“The Golden Hour”, a widely accepted concept that transport of the trauma patient within the initial 60 minutes after injury purports better outcomes has little empiric evidence directly supporting this relationship between time and outcome. While there have been many studies that suggest a survival benefit to shorter on-scene time and shorter transit time; most studies fail to substantiate a relationship.
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ATLS teaches inexperienced providers a systemic approach to trauma, with focus on stabilization and appropriate transfer of care. It is designed for providers who do not have much trauma exposure, not necessarily for providers who work in major trauma centers. This article reviews the scope of ATLS training and asks whether it is important or relevant for providers in major trauma centers.
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Sepsis and meningitis are rare but feared diagnoses in children, especially when they are unable to provide any meaningful history. Based upon available evidence, it can be assumed that delayed diagnosis in a dangerous condition would lead to worse outcomes. Children under the age of one month are almost universally treated as if they are immunosuppressed for this reason,
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Acute lumbar radiculopathy is characterized by radiating buttock and leg pain in a lumbar nerve root distribution caused by herniation of the nucleus pulposus. It has a lifetime prevalance greater than 10% and can result in significant pain and disability. Epidural steroid injections and lumbar diskectomy are commonly performed, however oral steroids may provide the same anti-inflammatory benefits are less invasive,
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Over the past decade, endovascular therapy has been increasingly studied as a potential intervention for ischemic stroke. However, prior randomized trials of endovascular therapy in ischemic stroke failed to demonstrate clinical benefit. The prevailing thought from those studies was that patients most likely to benefit from endovascular therapy were not carefully selected. Specifically, patients did not receive rapid imaging to demonstrate a proximal occlusion and to rule out a large area of infarction prior to inclusion in those studies.
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Atrial fibrillation (AF) is a commonly encountered dysrhythmia in the Emergency Department (ED). Atrial flutter is less common but its management is very similar to that of AF. In patients with chronic AF or unknown time of onset and a rapid ventricular response (RVR), rate control and consideration and initiation of anticoagulation therapy are the standard ED approach.
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Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over a decade, calcium channel blockers (i.e. nifedipine) and,
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Injuries are a major cause of death worldwide. Millions of people die every year from traffic injuries. In fact, they are the 9th leading cause of death around the world. Additionally, another 1.5 million people die every year from interpersonal violence. Hemorrhage accounts for about 1/3 of all trauma deaths and as such, it should be our goal to find treatments to decrease death from hemorrhage.
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