Brown Emergency Medicine Blog — BROWN EMERGENCY MEDICINE BLOG

$When laughter isn’t the best medicine: The serratus anterior plane block for multiple rib fractures$

When laughter isn’t the best medicine: The serratus anterior plane block for multiple rib fractures

A 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?

Community EM, Sports Medicine, Trauma, UltrasoundBrendan HolmesApril 15, 2022Ultrasound, Nerve BlockComment

Geriatrics Going to Ground : Ultrasound-Guided Femoral Nerve Block

“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…”

Under Pressure: An Uncommon Location for Compartment Syndrome

A 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…

Orthopedics, Sports Medicine, TraumaJeffrey SavarinoOctober 29, 2021Compartment SyndromeComment

Fire-related Injuries in Children

“EMS called with a pediatric code in progress from a house fire, approximately 5 minutes out. A 2-year-old female with unknown past medical history was brought in with CPR in progress. History was limited as there was no family with the patient. Per EMS, firefighters were called to scene of a house fire and the patient and her sister were found in an upstairs bedroom, both unresponsive and pulseless…”

Pediatrics, Trauma, Critical CareStephanie HessOctober 8, 2021pediatrics, pediatric trauma, smoke inhalation, BurnsComment

Age Matters: Managing Femur Fractures in Kids

“In one overnight shift on the orthopedics service, our team evaluated three different pediatric patients with the same underlying injury: a femoral fracture. But, the management of all three children was different and the underlying reason for the different management: age….”

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