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Fracture management in emergency department

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https://www.readbyqxmd.com/read/29326858/improving-management-of-paediatric-buckle-fracture-in-orthopaedic-outpatients-a-completed-audit-loop
#1
M N Baig, C Egan
Introduction Paediatric patient bone fractures are the source of a large number of orthopaedic outpatient visits, especially for fracture clinics. The National Institute for Health and Care Excellence (NICE) guideline NG38 provides guidance on assessing and managing non-complex fractures, such as buckle (i.e., torus) fractures in paediatric patients. Objective We retrospectively audited outpatient records of children younger than 12 years presenting with distal radius buckle fractures for May and June 2017...
November 8, 2017: Curēus
https://www.readbyqxmd.com/read/29324529/inappropriately-timed-pediatric-orthopaedic-referrals-from-the-emergency-department-result-in-unnecessary-appointments-and-financial-burden-for-patients
#2
Taylor J Jackson, Todd J Blumberg, Apurva S Shah, Wudbhav N Sankar
BACKGROUND: Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system...
January 10, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29306971/trauma-care-in-german-speaking-countries-have-changes-in-the-curricula-led-to-changes-in-practice-after-10%C3%A2-years
#3
Sarah Kuhn-Régnier, Michael Stickel, Björn-Christian Link, Henning Fischer, Reto Babst, Frank J P Beeres
PURPOSE: Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur...
January 6, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29290895/falls-from-height-a-retrospective-analysis
#4
Kasim Turgut, Mehmet Ediz Sarihan, Cemil Colak, Taner Güven, Ali Gür, Sükrü Gürbüz
BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively...
2018: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29273012/a-prospective-observational-cohort-study-of-patients-presenting-to-an-emergency-department-with-acute-shoulder-trauma-the-manchester-emergency-shoulder-mesh-project
#5
Michael J Callaghan, Janos P Baombe, Dan Horner, Charles E Hutchinson, Dilraj Sandher, Simon Carley
BACKGROUND: Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography. METHODS: A prospective, observational cohort study...
December 22, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29261271/managing-dislocations-of-the-hip-knee-and-ankle-in-the-emergency-department-digest
#6
Caylyne Arnold, Zane Fayos, David Bruner, Dylan Arnold, Nachi Gupta, Jeffrey Nusbaum
Dislocation of the major joints of the lower extremities--hip, knee, and ankle--can occur due to motor-vehicle crashes, falls, and sports injuries. Hip dislocations are the most common, and they require emergent management to prevent avascular necrosis of the femoral head. Knee dislocations are uncommon but potentially dangerous injuries that can result in amputation due to the potential for missed secondary injury, especially if they are reduced spontaneously. Isolated ankle dislocations are relatively rare, as most ankle dislocations involve an associated fracture...
December 20, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29243880/review-article-best-practice-management-of-common-knee-injuries-in-the-emergency-department-part-3-of-the-musculoskeletal-injuries-rapid-review-series
#7
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites...
December 15, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29239540/-clavicle-fracture-what-s-new-in-2017
#8
Benoît Maeder, Patrick Goetti, Frédéric Vauclair
Clavicle fracture is a common injury for the general practitioner, the accident and emergency department doctor and the orthopedic trauma surgeon. Historically, most clavicle fractures were treated conservatively. During the last two decades, clinical studies have shown higher rates of nonunion or symptomatic malunion than previously thought. These publications lead to an increase in surgical management of clavicle fractures. However, recent randomized controlled trials failed to confirm any strong clinical outcome improvement after surgical treatment...
December 13, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29235235/review-article-best-practice-management-of-common-ankle-and-foot-injuries-in-the-emergency-department-part-2-of-the-musculoskeletal-injuries-rapid-review-series
#9
REVIEW
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017...
December 13, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29230475/improving-decisions-about-transport-to-the-emergency-department-for-assisted-living-residents-who-fall
#10
Jefferson G Williams, Michael W Bachman, Michael D Lyons, Benjamin B Currie, Lawrence H Brown, A Wooten Jones, Jose G Cabanas, Alan K Kronhaus, J Brent Myers
Background: Residents of assisted living facilities who fall may not be seriously ill or injured, but policies often require immediate transport to an emergency department regardless of the patient's condition. Objective: To determine whether unnecessary transport can be avoided. Design: Prospective cohort study. Setting: One large county with a single system of emergency medical services. Participants: Convenience sample of residents in 22 assisted living facilities served by 1 group of primary care physicians...
December 12, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29230336/metastatic-spinal-cord-compression-secondary-to-liver-cancer
#11
Daniel Gams Massi, Japhari Nyassinde, Ngor Side Diagne, Ramy Abdennaji, Kamadore Toure, Moustapha Ndiaye, Amadou Gallo Diop, Mouhamadou Mansour Ndiaye
Metastatic spinal cord compression (MSCC) is a medical emergency that requires rapid diagnosis and treatment to reduce pain, to preserve neurological functioning, and to prolong survival. The diagnosis of liver cancer is often neglected in the differential diagnosis of MSCC. Treatment is usually palliative and evolution is often fatal. This is a case report of a 28-year-old patient living in Mauritania hospitalized in November 2014 at the neurology department of Fann national teaching hospital in Dakar, for the management of a chronic dorsal spinal cord compression...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/29200140/evaluating-the-implementation-barriers-of-an-intranasal-fentanyl-pain-pathway-for-pediatric-long-bone-fractures
#12
Tamara Arnautovic, Kathryn Sommese, Paul C Mullan, Steven Barron Frazier, Turaj Vazifedan, Dana Erikson Ramirez
OBJECTIVES: This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway. METHODS: A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29194222/risk-factors-for-admission-and-prolonged-length-of-stay-in-pediatric-isolated-skull-fractures
#13
Daniel C Williams, Anbesaw W Selassie, William S Russell, Keith T Borg, William T Basco
OBJECTIVES: This study aimed to assess management of pediatric isolated skull fracture (ISF) patients by determining frequency of admission and describing characteristics associated with patients admitted for observation compared with patients discharged directly from the emergency department (ED) and those requiring a prolonged hospitalization. METHODS: We evaluated children younger than 5 years who presented with ISF using the South Carolina Traumatic Brain Injury Surveillance and Registry System data from 2001 to 2011...
December 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29189590/management-of-pediatric-isolated-skull-fractures-a-decision-tree-and-cost-analysis-on-emergency-department-disposition-strategies
#14
Daniel C Williams, W Scott Russell, Annie L Andrews, Kit N Simpson, William T Basco, Ronald J Teufel
OBJECTIVE: Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)-based disposition scenarios for a pediatric patient presenting with ISF. METHODS: We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29185671/managing-dislocations-of-the-hip-knee-and-ankle-in-the-emergency-department
#15
Caylyne Arnold, Zane Fayos, David Bruner, Dylan Arnold
Dislocation of the major joints of the lower extremities--hip, knee, and ankle--can occur due to motor-vehicle crashes, falls, and sports injuries. Hip dislocations are the most common, and they require emergent management to prevent avascular necrosis of the femoral head. Knee dislocations are uncommon but potentially dangerous injuries that can result in amputation due to the potential for missed secondary injury, especially if they are reduced spontaneously. Isolated ankle dislocations are relatively rare, as most ankle dislocations involve an associated fracture...
December 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29182002/acute-hand-injury-splinting-the-good-the-bad-and-the-ugly
#16
T Richards, R Clement, I Russell, D Newington
Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29174834/a-systematic-review-and-meta-analysis-of-the-management-and-outcomes-of-isolated-skull-fractures-in-children
#17
REVIEW
Silvia Bressan, Luca Marchetto, Todd W Lyons, Michael C Monuteaux, Stephen B Freedman, Liviana Da Dalt, Lise E Nigrovic
STUDY OBJECTIVE: Most studies of children with isolated skull fractures have been relatively small, and rare adverse outcomes may have been missed. Our aim is to quantify the frequency of short-term adverse outcomes of children with isolated skull fractures. METHODS: PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, and gray literature were systematically searched to identify studies reporting on short-term adverse outcomes of children aged 18 years or younger with linear, nondisplaced, isolated skull fractures (ie, without traumatic intracranial injury on neuroimaging)...
November 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29170353/56%C3%A2-manipulation-and-reduction-of-paediatric-forearm-fractures-using-es-ketamine-in-a-paediatric-emergency-department-a-5-year-study
#18
Shirley Mulvaney
BACKGROUND: Forearm fractures are the most common paediatric injury presenting to A+E.1,2 Literature supports safe and effective treatment of these injuries in A+E using a variety of sedation methods, including ketamine.3,4 The Paediatric Orthopaedic Trauma Snapshot (POTS) study showed that only 35% of A+Es nationally allow manipulation of these injuries in the department. METHODS: A retrospective analysis was undertaken of all patients presenting with fractures of the forearm between January 2012 to December 2016 who were treated with reduction and manipulation in the Alder Hey A+E department using Es-ketamine...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170335/38%C3%A2-a-comparison-of-two-interventions-in-the-treatment-of-severe-ankle-sprains-and-distal-fibular-avulsion-fractures-a-patient-perspective
#19
Sarah Powell
: Stable ankle injuries are highly prevalent in Emergency Departments across the UK. Appropriate management to enable patients to experience a smooth recovery and prevent chronic ankle instability or reoccurrence is a priority. Current literature states that stable ankle fractures and severe ankle sprains can be successfully managed with the below knee plaster or the aircast brace and crutches. The functional brace has proved to be clinically effective in several reports. There has however, been no research to measure patient satisfaction levels between these two treatments...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170328/31%C3%A2-the-quality-improvement-qip-improving-multidisciplinary-staff-engagement-with-quality-improvement-in-the-rvh-emergency-department
#20
Olly Bannon, Emma Greenwood
: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients.Two consultants undertook training in QI and then decided to develop a QI project aiming to empower staff and embed QI as daily practice. An ED QI steering group of interested multidisciplinary members was formed and devised an improvement plan to increase staff engagement with QI...
December 2017: Emergency Medicine Journal: EMJ
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