An 86-year-old female with past medical history of atrial fibrillation and coronary artery disease on apixaban and clopidogrel presents as a trauma activation after a mechanical fall from standing at her nursing facility. She does not remember the fall, but her nurse reports she tripped over her walker, fell and struck her head. She did not lose consciousness…
Read MoreThe overhead announcement goes off: “Team B to the trauma room”. The report: EMS is bringing a 2-year-old female that was found unresponsive in the family swimming pool by her mother after being alerted by an older sibling. Unknown downtime. The patient is being bagged by bag-valve mask (BVM) and has slow, but palpable, femoral pulses, she is unresponsive, ETA 2 minutes…
Read MoreA 67-year-old man presents to the emergency department after a mechanical fall from standing. During his trauma evaluation, he is found to have severe right-sided chest wall tenderness. His imaging demonstrates multiple right-sided rib fractures with an otherwise unremarkable workup. The patient is in significant discomfort and is given acetaminophen and morphine. Despite this, he remains in severe pain and has difficulty taking deep breaths. The patient is given an incentive spirometer and his maximum vital capacity is measured at 500 ml. What complications is this patient at risk of developing? What interventions can be performed in the emergency department to help manage his pain?
Read More“It would be unusual to go too many shifts as an emergency medicine provider without seeing the classic elderly female patient with hip pain after a fall. On exam, the patient would likely be uncomfortable with their hip appearing shortened and externally rotated on exam. Before you even view the X-ray, you know they likely fractured their hip. You ascertain whether it was a mechanical fall, if there were other injuries, if the injury is open or closed and if the patient is neurovascularly intact. You proceed to order your imaging and consider your plan for pain control. Sound familiar…”
Read MoreA 35-year-old-patient presents following motor vehicle collision as a restrained passenger. The vehicle's dashboard was displaced into the cabin, causing prolonged entrapment of the patient’s lower extremities. The patient’s left thigh was noted by EMS to have an obvious deformity with bleeding from an anterior wound. A tourniquet was placed to the proximal left thigh. A deformity was also noted to the right thigh without obvious external hemorrhage…
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