WEST – New Blunt Thoracic Aortic Injury Algorithm
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The Western Trauma Association Algorithms Committee has released new evaluation and management guidelines and a step-by-step algorithm (see below) surrounding blunt thoracic aortic injury.
Imaging
Does E-FAST Add Value Before CT Traumagram?
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An initial diagnostic workup that includes an E-FAST exam and targeted chest and pelvis x-rays allows clinicians an opportunity to assess and intervene appropriately on the majority of patients prior to WBCT in the setting of blunt trauma.
Source
Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open. 2022 Dec 1;5(12):e2245432. doi: 10.1001/jamanetworkopen.2022.45432.
A Simple Way to Find More GI Bleeds on CT
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In patients with a gastrointestinal bleed (GIB), CT imaging was more often diagnostic when the specific indication (GIB) was listed within the requisition order and multiphase studies were ordered.
Source
Importance of communication of CT indication for imaging yield in patients with gastrointestinal bleed. Am J Emerg Med. 2022 Dec 5;64:101-105. doi: 10.1016/j.ajem.2022.12.003. Online ahead of print.
How to Read a CXR – A CXR Checklist
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Here is a consistent, systematic, and comprehensive approach to interpreting chest x-rays and a checklist to prevent common errors. We modified the checklist to make it easier to remember.
No More LPs? Can CT Rule Out SAH 24-48 Hours From Onset?
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Non-contrasted multislice CT (MSCT) is known to be highly sensitive in detecting subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset. Now, with modern MSCT, it looks like we can safely extend the timeframe even more.
Stop the Bleeding…of Unnecessary Care – Another Strike Against Delayed Head CT
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No significant difference in delayed intracranial hemorrhage (dICH) was seen in patients on antithrombotic (AT) medication vs. no AT among patients with repeat CT.
Source
Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)00580-7. doi: 10.1016/j.annemergmed.2022.08.006. Online ahead of print.
Do We Need Delayed Head CT for Anticoagulated TBI Patients?
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Patients ≥65 years on warfarin with head injury were found to have a significantly higher rate of delayed intracranial hemorrhage (dICH) compared to elderly on direct oral anticoagulants (DOACs) and those not on anticoagulation (AC).
Source
Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department. CJEM. 2022 Oct 15. doi: 10.1007/s43678-022-00392-z. Epub ahead of print.
Old Person + Delirium = Head CT
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Among patients ≥65 years who presented to the ED with delirium, confusion, or altered mental status, 15.6% had an abnormal head CT. Presence of neurologic deficit was a significant predictor for abnormal CT, but anticoagulation was not.
Source
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med. 2022 Nov 4. doi: 10.1111/acem.14622. Online ahead of print.
Would You Hold Still for 2 Seconds? – New Fast CT Means Less Pediatric Sedation
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Newer CT scanners led to faster head CT by about 10 seconds, and this decreased the number of pediatric patients who required sedation.
Source
Impact of a Faster Computed Tomography Scanner on Sedation for Pediatric Head Computed Tomography Scans in 2 Large Emergency Departments-A Retrospective Study. Pediatr Emerg Care. 2022 Aug 5. doi: 10.1097/PEC.0000000000002816. Online ahead of print.
Guess the Radiation Risk – Portable X-Rays in the Emergency Department
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Despite a high number of portable radiographs obtained in the ED, exposure to this ionizing radiation does not appear to be a significant occupational hazard, and existing precautions appear to be adequate.
Source
Risk of Radiation Exposure to Emergency Department Personnel From Portable Radiographs. J Emerg Med. 2022 Oct 12;S0736-4679(22)00449-8. doi: 10.1016/j.jemermed.2022.08.002. Online ahead of print.