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Trip, Slip, Scan? Rethinking Head CTs in the Elderly
Ground-level falls are a leading reason older adults get head CTs in the ER, largely because current rules treat age > 65 as a risk factor by itself. Yet many emergency physicians question whether that’s always necessary for well-appearing patients. A new systematic review and meta-analysis in Annals of Emergency Medicine digs deeper, asking: what other factors truly predict intracranial hemorrhage after ground-level falls? Join Dr. Snyder as she explores the findings, limitations, and what they mean for everyday practice.
Grand Rounds Recap - 9/17/2014
Radiation in Pregnancy with Dr. Polsinelli
Radiation effects can be deterministic or stochastic.
- Deterministic effects cause direct cell damage (radiation burns, teratogenicity, intrauterine death, genetic material damage). There is no evidence of teratogenicity in diagnostic testing radiation ranges (<50mGy). Genetic damage (causing effects in future generations) is theoretical and has not been reported. IUD is a concern, but on a population based scale there was no noted increase in incidence of fetal demise after large scale radiation event and this cannot be studied in vivo.
- Stochastic effects increase the probability of developing cancer. There is no minimum threshold and increasing dose increases probability. Risk of cancer noted to be ~5% if exposed to 1Gy of radiation. (for comparison maternal radiation is: chest xray = 0.1mGy; CT abd/pelvis 10mGy)
Interpretation of Head CTs
In the video series below, PGY-1 resident, Dr. Gorder, leads us through the key aspects of CT head interpretation. Attention is paid to the development of a rigorous systematic approach to review and interpretation of head CTs to aid in the identification of blood, ischemia, mass, signs of increased ICP, as well as fracture. In the second video, the key anatomic features seen on head CT's are covered.