The past couple of decades have seen increased access to and ease of using CT scanning for traumatically injured patients. Given that the abdomen is an important source of occult bleeding, routine use of abdominal CT scans has become increasingly common and has predictably yielded many negative studies as well as finding clinically irrelevant abnormalities.
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Emergent endotracheal intubation has risks of complications including hypoxia, pulmonary aspiration, and prolonged time to intubation. Previous studies from the anesthesiology literature suggests that bed-up head-elevated (BUHE) positioning is associated with improved glottic views and prolonged apnea time. Using this positioning method could lead to decreased complication rates with emergent intubation.
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Irrigation after incision and drainage (I+D) of an abscess in the ED is considered by some sources to be standard care but local practice varies considerably. There are no randomized controlled trials to date that look at the potential benefits of this procedure. Irrigation increases the time required for the procedure and increases pain experienced by the patient.
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Airway management is a critical part of the management of patients presenting with traumatic brain injury (TBI). Emergency Physicians (EPs) have no ability to change the primary injury once it has occurred and so our focus is on preventing secondary brain injury. Hypoxemia and hypercarbia are major contributors to morbidity and mortality and management must focus on preventing them.
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Emergency Department (ED) patients frequently present with injuries and disease requiring procedural sedation and analgesia (PSA). PSA is a core skill for Emergency Physicians (EP) and acts to relieve pain and anxiety for patients. The procedure involves providing sedative and analgesic agents in order to allow EPs to effectively perform critical procedures from joint reduction to incision and drainage of abscesses to laceration repairs to preoxygenation.
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Annual emergency department visits for skin and soft tissue infections (SSTI) are on the rise nationwide, and an increased incidence of abscesses is the likely culprit. MRSA is quickly emerging as the most common cause of purulent SSTIs, and Trimethoprim-Sulfamethoxazole (TMP-SMX) remains a cost-effective first line enteral antimicrobial to treat it. The primary treatment for a cutaneous abscess is incision and drainage (I&D),
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Warfarin and clopidogrel are two commonly prescribed anticoagulant medications, and based on previous studies, patients taking either of these medications who suffer blunt head trauma are at an increased risk for traumatic intracranial hemorrhage (ICH). Additionally, there is concern that patients on these agents can have delayed traumatic ICH (traumatic ICH occurring within 2 weeks after an initially normal CT scan result in the absence of recurrent head trauma).
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