Contributor: Nick Tsipis MD Educational Pearls: The scaphoid bone is the most proximal carpal bone just distal to the radius Fractures of the scaphoid bone are sometimes missed by plain X-rays A 2020 review found a 21.8% incidence of missed scaphoid fractures later diagnosed by advanced imaging modalities Only MRI has a sensitivity above 90%…
Read MoreContributors: David Young MD, John Hesling MD, Travis Barlock MD, Jeffrey Olson Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss several clips from the event “Ukraine Brewtalk” from October 2022. This event was hosted by the University of Colorado’s Center for COMBAT Research and Emergency Medical Minute…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Torus (Buckle) fractures are a commonly encountered pediatric fracture pattern Typically presents as wrist pain secondary to a child falling on outstretched hand One edge of the bone “buckles” or bends because children’s bones are softer and more pliable Management Older studies have shown that short term immobilization with…
Read MoreContributor: Jared Scott, MD Educational Pearls: Immediate resuscitative thoracotomy can be performed in the ED to gain rapid access to the thoracic cavity in cases of traumatic cardiac arrest Western Trauma Association Society Criteria for ED thoracotomy Blunt trauma + <10 min of prehospital CPR Penetrating trauma to torso + <15 min prehospital CPR Penetrating…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Achilles tendon rupture usually presents in younger, healthy patients after a sports injury Patients typically present complaining of an abrupt onset ankle pain after feeling a “pop” Pain can be localized to posterior ankle and patient’s lack the ability to plantarflex Achilles rupture is a clinical diagnosis and does…
Read MoreContributor: Jared Scott, MD Educational Pearls: If a patient is in significant pain, a digital block can be helpful. Pain management alone may allow for manual ring removal. Ring cutters and trauma shears with specialized ring cutters can be attempted but will destroy the ring and some materials may be resistant to cutting. 2 alternative…
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A Shocking Adverse Effect Chief Complaint: Defibrillator shock HPI: 50-year-old biologic male who identifies as a female presented after reportedly being shocked by her defibrillator 5 times before calling EMS, EMS noted that they witnessed 1 shock. They also noted that blood pressure was in the low 100s and heart rate was between 200-260 before…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Multiple factors affect if a digit can be reattached including: location of digit injury, mechanism of injury, duration since injury, preservation mechanism. Recommended preservation is via indirect cooling. This is accomplished by wrapping the amputated digit piece in saline soaked gauze, placing the wrapped piece in a waterproof bag…
Read MoreContributor: Nick Hatch, MD Educational Pearls: “Smiling Death” describes the prehospital phenomenon of a person who is happy to be extricated from an extended period of crush injury, but dies suddenly soon after the rescue. Smiling Death is caused by Crush Syndrome. Crush Syndrome begins when large areas of tissue are damaged by compression and…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Pulse pressure is the difference between the systolic and diastolic blood pressure, normal is about 40 A narrow pulse pressure is generally thought of as less than 30 mmHg which may signal peripheral vasoconstriction in response to lower blood volumes 2020 study examined hypotension and narrow pulse pressure in…
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