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Fracture management in emergency department

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https://www.readbyqxmd.com/read/29130608/impact-of-web-based-clinical-practice-guidelines-on-paediatric-fracture-clinics
#1
Mark W Camp, James R Barnes, Mohita Damany, Leo T Donnan
BACKGROUND: In an effort to standardize management and reduce over-treatment of uncomplicated paediatric fractures, the Victorian Pediatric Orthopaedic Network and the Royal Children's Hospital, Melbourne, created publically available web-based paediatric fracture pathways. The aim of this study was to determine the impact of web-based fracture pathways on the clinic volume at a tertiary-care paediatric fracture clinic. METHODS: A comparative retrospective review was performed at a large, urban, tertiary-care children's hospital...
November 12, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29126081/multiple-chronic-condition-profiles-and-survival-among-oldest-old-male-patients-with-hip-fracture
#2
Jinmyoung Cho, Eileen M Stock, I-Chia Liao, John E Zeber, Brian K Ahmedani, Rashmita Basu, Charlene C Quinn, Laurel A Copeland
To improve understanding of survival among very elderly male patients with surgically repaired hip fractures, this study applied classification techniques to multiple chronic conditions (MCC) then modeled survival by latent class. Veterans Health Administration (VHA)'s electronic medical records on male inpatients age 85-100 years (n=896) with hip fracture diagnosis and repair were used. MCC defined by Charlson and Elixhauser disorders, medications, demographic covariates, and 5 years follow-up survival were included...
October 28, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29117892/emergency-department-referral-patterns-of-australian-general-practitioner-registrars-a-cross-sectional-analysis-of-prevalence-nature-and-associations
#3
Nigel Catzikiris, Amanda Tapley, Simon Morgan, Mieke van Driel, Neil Spike, Elizabeth G Holliday, Jean Ball, Kim Henderson, Lawrie McArthur, Parker Magin
Objective Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals.Methods A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015...
November 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29079373/longest-delayed-hemothorax-reported-after-blunt-chest-injury
#4
Darren Yap, Miane Ng, Madhu Chaudhury, Nik Mbakada
INTRODUCTION: Blunt chest injury is a common presentation to the emergency department. However, a delayed hemothorax after blunt trauma is rare; current literature reports a delay of up to 30days. We present a case of 44-day delay in hemothorax which has not been previously reported in current literature. CASE REPORT: A 52-year-old Caucasian male first presented to the emergency department complaining of persistent right sided chest pain 2weeks after having slipped on a wet surface at home...
October 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29051871/bilateral-divergent-shoulder-s-fracture-dislocation-case-in-an-ischemic-stroke-patient
#5
Atchi Walla, Faré Gnandi-Piou, Pilakimwé Egbohou, Komi Assogba, Mawuko Quacoe
INTRODUCTION: The literature review revealed that nowadays only about 15 cases of bilateral shoulder dislocation associated with the fracture of the upper end of the humerus have been published. The triad of lesional mechanism designated by the triple syndrome E composed of epilepsy, electrocution, and external trauma was the circumstances noted in which these fractures dislocations occur with migration of the two humeral heads either forward or backward. CASE REPORT: An architect of 36-year-old, right-handed, was admitted in emergency department for loss of knowledge of progressive installation...
May 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/29041997/a-web-based-module-and-online-video-for-pain-management-education-for-caregivers-of-children-with-fractures-a-randomized-controlled-trial
#6
Stevi Golden-Plotnik, Samina Ali, Amy L Drendel, Tammy Wong, Frank Ferlisi, Sydney Todorovich, Kyle Canton, Michael Miller, Julia Younan, Sharlene Elsie, Naveen Poonai
Introduction Over 80% of children experience compromise in functioning following a fracture. Digital media may improve caregiver knowledge of managing fracture pain at home. OBJECTIVES: To determine whether an educational video was superior to an interactive web-based module (WBM) and verbal instructions, the standard of care (SOC). METHODS: This randomized trial included caregivers of children 0-17 years presenting to the emergency department (ED) with non-operative fractures...
October 18, 2017: CJEM
https://www.readbyqxmd.com/read/29036004/the-utility-of-clinical-ultrasonography-in-identifying-distal-forearm-fractures-in-the-pediatric-emergency-department
#7
Iratxe Galletebeitia Laka, Frederic Samson, Inigo Gorostiza, Andrés Gonzalez, Carlos Gonzalez
OBJECTIVE: The aim of this study is to evaluate the utility of Point-Of-Care Ultrasound (POCUS) for diagnosing distal forearm fractures in pediatric emergency departments (ED). PATIENTS AND METHODS: A prospective observational study was carried out in children aged younger than 15 years attended in an ED with an indication of radiography because of a suspected distal forearm fracture. The POCUS was performed considering cortical irregularity or disruption compatible with fracture...
October 13, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28978258/hypovolemic-shock-caused-by-delayed-onset-superior-gluteal-artery-rupture-successfully-treated-with-arteriographic-embolization
#8
YongHun Kim, WooSurng Lee
INTRODUCTION: Rupture of the superior gluteal artery (SGA) is usually associated with pelvic bone fractures and acetabular fractures secondary to blunt trauma. However, despite recent advances in technologies and tools, rupture of the SGA remains a challenging problem because it is difficult to manage and is frequently associated with significantly high mortality and morbidity. PATIENTS AND METHODS: We present a case of an 82-year-old man, who presented to our emergency department after a cultivator turnover accident and who showed stable initial vital signs and manifested only as blunt buttock traumatic contusion without any pelvic bone or acetabular fracture, which resulted in delayed massive bleeding from the SGA on eight days after trauma...
October 4, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28968316/management-of-a-brain-abscess-presumably-caused-by-radiation-osteomyelitis-of-the-mandible
#9
Tadahide Noguchi, Naruo Okada, Yoshiyuki Tsuchiya, Shunji Sarukawa, Akifumi Fujita, Hiroshi Nishino, Yoshinori Jinbu, Yoshiyuki Mori
In this clinical report, we present the management of a brain abscess that was presumed to be caused by radiation osteomyelitis of the mandible. The patient underwent chemoradiotherapy for oropharyngeal carcinoma on the left side at the Department of Otolaryngology of our hospital in 2000. Local recurrence or metastasis did not occur post-treatment. In January 2009, the patient was diagnosed with radiation osteomyelitis of the mandible on the left side, complicated by a pathologic fracture. In July 2011, numbness occurred in the left upper extremity and the patient was transferred to the emergency center of our hospital...
September 29, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28959427/raised-serum-lactate-in-a-cirrhotic-patient-presenting-after-a-trivial-fall
#10
Olusegun M Ayeko, Jonathan Barrow, Michael O Ayeko
We present the case of a pelvic fracture in a 69-year-old man with Child-Pugh class C cirrhosis who presented to the Accident and Emergency department after a slip on wet grass. After initially being systemically well, he became haemodynamically unstable in the Emergency department requiring resuscitation via the massive transfusion pathway. He was admitted to intensive care unit for resuscitation following a CT angiogram which showed no arterial bleed, but significant retroperitoneal haematoma. He received a prophylactic embolization of the internal iliac artery 2 days later and his acetabular fracture was managed with skeletal traction...
September 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28947526/management-of-amiodarone-extravasation-with-intradermal-hyaluronidase
#11
Ashley N Fox, Ruben Villanueva, Jamie L Miller
PURPOSE: The case of a patient who experienced extravasation while receiving amiodarone via a peripheral infusion and was treated with intradermal hyaluronidase is reported. SUMMARY: A 60-year-old Caucasian man arrived at the emergency department after a motor vehicle collision. The patient was noted to have a subdural hematoma, multiple rib fractures, sternal body fracture, abdominal wall injury, left clavicle fracture, right humerus fracture, and vertebral fractures...
October 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28933808/pediatric-orthopedic-injuries-evidence-based-management-in-the-emergency-department-digest
#12
Jamie Lien, Kathryn H Pade
Upper and lower extremity injuries are common in children, with an overall risk of fracture estimated at just under 1 in 5 children. Pediatric bone anatomy and physiology produce age specific injury patterns and conditions that are unique to children, which can make accurate diagnosis difficult for emergency clinicians. This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities. Evidence-based recommendations for management of pediatric fractures, including appropriate diagnostic studies and treatment, are also discussed...
September 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28926505/do-all-clavicle-fractures-in-children-need-to-be-managed-by-orthopedic-surgeons
#13
John Adamich, Andrew Howard, Mark Camp
OBJECTIVES: Although many uncomplicated pediatric fractures do not require routine long-term follow-up with an orthopedic surgeon, practitioners with limited experience dealing with pediatric fractures will often defer to a strategy of frequent clinical and radiographic follow-up. Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system. METHODS: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of clavicle fractures was performed...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28913762/the-role-of-computed-tomography-ct-in-predicting-diplopia-in-orbital-blowout-fractures-bofs
#14
Michaela Cellina, Chiara Floridi, Marta Panzeri, Oliva Giancarlo
PURPOSE: The management of orbital blowout fractures (BOFs) is controversial: the evaluation of diplopia is the most important criterion for planning whether to undertake surgery. Our aim was to determine CT findings that may suggest the presence of diplopia when patients with BOFs cannot be adequately examined to plan an orbital repair. METHOD AND MATERIALS: We retrospectively evaluated CT of all patients presented to our Emergency Department for blunt craniofacial trauma (N = 3334) from January 2014 to March 2016, selecting patients with CT-demonstrated BOFs...
September 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28894783/intravenous-lidocaine-versus-morphine-sulfate-in-pain-management-for-extremity-fractures-a-clinical-trial
#15
Arash Forouzan, Hassan Barzegari, Hassan Motamed, Ali Khavanin, Hamideh Shiri
INTRODUCTION: Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. METHOD: In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28870847/bundle-of-care-for-blunt-chest-trauma-patients-improves-analgesia-but-increases-rates-of-intensive-care-unit-admission-a-retrospective-case-control-study
#16
Cédric Carrie, Laurent Stecken, Elsa Cayrol, Vincent Cottenceau, Laurent Petit, Philippe Revel, Matthieu Biais, François Sztark
INTRODUCTION: This single-centre retrospective case-control study aimed to assess the effectiveness of a multidisciplinary clinical pathway for blunt chest trauma patients admitted in emergency department (ED). PATIENTS AND METHODS: All consecutive blunt chest trauma patients with more than 3 rib fractures and no indication of mechanical ventilation were compared to a retrospective cohort over two 24-month periods, before and after the introduction of the bundle of care...
September 21, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28825959/pediatric-orthopedic-injuries-evidence-based-management-in-the-emergency-department
#17
REVIEW
Jamie Lien
Upper and lower extremity injuries are common in children, with an overall risk of fracture estimated at just under 1 in 5 children. Pediatric bone anatomy and physiology produce age specific injury patterns and conditions that are unique to children, which can make accurate diagnosis difficult for emergency clinicians. This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities. Evidence-based recommendations for management of pediatric fractures, including appropriate diagnostic studies and treatment, are also discussed...
September 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28797555/to-log-roll-or-not-to-log-roll-that-is-the-question-a-review-of-the-use-of-the-log-roll-for-patients-with-pelvic-fractures
#18
REVIEW
Inês Filipa da Cunha Rodrigues
Pelvic fractures are one of the most serious injuries in polytrauma - massive haemorrhage is a major complication and the leading cause of death. The assessment and early management of these injuries in the Emergency Department (ED) focuses on the recognition of haemodynamic instability and should follow Advanced Trauma Life Support (ATLS) guidelines. The log-roll technique, although an accepted practice in trauma care, has been reported to be inadvisable when a pelvic fracture is suspected. This paper, which includes a case study, briefly explains the pathophysiology and initial management of pelvic fractures...
May 10, 2017: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/28795066/otolaryngological-presentations-in-times-of-terror-profile-from-a-tertiary-health-center-in-north-central-nigeria
#19
Adeyi A Adoga, Daniel D Kokong, Kenneth N Ozoilo
OBJECTIVES: To report the incidence, socio-demographic characteristics, otorhinolaryngological presentations and outcomes of management of patients at the Jos University Teaching Hospital following terror attacks. METHODS: A prospective descriptive hospital based study of consecutive patients presenting with ear, nose and throat injuries as a result of bomb blasts and ethno-religious crises within a six-year period and managed at the Jos University Teaching Hospital were studied for age, gender, ear, nose and throat presentations, injury mechanism, interventions and outcome of interventions...
July 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28770512/immediate-intensive-mobilization-compared-with-immediate-conventional-mobilization-for-the-impacted-osteoporotic-conservatively-treated-proximal-humeral-fracture-a-randomized-controlled-trial
#20
S Carbone, C Razzano, P Albino, R Mezzoprete
PURPOSE: To select in a 2-year survey of proximal humerus fractures accessing the emergency department, a population of osteoporotic stable impacted fractures and to randomize them into two groups, one with an immediate intensive mobilization program and the other with an immediate conventional mobilization program. METHODS: In emergency department, patients with clinical signs of shoulder girdle fracture were submitted to standard X-ray examination and CT scan...
August 2, 2017: Musculoskeletal Surgery
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