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?

October 8, 2018

Definition:

  • Accidental hypothermia is an unintentional core body temperature of < 35°C when heat loss to surroundings is greater than heat generation
  • Most frequent cause is environmental exposure
  • Patient with impaired thermoregulation can develop hypothermia in relatively warm environments
    • Elderly, underlying illness, trauma, intoxication, or malnutrition (Brown 2012)

May 31, 2018

Definition: Syndrome characterized by dysfunction of multiple lumbar and sacral nerve roots in the lumbar vertebral canal due to compression

Anatomy

  • The spinal cord terminates in the conus medullaris at the T12/L1 vertebral body in adults
  • Cauda equina
    • Collection of nerve roots from L1-S5
    • Compression from various causes results in lower motor neuron pathology

May 28, 2018

Background: Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. Due to the large number of critical structures in the neck, a clear knowledge of the anatomy is necessary for proper evaluation and management.

Epidemiology (Evans 2018)

  • Represent 1% of all trauma admissions in the US and have a 5% mortality rate
  • 80% of morality secondary to cerebral infarction
  • ~ 20% of mortality secondary to uncontrolled hemorrhage