1. Only 10% of injured patients are initially managed at regional Trauma Centers 2. Community hospital emergency physicians play a pivotal role in the management of acute injury 3. Over-testing before transfer may cause hazardous delays in care 4. Adult and children who suffer blunt traumatic arrest are almost always dead 5. Contact trauma with cases that may be transferred solely for organ donation - we almost always take these 6. Action steps to take BEFORE transfer include: (a) airway management, (b) treatment of pneumothorax, (c) repair of actively bleeding lacerations, (d) basic resuscitation, (e) reversal of anticoagulation, (f) splinting of extremities 7. Avoid long-acting paralytics in TBI during transfer - this will compromise the exam
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There are two phases to the development and presentation of a "memorable lecture": (1) preparation, (2) delivery. Elements of PREPARATION include: a. Picking the right topic b. Mastering the material c. Sequencing the lecture d. Right-sizing the content e. Designing slides that work Elements of DELIVERY include: a. Getting ready for the big day b. Learning your audience c. Developing your delivery style d. Tie everything together e. Planning for next time • Give epinephrine early and in the correct dose for anaphylaxis • Be prepared for the difficult airway in all cases of severe anaphylaxis • There are no contra-indications to epinephrine when it comes to severe anaphylaxis. • Consider anaphylaxis in every patient who presents in shock, because anaphylaxis can rarely present with isolated hypotension
• PID is a common disease amongst young women and has a wide variety of clinical presentations • PID is a rare but known cause of small bowel obstruction in adolescents • Beware the sterile pyuria • Errors in the emergency department are multifaceted and fall into three domains: cognitive, environmental, and systems errors • Most cognitive errors are caused by use of heuristics (cognitive shortcuts) • There are steps to mitigating cognitive error: baseline knowledge of cognitive errors, attempt to disconfirm, and cognitive stops. In the management of Submassive and Massive PE:
1. Be wary of ECG Early Depolarization (ER) pattern limited ONLY to the inferior limb leads. ER is most typically found in anterolateral precordial leads, and may extend to inferior leads (roughly 50% of cases). Rarely is ER found ONLY in inferior leads. 2. In the setting of RBBB, follow typical interpretation scheme for myocardial injury, as suggested by the Universal Definition of Myocardial Infarction statement paper. 3. LVH is typically associated with ST amplitude changes DISCORDANT with the major forces of the QRS complex. That is, when the QRS is predominantly upright, the ST segment may be depressed; when the QRS is predominantly down going, the ST is often elevated. 4. When in doubt regarding the ECG diagnosis of an occluded epicardial coronary artery (STEMI call??), engage in immediate discussion with your interventional cardiology physician colleagues. These decisions are not always straight forward or easy. Share the ECG image with your cardiologist, and provide clinical scenario background to inform the decision you all will make together. 5. Francis N. Wilson MD (1890 – 1952): originator of Wilson’s Central Terminal (reference electrode for unipolar precordial leads)
Additional coverage of Submersion Topics: See PedEMMorsels - Submersion Basics See PedEMMorsels - C-Spine Injuries and Submersions See PedEMMorsels - Prolonged QTc and Submersions See PedEMMorsels - Submersion Prevention |
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