Consultant Corner: Acute Management of the Dislocated Shoulder, Part 1

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Consultant Corner: Acute Management of the Dislocated Shoulder, Part 1

Can’t remember the full physical examination of a shoulder joint? Or all the techniques and their names for reducing a dislocated shoulder? Join us for a special consultant edition of TTSRU - Dr Nana Simpson, a recent graduate of orthopedic surgery residency, and Dr Charlie Brower, a recent graduate of our EM residency, discuss a full approach to the shoulder exam and management of the dislocated shoulder. This is part 1 of a two-part post.

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Intern Diagnostics: Approach to the Limping Child

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Intern Diagnostics: Approach to the Limping Child

When a child walks into the ED with an abnormal gait, the challenge begins—not just in identifying the cause, but in knowing which limps signal something more serious. Join Dr Huang as she walks us through a structured approach to the limping child, highlighting key history and exam findings, critical diagnoses you can’t afford to miss, and the importance of considering non-accidental trauma in your workup.

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When Lung-Protective Ventilation Isn’t Brain-Protective? A Look at the PROLABI Trial

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When Lung-Protective Ventilation Isn’t Brain-Protective? A Look at the PROLABI Trial

Lung-protective ventilation (LPV), characterized by low tidal volumes and appropriate PEEP, is a cornerstone in managing patients with acute respiratory distress syndrome (ARDS). However, its application in patients with severe acute brain injury raises concerns. The potential for lung protective ventilation to increase intracranial pressure due to hypercapnia and elevated PEEP levels necessitates a closer examination of its safety and efficacy in this unique patient population.

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Diagnostics and Therapeutics: Caustic Ingestions in the Emergency Department

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Diagnostics and Therapeutics: Caustic Ingestions in the Emergency Department

Join Dr Amin as she describes the challenges, treatment, and sometimes life-saving interventions for patients presenting with caustic ingestions in the emergency department. From rapid assessment to tailored treatment strategies, she breaks down the essentials every clinician must know.

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Intimate Partner Violence: A Primer for Emergency Medicine Practitioners

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Intimate Partner Violence: A Primer for Emergency Medicine Practitioners

Intimate partner violence (IPV) is a widespread public health problem. By definition, IPV refers to actual or threatened psychological, physical, or sexual harm by a current or former partner or spouse. The exact scope of the issue is difficult to ascertain given that a large proportion of incidents go unreported but is estimated to affect over 12 million people in the United States every year. The Emergency Department often serves as a first point of contact for survivors of intimate partner violence. Studies have shown that women experiencing intimate partner violence are more likely to seek medical care than to seek assistance from social services or criminal justice agencies, and it is estimated that approximately 6% of patients presenting to the Emergency Department have experienced IPV within the past year.

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Is Old Age a Reason to Scan a Cervical Spine?

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Is Old Age a Reason to Scan a Cervical Spine?

Many clinical decision rules exclude elderly patients from the derivation cohorts. So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.

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Using Sound Waves to Help a Cric

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Using Sound Waves to Help a Cric

It is well known that ultrasound has exploded in its application in both diagnostics and procedures and has ultimately revolutionized the way we practice medicine. With its growing use, more and more providers are comfortable using ultrasound for both identification of anatomy/pathology and to guide procedures that were previously only done with landmarks. While having the skills to perform landmark guided procedures is incredibly important, there is much value in being able to visually confirm anatomy to avoid procedure complications, especially when landmarks are difficult to palpate / identify in certain individuals. This recap of a recent journal club article covers a paper looking into the use of POCUS to help perform cricothyrotomy.

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What is Clinical Informatics Anyway?

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What is Clinical Informatics Anyway?

When I began my clinical informatics elective I planned to spend my time taking online courses on how to improve my Epic efficiency. After a day or so of online sessions I realized that (a) I’m already an Epic master (sort of) and (b) I hoped there was more to “clinical informatics” than faster documentation. So let’s begin at the beginning: what is clinical informatics?

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Avoiding Hypoxemia During Intubation

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Avoiding Hypoxemia During Intubation

More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.

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Intern Core Content: Disorders of the Adrenal Glands

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Intern Core Content: Disorders of the Adrenal Glands

Join Dr Haupt as she discusses the adrenal glands, their role in hormone production and other functions throughout the body, and common problems that can occur when the adrenal glands are not working properly. Although most of these issues are non emergent problems, occasionally they will be seen in some sort of acute adrenal crisis in the emergency department and ER physicians should be well versed in their often subtle presentations!

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Is Hyperoxemia in Trauma Bad?

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Is Hyperoxemia in Trauma Bad?

Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.

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A D-Dimer for Patients with High Pre-Test Probability of PE?

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A D-Dimer for Patients with High Pre-Test Probability of PE?

We know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?

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