Helicopter emergency medical services (HEMS) offers rapid transport to trauma centers while simultaneously providing advanced prehospital care. It is through these reasons that HEMS carries a survival benefit over ground emergency medical services (GEMS). However, increasing financial burdens and aviation risks to flight crews/patients complicate the decision to transport a patient by HEMS.
Do you sound like a first year medical student when discussing hand injuries by phone with consultants? Forget all the tendon anatomy you crammed for in anatomy? FDP? FDS? FPL? Then check out this post for a "Back to Basics" online hand exam lecture by Dr. Fred Heckler from UPMC.
Case: 24 year old male with no significant past medical history presents to local urgent care with chief complaint of left knee pain. Patient reports playing basketball just prior to arrival and reports landing on left knee and "jamming it."
Following a severe brain injury the goal of the clinician is to prevent secondary brain injury. This entails increasing oxygen delivery to the brain by preventing hypoxia and increasing cerebral perfusion. Hyperosmolar therapy, including mannitol and hypertonic saline, is often used to decrease ICP.
Lacerations of the tongue often require special consideration considering the tongue's anatomic location and functional importance. Repair of tongue lacerations are often plagued by patient intolerance and inadequate anesthesia of the area. This posts aims to introduce the basics of management of tongue lacerations.
Managing Tongue Lacerations:
Your patient in the Emergency Department has a Zone II or Zone III finger amputation which requires primary closure of the wound prior to discharge with appropriate outpatient follow up. However, a protruding piece of bone often prevents closure of the skin flap and requires trimming by using a rongeur. While this process is typically carried out by an orthopedic or hand surgical consultant, this post aims to introduce the use of a ronguer during management of finger amputation in the Emergency Department.
The most commonly used induction agent for rapid sequence intubation in the acutely injured patient is etomidate, largely due to its rapid onset of action and hemodynamically "neutral" effects. The dose-dependent effect of etomidate in suppressing adrenal synthesis of cortisol leading to adrenal insufficiency has left the door open for ketamine to be also considered as the rapid induction agent of choice in these critically injured patients.