Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients. To examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13–15) – from initial presentation to the ED to discharge.
An alternate approach would be to position naloxone kits where they are most needed in a community, in a manner analogous to automated external defibrillators. We hypothesized that opioid overdoses would show geospatial clustering within a community, leading to potential target sites for such publicly deployed naloxone (PDN).
This was a secondary analysis from a prospective cohort study of all trauma patients transported by ALS units over a 14-month period. We included patients who received intravenous access and were transported to a Level I trauma center.
Volume 14, Issue 6, 2014
James F. Holmes, MD, MPH, et al.
To determine if increased trauma team response results in alterations in resource use in a population of children <6 years, especially in those least injured.
Author Affiliation Bruce M. Lo, MD Eastern Virginia Medical School, Sentara Norfolk General Hospital, Department of Emergency Medicine, Norfolk, Virginia A previously healthy 36-year-old male who was a restrained driver presented with bilateral hip pain after a motor vehicle collision (MVC) put his vehicle in a ditch. On examination, the patient was alert and oriented […]
Intro: About 10,000 escalator-related injuries per year result in emergency department treatment in the United States. Since the 1990s, a steady increase has been reported, but few statistics on escalator-related injuries have been published worldwide.
Conclusion: Escalator accidents can result in severe trauma. Significant gender differences in escalator accidents have been observed. Alcohol intoxication and age are significant risk factors in escalator-related accidents and might be possible targets for preventive measures.
This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedside emergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompt urological consultation and timely surgical repair. The utility of bedside emergency ultrasound in the evaluation of testicular trauma, as well as the outcome of our case, is discussed here.
Intro: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.
Conclusion: In a large heterogenous group of clinicians who typically care for trauma patients, the sonographic evaluation for pneumothorax was as accurate as supine chest radiography. Thoracic ultrasound may be helpful in the initial evaluation of patients with truncal trauma.
A 29-year-old man with sudden onset of dyspnea and chest pain with impairment of the general status after falling down from five meters was transferred to our emergency department. He was completely asymptomatic before the injury, but hypotensive (80/50 mmHg) and tachycardic (112 beats/minute) after the injury. Chest radiograph revealed a bulging cardiac silhouette on the right paracardiac region with an increased cardiothoracic ratio of 70%.
Patients suffering from severe orbital trauma are at risk for numerous complications, including orbital compartment syndromes. This can result in an afferent pupillary defect, which must be evaluated for on physical examination. Unfortunately, these at-risk patients are often challenging to examine properly due to surrounding edema. Point-of-care ultrasonography can be used as an adjunct to the standard examination in this situation.
Introduction: Many traumatic pneumothoraces (PTX) are not seen on initial chest radiograph (CR) (occult PTX) but are detected only on computed tomography (CT). The primary objective of this study was to retrospectively determine the effectiveness of CR for detecting PTX in trauma patients.
Conclusion: Factors associated with PTX on CR included air in the soft tissue on CR and size of the PTX. Even when PTX is not apparent on CR, 44% of these PTXs received placement of a chest tube.
Emergency physicians (EP) frequently estimate blood loss, which can have implications for clinical care. The objectives of this study were to examine EP accuracy in estimating blood loss on different surfaces and compare attending physician and resident performance.
Author Affiliation Omar K Danner, MD Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia Kenneth L Wilson, MD Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia Sheryl Heron, MD, MPH Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia Yusuf Ahmed, MD King Saud University, Department of Epidemiology, College of Pharmacy, […]
This study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development.
Author Affiliation Omar K Danner, MD Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia L Ray Matthews, MD Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia Kenneth L Wilson, MD Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia Sheryl L Heron, MD, MPH Department of Emergency Medicine, Emory University School of Medicine, […]
As 5-year mortality rates for recidivism are as high as 20%, it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome.
Internuclear ophthalmoplegia is a rare condition caused by injury to the medial longitudinal fasciculus in the brainstem. It usually occurs in conditions such as stroke or multiple sclerosis and is extremely rare after head injury. We report a case of unilateral internuclear ophthalmoplegia, which occurred after a minor head injury in a young male. His only symptoms were headache and diplopia. He was treated conservatively, and his symptoms settled after 3 months.
A 58-year-old female presented to the emergency department (ED) with pain and swelling to the right arm after receiving propofol during an outpatient procedure for nasal polyps.
A 43-year-old man presented to the emergency department after he was swimming in the ocean and felt a sudden sting followed by a burning pain and muscle spasms in his right hand.
A healthy 19-year-old male presented with complaints of right ankle pain. Twelve hours before, he had jumped off a skateboard, inverting and abrading his right ankle.
A 30-year-old man presented to the emergency department after a motorcycle accident at high speed. He reported neck pain and referred paresthesia along the fourth and fifth fingers of both the left and the right hand. The patient arrived at hospital hemodynamically stable.
We present a case of pylephlebitis, which is an infective suppurative thrombosis of the portal vein. Pylephlebitis is an uncommon complication of intra-abdominal infections and carries with it significant morbidity and mortality.
The objective of this study was to determine the prevalence of intra-abdominal injury (IAI) and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation.
A 35-year-old man presented to the emergency department complaining of right hip pain after being struck by a car while crossing the road. His vital signs were stable, and he complained of right hip pain. He had no other comorbidity. On examination, tenderness and reduced abduction were noted in his right hip, but the gait was normal.
This study assesses the efficacy of the rapid sequence intubation (RSI) protocol in preventing patient recollection of resuscitative events and patient discomfort during intubation, as subjectively determined by the patient.
