Tamingthesru
Diagnostics and Therapeutics: Managing Pneumothorax
There are many different types of pneumothorax (PTX), and the management paradigm has shifted in recent years as the research has exploded on this topic. This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Institutional resources and specialty services may further dictate the management of PTX. This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department.
Grand Rounds Recap 9.27.23
It was a stellar week here at UCEM Grand Rounds! We kicked off the day with a lecture from our colleague at CCHMC, Dr. Dean, about management of pediatric airways. We then transitioned to a review of landmark studies in EM, specifically with regards to targeted and systemic thrombolysis for MI, stroke, and PE. We continued our day by discussing evidence based medicine and the implementation of this in the prehospital setting with EMS faculty, Dr. Richards. Next, Drs. de Castro and Thompson faced off in an epic battle of CPC where we covered the diagnosis and management of euglycemic DKA. This was then followed by Dr. Vaughan’s R1 diagnostics and therapeutics lecture on pneumothoracies. Finally, we wrapped up the day with Dr. Gillespie’s R4 capstone lecture.
Twists and Turns: Identifying Maisonneuve Fractures in the ED
A Maisonneuve fracture is a specific ankle fracture pattern that involves the medial malleolus, syndesmosis and proximal fibula. It can be easily missed if a provider does not routinely evaluate the proximal fibula as part of their ankle examination, as x-rays of the ankle can often appear normal. Disruption of these structures yields an unstable ankle fracture, thus making close follow up for operative management imperative. It is key to identify this fracture when patients present to the Emergency Department with ankle injuries to ensure definitive management and prevention of complications down the line.