione. La gamba non è edematosa e la paziente ci appare in ottime condizioni generali. I parametri vitali assolutamente normali
“E’ due giorni che mi è venuta, il mio medico mi ha detto di venire subito. Pensa sia una trombosi…”
La guardiamo con l’eco. E’ presente una trombosi superficiale di circa 3 cm di estensione a livello della superficie mediale della gamba. Il circolo venoso profondo pervio.
Cosa fare? Qual è l’approccio terapeutico migliore in una situazione come questa? 
Dobbiamo anticoagulare la paziente o somministrare antinfiammatori? La compressione aiuta? E la mobilizzazione?
Un buon motivo per cercare di approfondire..."

sábado, 1 de julio de 2017

dasSMAC - Day 3

R.E.B.E.L. EM - Emergency Medicine Blog
R.E.B.E.L.EM - June 29, 2017 - By Astin M
Post Peer Reviewed by Rezaie S
"The 2017 edition of the Social Media And Critical Care (SMACC) conference was held in Berlin, Germany this year (#dasSMACC). Over 2000 emergency physicians, intensivists, anesthetists, EMS providers, and nurses piled into the Tempodrom for three days of inspiring lectures and an all-around good time. This conference is truly a leader in innovation and continues to push the boundaries of medical education and entertainment. Here are some of the lessons learned and take home messages from the third day of the conference.
The final day of SMACC began with a panel on the future of medical education. Simon Carleyserved as the moderator for the panel that included Walter Eppich, Jenny Rudolph, Chris Nickson, Victoria Brazil, Daniel Cabrera, and Sandra Viggers..."

dasSMAC - Day 2

R.E.B.E.L. EM - Emergency Medicine Blog
R.E.B.E.L.EM - June 29, 2017 - By Astin M
Post Peer Reviewed by Rezaie S
"The 2017 edition of the Social Media And Critical Care (SMACC) conference was held in Berlin, Germany this year (#dasSMACC). Over 2000 emergency physicians, intensivists, anesthetists, EMS providers, and nurses piled into the Tempodrom for three days of inspiring lectures and an all-around good time. This conference is truly a leader in innovation and continues to push the boundaries of medical education and entertainment. Here are some of the lessons learned and take home messages from the second day of the conference."

miércoles, 28 de junio de 2017

dasSMAC - Day 1

R.E.B.E.L. EM - Emergency Medicine Blog
R.E.B.E.L.EM - June 27, 2017 - By Astin M
Post Peer Reviewed by Rezaie S

"The 2017 edition of the Social Media And Critical Care (SMACC) conference was held in Berlin, Germany this year (#dasSMACC). Over 2000 emergency physicians, intensivists, anesthetists, EMS providers, and nurses piled into the Tempodrom for three days of inspiring lectures and an all-around good time. This conference is truly a leader in innovation and continues to push the boundaries of medical education and entertainment. Here are some of the lessons learned and take home messages from the first day of the conference..."

HS in combat casualties

Disaster and Military Medicine logo
Parli R & and Puri B. Disaster and Military Medicine 2017; 3:2
DOI: 10.1186/s40696-017-0030-2
"Abstract
This brief update reviews the recent literature available on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the combat casualty care (CCC) environment. A number of changes need to be incorporated in the CCC guidelines: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hetastarch is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain tactical field care settings where this option might be feasible (FSC, GH) is discussed; (4) 1:1:1 damage control resuscitation (DCR) with plasma: packed red blood cells (PRBC): platelets is preferred to 1:1 DCR with plasma: PRBC when platelets are available; and (5) the 30-min wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure has been eliminated. Also included is an order of precedence for resuscitation fluid options. There should be an emphasis on hypotensive resuscitation in order to minimize (1) interference with the body’s hemostatic response and (2) the risk of complications of over resuscitation. Hetastarch is retained as the preferred option over crystalloids when blood products are not available because of its smaller volume and the potential for long evacuations in the military setting."

Biliary Colic Mimics

Logo
eemDocs - Jun 27, 2017 - Author: Whitworth K - Edited by: Koyfman a & and B
"Take Home Points
  • It is difficult to distinguish between Cholelithiasis and Acute Cholecystitis by history and physical alone. Use an ultrasound!
  • Remember an ultrasound demonstrating gallstones with a positive “sonographic” Murphy’s sign is often enough to nail the diagnosis of Acute Cholecystitis.
  • The older the patient, the broader the differential. CT imaging may be more useful in select patients.
  • Don’t forget the lipase!
  • Fear the Fever! Consider Acute Cholecystitis or Cholangitis, but don’t forget about intraabdominal abscess or a right-sided pneumonia."

Blunt Chest Trauma

Logo
emDocs - June 26, 2017 - Authors: Simon E and Sessions D
Edited by: Koyfman A and Singh M
"Bottom line
Both NEXUS Chest CT-All and CT-Major have > 99% sensitivity in detecting major thoracic injuries. NEXUS Chest CT-All has > 95% sensitivity in detecting major and minor thoracic injuries following blunt trauma (in patients presenting within 6 hours of injury).
If you’ve read to this point and are wondering, what about ultrasound? We’ve got you covered:
Bedside ultrasound is a useful adjunct in the evaluation of patients presenting following blunt chest injury as it allows for the rapid detection of pneumothoraces, hemothoraces, and pericardial effusions. As compared to CXR, US demonstrates greater sensitivity for the detection of pneumothoraces (sensitivity 86%30) and is more accurate in the diagnosis of hemothoraces, however, CT remains the gold standard.
To summarize our discussion:
Note: This varies from the widely accepted trauma surgery approach, which would advocate for a screening CXR in the evaluation of a patient who sustains blunt chest injury."

martes, 27 de junio de 2017

Fall Assessment (Part 2)

EM Didctic - June 26, 2017 - By Lakshay Chanana 
"Several studies report that falls are the most common reason for geriatric trauma. Injuries in elderly tend to be more severe as compared to young even with similar mechanisms and severity. While evaluation an elderly with a fall, we also need watch for complications of prolonged immobility as well such as rhabdomyolysis, pressure sores, dehydration..."

To Cric or Not to Cric?

TAMING THE SRU - June 26, 2017
this image was published with the written consent of the patient.       this image was published with the written consent of the patient.
(IMAGES PUBLISHED WITH THE WRITTEN CONSENT OF THE PATIENT)

...Difficult airways can be stressful for the provider, the team, and the patient. Vocalizing the airway plan for all involved is helpful to ensure that all team members know their roles and the plan going forward. Lack of knowledge that the backup plan involves a surgical airway can increase anxiety among the team members involved and lead to unnecessary errors or delays. In the case outlined above, each provider knew the initial plan and was aware of the alternative which helped to facilitate a seamless transition from the failed awake look attempt to the definitive surgical airway. 
In summary, performing a surgical cricothyrotomy is one of the most stressful situations that emergency providers face. Realistic simulation for this procedure is difficult to replicate. Therefore, learning from the experience of others can help future providers save the life of the patient that cannot oxygenate, cannot ventilate, and cannot intubate. 
For futher reading and videos - See Dr. Hill's Cric Page

Intubation in Arrest

SCANCRIT -  June 25, 2017 By Thomas D
"Another study on airway management in cardiac arrest was just published in JAMA. The study was done in Denmark, where all intubations elective and emergency are done by anaesthestetists. It was a retrospective study, where they matched intubated patients with historical arrest patients not intubated at that same point in resus time. Intubation lowered the pt’s chance of survival to discharge with CPC. So, another study against intubation in cardiac arrest. Or?...
The real conclusion
From the studies we have now, we can confidently say that intubation with or without CPR pauses still harms the patient with a standard ventilation strategy, which often is hyperventilation by hand. Ventilation should be low and slow."

sábado, 24 de junio de 2017

Bilateral leg edema

Logo
emDocs - June 19, 2017 - Authors: Weymouth W and Ong D
Edited by: Koyfman A and Long B
"Take Home Points
  • Major organ systems involved with peripheral edema include the heart, kidneys, and liver.
  • History and exam are the most important aspects of the evaluation of lower extremity edema.
  • Look for signs of cirrhosis and ascites. If ascites is present, obtain LFTs and perform paracentesis.
  • Consider a BNP or bedside ultrasound (if clinically indicated), BMP, and a UA to evaluate for heart failure and nephrotic syndrome.
  • Consider other tests as indicated (i.e. history of malignancy-DVT ultrasound, woman of childbearing age-pregnancy test, etc.)"

Incidente terrorista

Semes Divulgación logo
junio 23, 2017 
"Si te ves involucrado en un incidente terrorista, sigue los consejos que te ofrecemos desde #DivulgaSEMES y el Grupo de Enfermería Militar de SEMES"

Knowledge Translation Recommendations

An online community of practice for Canadian EM physicians
CanadiEM - June 3, 2017 - By Brent Thoma
"As part of the 2017 Canadian Association of Emergency Physicians (CAEP) Conference an Academic Symposium was held on research. One aspect of this symposium investigated best practices for knowledge translation in the emergency department. The 10 recommendations presented in the above infographic and following below were compiled using the preliminary results of a systematic review that was conducted on this topic along with the results of a national survey of emergency physicians. In addition to seeking the input of the symposium participants, we hope to receive additional feedback from the virtual community of emergency physicians and practitioners online. We would appreciate your feedback. All responses will be analyzed and incorporated to improve the final recommendations."


jueves, 22 de junio de 2017

Whole Body CT vs. Selective Imaging in Trauma

Logo
emDocs - Jun 21, 2017 - Authors: Long B & & April M - Edited by: Koyfman A
"Recommendations
  • There are protocols determining need for WBCT in trauma. Most of these take into account mechanism of injury, patient injuries, hemodynamic status, and other studies such as labs and FAST scan, with recommendation to obtain WBCT in patients with abnormal mental status, hemodynamic instability, and suspicion of critical injury.30,65-67
  • Ultimately, the physician should go through their trauma ABC’s and conduct a history and exam. US should be a component of this exam. Patients with concern for severe polytrauma or those who are not clinically evaluable may benefit from WBCT. At this point, in patients who are evaluable with no evidence of polytrauma, selective imaging based on history and exam is recommended."

miércoles, 21 de junio de 2017

Falls in Elderly

EM Didactic - By Rishal Rahman - June 19, 2017
"Definition
An event that leads to a conscious subject unintentionally coming to rest on ground or a lower level, not as a result of a overwhelming hazards or a major intrinsic event. e.g. – not due to trauma, seizure or syncope. A recurrent fall is defined as 2 or more falls occurring within 6 months, which need extensive evaluation for etiology...

Take home
  • During all the stages of working up, ask yourself - what could have precipitated this fall? Spend more time on history (next of kin, nursing home, paramedics)
  • Have a low threshold for admitting elderly with unexplained events
  • Keep the thought process broad with all differentials and causes in mind
  • Some times you may not be able to get that answer, that's okay – make sure you are not missing any thing gross."