UMEM Educational Pearls - Trauma

Category: Trauma

Title: C-spine Clearance in the mentally altered patient by Ahmed Al Hazmi

Keywords: C-Spine Clearance, altered mental status (PubMed Search)

Posted: 10/19/2018 by Michael Bond, MD (Emailed: 10/20/2018)
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Takeaways

Bottom Line
  • High-quality CT is adequate for clearing c-collar in obtunded patients.
  • A follow-up exam before discharging the patient strengthens your decision making and documentation.
  • MRI can be reserved for high-risk patients, patients who are being admitted to surgical critical care units, and those who have residual findings once alert.

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Category: Trauma

Title: Find the inconsistencies (UPDATED). Written by Dr. Michael Allison

Keywords: blunt trauma, pneumothorax, CXR supine, ultrasound, seashore, stratasphere (PubMed Search)

Posted: 2/14/2011 by Haney Mallemat, MD (Updated: 8/28/2014)
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Question

(Please note the prior version of this pearl was incorrect with respect to the images referenced. This version is corrected.)

Patient s/p blunt chest trauma. CXR (image 1) vs. lung ultrasound (image 2), do you see any inconsistencies?

 

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Category: Trauma

Title: What's wrong with this picture? By John Greenwood, MD

Keywords: Apical cap, dissection, blunt aortic injury, chest xray, radiology (PubMed Search)

Posted: 1/31/2011 by Haney Mallemat, MD
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Question

44 y/o female restrained driver s/p motor vehicle crash complaining of chest pain and shortness of breath. 

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Category: Trauma

Title: Lidocaine with Epinephrine and it use on Fingers and Toes

Keywords: Epinephrine, Lidocaine, Fingers, (PubMed Search)

Posted: 2/7/2009 by Michael Bond, MD (Updated: 7/18/2019)
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Lidocaine with Epinephrine and it use on Fingers and Toes

It has been taught for a long time that Lidocaine with Epinephrine should not be used on fingers, toes, ears and nose [There has to be a kid's song in there somewhere] due to the risk of vasoconstricition/vasospasm and possible digitial infarcation.

The short story is that this practice is not supported by the literature, and there are now numerous publications that have shown that lidocaine with epinephrine is safe for use on the finger tips.  It turns out the the original case reports were submitted with procaine and epinephrine and not lidocaine with epinephrine.  Most of the cases of digital infarction where with straight procaine that is now thought to have been contaiminated or too acidic pH close to 1 when injected.

The effects of epinephrine last approximately 6 hours. This time is well within the accepted limit of ischemia for fingers that has been established in digitial replanation.

So why use Lidocaine with Epinephrine:

  1. Provides a longer period of anesthesia
  2. Decreases bleeding which:
    1. Improves visualization of tendons and underlying structures
    2. Makes repairs easier
    3. Decreases need for a torniquet

 

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Category: Trauma

Title: Abdominal Trauma

Keywords: Seatbelt Sign, Abdominal, Trauma (PubMed Search)

Posted: 10/28/2007 by Michael Bond, MD (Updated: 7/18/2019)
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Seat Belt Sign:

  • Patients with a seat belt sign have a high risk of hollow viscus injury
  • Often have a negative CT scan
  • Admit for serial exams and observation, at an absolute minimum patient should be watched 6 hours.
  • Look for associated Lumbar Chance Fractures.

Category: Trauma

Title: Traumatic Ankle Pain

Keywords: Ankle, Maisonneuve, Jones, Fracture (PubMed Search)

Posted: 7/14/2007 by Michael Bond, MD (Updated: 7/18/2019)
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Traumatic Ankle Pain When examining a patient who presents with Ankle Pain, make sure that you examine/palpate the proximal fibula and the base of the fifth metatarsal. Pain over the proximal fibula will necessitate a full Tibia/Fibula x-ray to rule out a Maisonneuve Fracture [a proximal fracture of fibula resulting from external rotation; injury may occur with medial or posterior malleolus fracture, a ligament rupture, as well as rupture of interosseous membrane. Pain over the base of the 5th metatarsal suggests a Jones Fracture [ involves fx at base of fifth metatarsal at metaphyseal-diaphyseal junction, which typically extends into the 4-5 intermetatarsal facet; is located w/in 1.5 cm distal to tuberosity of 5th metatarsal & should not be confused w/ more common avulsion fx (Dancer s Fracture) of 5th metatarsal styloid]