Can We Observe Liver Lacs with Active Extravasation?
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Observation is highly effective in select hemodynamically stable patients with liver laceration and active extravasation and leads to few additional interventions in these patients, while angioembolization is associated with higher rates of drain placement for abscess or biloma and increased length of stay (LOS).
Source
An observation-first strategy for liver injuries with "blush" on computed tomography is safe and effective. J Trauma Acute Care Surg. 2023 Feb 1;94(2):281-287. doi: 10.1097/TA.0000000000003786. Epub 2022 Sep 23.
A New TASER Model is Out There – What You Need to Know
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Conducting energy devices (CEDs, i.e., TASER) are used to bridge the gap between interpersonal (punching, batons, spray) and firearm techniques when deescalating violent or serious situations by law enforcement. This article covers general considerations of CEDs and specific need to know info on the newest TASER model to hit the streets.
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.
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.
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.
Why Are We Still Doing DRE in Trauma Patients?
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Use of the digital rectal exam (DRE) in trauma patients has repeatedly demonstrated poor sensitivity for injuries and has little impact on clinical management, with a high false negative rate in pediatric populations.
How Accurate Is Physical Exam for Pediatric Skull Fracture?
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Physical exam for pediatric skull fracture has poor sensitivity. Avoid overconfidence in exam as a screening tool.
Source
Physical Examination Sensitivity for Skull Fracture in Pediatric Patients with Blunt Head Trauma: A Secondary Analysis of the National Emergency X-Radiography Utilization Study II Head Computed Tomography Validation Study. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)01031-9. doi: 10.1016/j.annemergmed.2022.08.442. Online ahead of print.
Should Medics Clear C-Spine in the Field?
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In this large, single-center prospective cohort implementation study, paramedics were able to apply a modified Canadian C-spine rule to assess low risk trauma patients and transport a large proportion of them to a higher level of care without spinal precautions.
How and When to Work Up Bleeding Disorder in Suspected Abuse
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Not all pediatric bruising needs workup for a bleeding disorder. This report details not only how but when to do it.