January 28, 2019

Diagnosis and management of concussion in children is part of our everyday bread and butter in the Emergency Department. Given the estimated 1.1 million - 1.9 million pediatric concussions we see annually in the United States, it is no wonder why. [1] We are well aware that pediatric concussions (more accurately termed mild traumatic brain injury, mTBI) occur most commonly from direct blunt head trauma, but they can also occur via indirect forces. Regardless of mechanism, concussions result in temporary neurologic and/or cognitive impairment that can last hours to days, with long-term sequelae potentially lasting weeks to months.

December 6, 2018

Friday, 2300 hours:

A 24 year-old woman presents to your Emergency Department after a motor vehicle collision. She was the restrained driver of a car that collided head-on with another vehicle. She is complaining only of chest pain and appears uncomfortable and anxious.  The monitor shows sinus tachycardia and you spot a sternal fracture on her chest x-ray.  After IVF and Fentanyl, she remains slightly tachycardic and you wonder:

  • Do I need to send a troponin?
  • If the troponin is negative does this patient need to be admitted?
  • What other testing should I consider in the Emergency Department?

November 5, 2018

Background: Care of trauma patients with severe bleeding has advanced in recent years with a focus on damage control resuscitation which includes permissive hypotension, hemostatic resuscitation (blood component resuscitation), and hemorrhage control. Minimizing crystalloids in favor of blood component-based resuscitation in the prehospital setting has the potential to reduce downstream complications by intervening closer to the time of injury before the development of coagulopathy, irreversible shock, and inflammatory response.  There is a paucity of high level evidence showing the efficacy and safety of plasma transfusions in the prehospital setting including retrospective studies which suffered from survivor bias (patients had to survive long enough to receive plasma) and small randomized clinical trials not showing survival benefit.  This has led to the publication of two randomized controlled trials: COMBAT and PAMPer.

August 16, 2018

Background: Alcohol and drug intoxication is common in trauma patients and a significant proportion of cervical spine (c-spine) injuries occur in patients with intoxication. A standard approach to both intoxicated and sober patients with suspected c-spine injury in many trauma centers includes the placement of a rigid cervical collar for spinal immobilization until the c-spine can be “cleared.”  Even after a negative CT, intoxicated patients often are immobilized for prolonged periods of time until a reliable exam can be performed due to concern for missed findings on CT scan, specifically unstable ligamentous injuries.  This practice is less than ideal, as prolonged c-spine immobilization is associated with DVT, atelectasis, aspiration pneumonia, and elevated intracranial pressures.  In 2015, the Eastern Association for the Surgery of Trauma (EAST) demonstrated that CT imaging of obtunded patients due to any cause would miss approximately 9% of cervical spine injuries, most of which are clinically insignificant. They additionally found no benefit to prolonged immobilization.

REBEL Review 88: Sub-Dissociative Ketamine for Acute Pain

Created July 23, 2018 | Trauma | DOWNLOAD