This post dives into the basics of the initial trauma evaluation.
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Initial Trauma Assessment
Journal Review
Diagnostic Accuracy of IVC Collapsablity to Predict Fluid Responsiveness in Spontaneously Breathing Patients
Background: Assessing fluid responsiveness in patients in shock is crucial as fluid balance is important in their management. Identifying patients who are fluid responsive allows us to rapidly increase their cardiac index. However, rapid infusion does not benefit all patients in shock and in some, may be harmful. As a result, it is crucial to identify parameters that can aid in identifying patients who may benefit from volume expansion.
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Subtalar Dislocation
This post discusses the uncommon but important to recognize subtalar dislocation
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The Paradox
The Paradox
“Go take a break.” “Let me quickly pick up these two patients.” “Go grab some food and come back.” “I’m fine, I’ll just…” “Sanjay, get the hell out and don’t come back for fifteen minutes.”
It was my sixth overnight in a row. After having struggled for over 15 minutes with trying to place an ultrasound guided IV in a sickle cell patient,
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Journal Review
The YEARS Study – Simplified Diagnostic Management of PE
Background
The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of CT pulmonary angiography (CTPA) for diagnosis. However, despite these algorithms, there is evidence of increasing use of CTPA along with diminishing diagnostic rate (less than 10%).
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Methemoglobinemia
This post discusses tips for diagnosis of MetHb and pearls for management.
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Journal Review
Physician Interpretation of Cardiac Standstill on US
Point of Care Ultrasound (POCUS) has gained wider use in resuscitation of patients presenting with cardiac arrest. POCUS can play an important role in determining the etiology of arrest as well as being used to determine the presence or absence of mechanical activity. The REASON study demonstrated that patients with PEA or asystole without cardiac activity on POCUS are extremely unlikely to survive to hospital discharge though this study did not investigate the more important question of a survival with a good neurologic outcome.
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Suture Materials
This post reviews the most common suture types encountered in the ED along with indications for using different types.
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