Lacerations. We close these all the time, right? But what if it is on the eyelid? Do we close these and what should we be looking for? Read on, as Dr. Li walks us through the evaluation and management of these (sometimes) complicated patients.Read More
In the Emergency Department, we frequently encounter patient's with facial fractures and associated lacerations. The orthopedic surgery literature strongly supports the use of antibiotics for open fractures. The facial surgery literature, however, does not have extensive publications addressing the use of antibiotics in open facial fractures. So what are we to do? Does every fracture get antibiotics? If not, which fractures?Read More
This is our final recap of our "Out on a Limb" Case Series! If you missed the initial "Moonlighter" case and discussion you can check it out here. There were a number of great responses to the questions which we'll recap below.
Q1 - What are your options in handling this situation?
You have a few options in handling this situation. As many of the respondents chimed in, the wound definitely needs to be cleaned out and closed and the patient requires antibiotics as soon as is reasonably and safely possible, especially since the injury is already 6 hours old. The first option is to complete a sedation and multilayer repair in the ED yourself. As many people point out, this is not an excellent proposition unless there are extreme extenuating circumstances.Read More
EMS Protocol Updates for 2015 with Dr. Leblanc
Use of EMS units as transport units
- If pt is transported to a facility that is not capable of taking care of the pt, you may be able to use the same squad to transport the pt to another facility
- Need to have an accepting doc
- May need to send additional personnel with the squad
- Push dose Epi regardless of type of shock - 1 ml of cardiac Epi into 9 mls of NS flush
- 1 ml q1-2 min
- For more info - EMCrit Podcast on Push Dose Pressors
- No more Dopamine!
Prescription Drug and Opiate Epidemic with Dr. Shawn Ryan
The US is the #1 country in the world for opiate prescription drug utilization
- The numbers quoted are likely greatly underestimated due to inconsistent documentation
- Death rate from opiate pain medication (OPM) has quadrupled in the time span of 1999-2010
- Death rate in 2012 was 5.6 per 100,000
- In 2011, 44 people per day died from opiate overdose in the US
- In 2007, unintentional opiate overdose became the leading cause of death in the US for young population
- OH death rate has grown faster than the national rate. At this time 5 people/day die in OH from opiate overdose