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Fracture management in emergency department

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https://www.readbyqxmd.com/read/29782453/a-robust-approach-to-implementing-fascia-iliaca-compartment-nerve-blocks-in-hip-fracture-patients
#1
Mark G Williams, Zachary Jeffery, Henry W Corner, John Charity, Marina Quantick, Natalie Sartin
BACKGROUND: A clear imperative exists to optimize the preoperative pain management of hip fracture patients. Increasingly, fascia iliaca compartment blocks (FICBs) are being effectively utilized as an adjunct to oral analgesia in the emergency department. PURPOSE: We investigated the feasibility, safety, and delivery rate when junior doctors and specialist nurses are trained in FICBs delivery, alongside the introduction of a step-by-step proforma. METHODS: We conducted a retrospective study of hip fractures patients presenting preinterventions (n = 138) between October and December 2014 and postinterventions (n = 246) between April and August 2015...
May 2018: Orthopaedic Nursing
https://www.readbyqxmd.com/read/29771483/managing-shoulder-injuries-in-the-emergency-department-fracture-dislocation-and-overuse
#2
Richard Pescatore, Andrew Nyce
The complex structures of the shoulder can be injured by fracture, dislocation, and overuse, and correctly identifying and classifying injury is essential to avoiding pain, disability, and life- and limb-threatening complications. This issue presents a systematic approach to classifying shoulder injuries based on the mechanism of injury and clinical presentation, choosing appropriate imaging, and determining the best strategies for treatment, including reduction, surgical consultation, or outpatient referral...
June 2018: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29762336/radiology-callbacks-to-a-pediatric-emergency-department-and-their-clinical-impact
#3
Rajan Arora, Nirupama Kannikeswaran
BACKGROUND: Clinical impact of radiology callbacks (missed initial radiologic diagnosis) remains largely unknown in the pediatric emergency department (PED). OBJECTIVE: The aim of this study was to describe the incidence, nature of radiology callbacks, and the impact on clinical care during the return visit (RV). METHODS: We performed a retrospective chart review of quality assurance database of RVs for radiology callbacks to our PED over a 1-year period...
May 14, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29748981/trial-of-life-well-infants-presenting-more-than-24-h-after-head-injury-with-a-scalp-haematoma-a-10-year-review
#4
Ahilan Parameswaran, Shmuel Heitner, Deepali Thosar, Adam Fowler, Susan Marks, Fenton O'Leary
AIM: To review the investigation, patterns of injury and short-term outcomes of infants younger than 12 months of age who presented more than 24 h after head injury with an isolated scalp haematoma. METHODS: A retrospective chart review of infants who presented with a head injury to the emergency department of a major paediatric hospital between 2006 and 2016. Patients were included if they presented more than 24 h after the injury, were clinically well and had a documented scalp haematoma...
May 10, 2018: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29714993/issues-in-geriatric-care-falls
#5
Dipesh Patel, Richard J Ackermann
One in three older adults falls each year. There are approximately 2.5 million falls among older adults treated in emergency departments. Falls account for 87% of all fractures in this age group. The biggest risk factor for falling is a history of falls. Other risk factors include frailty, sedative and anticholinergic drugs, polypharmacy, and a variety of medical conditions. Current recommendations are that all patients age 65 years and older should be asked about falls each year. Patients also can be screened for fall risk with a variety of approaches including questionnaires and the Timed Up & Go test...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29704027/implementation-of-the-western-australian-osteoporosis-model-of-care-a-fracture-liaison-service-utilising-emergency-department-information-systems-to-identify-patients-with-fragility-fracture-to-improve-current-practice-and-reduce-re-fracture-rates-a-12-month
#6
C A Inderjeeth, W D Raymond, A M Briggs, E Geelhoed, D Oldham, D Mountain
Fracture liaison service linked to an emergency department database effectively identifies patients with OP, improves best practice care, reduces recurrent fractures, and improves quality of life (QoL). The next step is to establish cost-effectiveness. This should be seen as the standard model of care. INTRODUCTION: The Western Australian Osteoporosis Model of Care recommends implementation of a fracture liaison service (FLS) to manage patients with minimal trauma fractures (MTFs). This study evaluates the efficacy of a FLS linked to a tertiary hospital emergency department information system (EDIS) in reducing recurrent fractures...
April 27, 2018: Osteoporosis International
https://www.readbyqxmd.com/read/29602782/kite-surfing-epidemiology-of-trauma
#7
Lisa Dunne, Evelyn Murphy, Peter Hugh Dawson, Michael Leonard
Kite surfing has become an increasingly popular recreational activity worldwide. Thrill seekers can span the water at high speeds and reach great heights risking injury and death. We report the case of a young kite surfer who sustained a fracture dislocation of the right acetabulum that required specialised surgical management. We present this case with a review of the literature outlining the incidence of pelvic and acetabular fractures in the kitesurfing community. Overall, there is a low incidence of pelvic fractures in comparison with other orthopaedic traumas reported among kite surfers, and the most commonly injured sites are the foot and ankle...
March 29, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29601466/longitudinal-clival-fracture-in-a-child-case-report-and-review-of-the-literature
#8
Bedia Gulen, Mustafa Serinken, Ozgur Karcioglu, Okkes Taha Kucukdagli
Clival fracture is a rare and serious injury, which mostly results in the death of the victim before reaching the hospital. The entity is hardly diagnosed in the early phase because of high mortality rates and deficiencies in completion of radiological imaging. The incidence of diagnoses increased year by year after the usage of computed tomography gained widespread availability. In this article, we aimed to present radiological and clinical characteristics of a 5-year-old patient brought to the emergency department after a motor vehicle accident...
April 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29599113/vomiting-with-head-trauma-and-risk-of-traumatic-brain-injury
#9
Meredith L Borland, Stuart R Dalziel, Natalie Phillips, Sarah Dalton, Mark D Lyttle, Silvia Bressan, Ed Oakley, Stephen J C Hearps, Amit Kochar, Jeremy Furyk, John A Cheek, Jocelyn Neutze, Franz E Babl
OBJECTIVES: To determine the prevalence of traumatic brain injuries in children who vomit after head injury and identify variables from published clinical decision rules (CDRs) that predict increased risk. METHODS: Secondary analysis of the Australasian Paediatric Head Injury Rule Study. Vomiting characteristics were assessed and correlated with CDR predictors and the presence of clinically important traumatic brain injury (ciTBI) or traumatic brain injury on computed tomography (TBI-CT)...
April 2018: Pediatrics
https://www.readbyqxmd.com/read/29594463/traumatic-brain-injury-in-indian-children
#10
REVIEW
Krishna Chaitanya, Archana Addanki, Rajendra Karambelkar, Rakesh Ranjan
INTRODUCTION: Traumatic brain injury (TBI) in children and adolescents is a community-based medical and educational challenge world-over due to increasing urbanization and motorization. In India, children between 1 to 15 years constitute significant proportion of the total population, who are vulnerable for TBI. In developed countries, pediatric trauma mortality still represents more than half of all childhood fatalities, which is 18 times more common than brain tumors. In this study, we attempted to analyze epidemiological factors, management, and outcome of TBI in children at a tertiary care center in Pune, Maharashtra...
March 29, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29589502/comparison-between-a-multicentre-collaborative-closed-loop-audit-assessing-management-of-supracondylar-fractures-and-the-british-orthopaedic-association-standard-for-trauma-11-boast-11-guidelines
#11
MULTICENTER STUDY
R Goodall, H Claireaux, J Hill, E Wilson, F Monsell, Boast Collaborative, P Tarassoli
Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves...
March 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29581683/an-analysis-of-presentation-pattern-and-outcome-of-chest-trauma-patients-at-an-urban-level-1-trauma-center
#12
Rajasekhar Narayanan, Subodh Kumar, Amit Gupta, Virinder Kumar Bansal, Sushma Sagar, Maneesh Singhal, Biplab Mishra, Sanjeev Bhoi, Babita Gupta, Shivanand Gamangatti, Adarsh Kumar, Mahesh Chandra Misra
Chest trauma is an important public health problem accounting for a substantial proportion of all trauma admissions and deaths. It directly account for 20-25 % of deaths due to trauma. Therefore, this study was conducted to analyze the presentation, patterns, and outcome of chest trauma in a level-1 urban trauma center. It was a prospective observational study of all patients presented with chest trauma to an urban level 1-trauma center over a period of 3 years. Demographic profile, mechanism of injury, injury severity scores (ISS), associated injuries, hospital stay, etc...
February 2018: Indian Journal of Surgery
https://www.readbyqxmd.com/read/29573894/the-effectiveness-of-mini-c-arm-fluoroscopy-for-the-closed-reduction-of-distal-radius-fractures-in-adults-a-randomized-controlled-trial
#13
Steven K Dailey, Ashley R Miller, Rafael Kakazu, John D Wyrick, Peter J Stern
PURPOSE: Most distal radius (DR) fractures are initially managed with closed reduction and orthosis application. Mini-C-arm fluoroscopy provides assessment of reduction quality in real time. Our null hypothesis was that there would be no difference in the reduction quality of DR fractures in the emergency department when using mini-C-arm fluoroscopy during reduction compared with standard reduction techniques (evaluating reduction quality with orthogonal radiographs taken in an orthosis)...
March 21, 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29569685/importance-of-knowledge-of-the-management-of-traumatic-dental-injuries-in-emergency-departments
#14
Acar Aren, Arzu Pınar Erdem, Gamze Aren, Zeynep Deniz Şahin, Ceren Güney Tolgay, Merve Çayırcı, Elif Sepet, Recep Güloğlu, Hakan Yanar, Kaya Sarıbeyoğlu
BACKGROUND: Hospital emergency departments (EDs) are confronted with managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests inadequate knowledge of the management of traumatic dental injuries (TDIs) among medical professionals. The aim of this study was to investigate the knowledge and attitudes regarding management of TDIs among Istanbul ED physicians. METHODS: Surveys were distributed to emergency departments (ED) directors and their physicians...
March 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29564214/use-of-ketamine-sedation-for-the-management-of-displaced-paediatric-forearm-fractures
#15
Anatole Vilhelm Wiik, Poonam Patel, Joanna Bovis, Adele Cowper, Philip Socrates Pastides, Alison Hulme, Stuart Evans, Charles Stewart
AIM: To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS: Following an agreed interdepartmental protocol, fractures of the radius and ulna (moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine...
March 18, 2018: World Journal of Orthopedics
https://www.readbyqxmd.com/read/29556697/mri-in-mild-pediatric-traumatic-brain-injury-diagnostic-overkill-or-useful-tool
#16
Gesa Cohrs, Monika Huhndorf, Nils Niemczyk, Lukas J Volz, Alexander Bernsmeier, Ash Singhal, Naomi Larsen, Michael Synowitz, Friederike Knerlich-Lukoschus
PURPOSE: Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI. METHODS: Children (0-18 years, sub-divided in four age-groups) with mild TBI who received MRI in the emergency department were identified...
March 19, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29538268/scaphoid-fractures-in-children-do-we-need-to-x-ray-a-retrospective-chart-review-of-144-wrists
#17
Jonathan Porter, Robert Porter, Kevin Joseph Chan
OBJECTIVES: The purpose of this study is to determine the predictive value of clinical suspicion for scaphoid fracture in children aged 4 to 11 years, to look at the efficiency and practicality of current management of children presenting to the emergency department, and to help quantify the burden of the treatment strategy of immobilization for 10 to 14 days on clinical grounds despite negative or equivocal x-rays on presentation. METHODS: We performed a retrospective chart review study of a consecutive sample of all children aged 4 to 11 years old who presented to a tertiary pediatric emergency department from January 1, 2009, to December 31, 2013, within 24 hours of a wrist injury, with a clinical suspicion sufficient to order a scaphoid x-ray...
March 12, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29488343/management-of-distal-radius-fractures-in-the-emergency-department-a-long-term-functional-outcome-measure-study-with-the-disabilities-of-arm-shoulder-and-hand-dash-scores
#18
Avijit Barai, Bruce Lambie, Conor Cosgrave, Joanne Baxter
OBJECTIVE: Distal radius fracture (DRF) is a common presentation to the ED. However, little is known about the long-term functional outcome of these patients following their initial management in the ED. METHODS: In order to evaluate the long-term functional outcome of DRF, we collected the Disabilities of Arm, Shoulder and Hand (DASH) scores from the patients who attended our ED with DRF between January 2014 and June 2015. We divided the patients into two groups based on their overall management: (i) conservative group who did not have any surgical interventions; and (ii) open reduction internal fixation (ORIF) group who needed surgical interventions in the theatre...
February 28, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29481516/bidirectional-management-of-a-transnasal-intracranial-chopstick-transecting-optic-nerve
#19
Tsung-You Tsai, Li-Ang Lee, Wei-Chieh Chao, Yi-Chan Lee
Herein, the authors report a rare patient with a transnasal intracranial penetration injury caused by a chopstick that resulted in optic nerve transection as well as the removal of the chopstick using a bidirectional approach. A 25-year-old male presented to our emergency department with right blindness and bilateral epistaxis. Preoperative computed tomographic angiography demonstrated a transnasal stick-like foreign body causing a skull base fracture and suspected vascular injury. Due to the shape of the chopstick and the high risk of massive bleeding, an exclusively endoscopic or open craniotomy approach is not suitable for removal...
February 23, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29479216/a-qualitative-study-of-the-at-home-pain-experience-for-children-with-an-arm-fracture
#20
Aaron Hanson, Amy L Drendel
Objective: Most children treated in the emergency department (ED) with painful conditions are discharged home to the care of their parents. There is growing evidence that at-home pain management is inadequate. No studies have evaluated the child's report of their at-home pain experience. Our objective was to explore the child's perspective on the pain experience at home after ED discharge. Methods: We performed semistructured interviews with children aged 4 to 14 years discharged from the ED with an arm fracture...
July 2017: Paediatrics & Child Health
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