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Antibiotics for Facial Fractures
EBCP, Grand Rounds Sanjay Shewakramani, MD EBCP, Grand Rounds Sanjay Shewakramani, MD

Antibiotics for Facial Fractures

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?

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NSAIDs in a Patient with Fractures?!
EBCP, Grand Rounds Jeffery Hill, MD M.Ed EBCP, Grand Rounds Jeffery Hill, MD M.Ed

NSAIDs in a Patient with Fractures?!

The Issue

NSAIDs are excellent analgesics that can decrease the use of opiatess for pain, but might lead to poor healing from orthopedic injuries.

Prior Evidence

In vitro studies and rat models since the early 80s showed delayed fracture healing with NSAIDs, and the effects appeared to be dose-related. These findings have been re-demonstrated in future in vitro and rat studies as well.   In humans however, the data has been, to say the least, mixed...

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Hemoptysis
EBCP, Grand Rounds Tyler Winders, MD EBCP, Grand Rounds Tyler Winders, MD

Hemoptysis

What is it?  Bleeding below the cords

More specifically, it may be subdivided into Massive and Non-Massive hemoptysis.  And while the definitions of massive vary from paper to paper, it is generally agreed that increasing volume over 24 hours is associated with increased mortality.  However, the literature consistently concludes that patients and providers are poor, at best, at estimating volume.  Thus, the simplest and most effective definition for massive hemoptysis is as such: expectoration of blood causing hemodynamic instability or abnormal gas exchange / airway obstruction.

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