#EM conf!

Thu, 01/26/2017 - 4:08pm
Author: 
Richard Byrne, MD
Editor: 
Richard Byrne, MD
  •  Consider incentive spirometer for hemodynamically stable, low risk trauma patients with rib injury to help determine need for further imaging and disposition in the elderly.

 

  • In a low risk trauma pt with lower rib pain with minimal suspicion for spleen/liver injury, why not perform a quick FAST exam to assess for free fluid? If you were planning on discharging the patient without a CT scan anyway, this might pick up an injury that would otherwise have been missed. Careful though! FAST should not replace CT scan to "rule out" traumatic injury to the abdomen!

 

  •  Have a patient with sudden change in clinical stability? START OVER. Repeat primary survey, repeat all vital signs, ecg, accucheck, bedside ultrasounds (FAST, cardiac). Emergency medicine patients are dynamic

 

  • Checking out a pediatric lateral elbow film? Draw your two lines first! The first is straight down the anterior humerus, should go through the anterior 1/3 of the capitellum. If the line passes in front of this point, suspect supracondylar fracture. Major complication? Volkmann's ischemic contracture. The second line goes through the middle of the radius and should pass through the middle of the capitellum. If it doesn't suspect radial head subluxation.

 

  • In severe TBI, minimize secondary brain injury by preventing and treating hypoxia and hypotension.

 

  • A basic guide to determine if a spinal fracture is stable or unstable is the Denis principle, which states that if 2 of the 3 spinal columns are disrupted, the fracture is unstable.

 

  •  Ultrasound pearl: The most accurate point to capture LV squeeze on parasternal short axis is between the papillary muscles at the level of the mitral valve

 

  • Ultrasound pearl: On apical four-chamber view if you can see the mitral and tricuspid valves in plane with each other you likely have an interpretable view.