Emergency Trauma Care: Current Topics & Controversies Volume IV
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Emergency Trauma Care: Current Topics & Controversies Volume IV

This course covers most recent advances in management of traumatic pneumothorax; evaluation, cleansing, and repair of acute traumatic wounds; diagnosis and management of rib fractures; and severe spinal cord injury or fracture management. Includes 16 AMA PRA Category 1 Credits™.

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Product Details

Date of Original Release: October 1, 2021

Date of most recent review: September 10, 2021

Termination date: October 1, 2024

Authors

Lee Schmidt, MD
Duke University School of Medicine, Durham, NC
Jacqueline Tran
Weill Cornell School of Medicine, New York, NY
Kaushal Shah, MD, FACEP
Assistant Dean of Academic Advising, Vice Chair of Education, Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Weill Cornell School of Medicine, New York, NY
Geoffrey Jara-Almonte, MD
Assistant Residency Director, Department of Emergency Medicine, NYC Health + Hospitals/ Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY
Chandni Pawar, MD
Mount Sinai Hospital Emergency Department, New York, NY
Patrick Maher, MD, MS
Assistant Professor, Emergency Medicine and Critical Care, Icahn School of Medicine at Mount Sinai, New York, NY
Stacey Barnes, DO, FACEP, FACOEP
Associate Program Director, Department of Emergency Medicine, St. Joseph’s University Medical Center, Paterson, NJ
Katrina D’Amore, DO, MPH
Core Faculty, Good Samaritan Hospital Medical Center, West Islip, NY; Clinical Assistant Professor, Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; Adjunct Clinical Instructor of Emergency Medicine, NYIT College of Osteopathic Medicine, Old Westbury, NY
Marco Propersi, DO
Clinical Assistant Professor, Department of Emergency Medicine, St. Joseph’s University Medical Center, Paterson, NJ
Miguel Reyes, MD
Clinical Assistant Professor, Department of Emergency Medicine, University of South Carolina School of Medicine Greenville, Greenville, SC

Peer Reviewers

Kamal Gursahani, MD, MBA
Vice Chair of Education & Associate Professor, Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Karan P. Singh, MD, MBA, FACEP, FAAEM, CPPS
Chief Medical Officer, San Gorgonio Memorial Hospital, Banning, CA
Michael Abraham, MD, MS, FAAEM
Adjunct Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD
Jared Ham, MD
Department of Emergency Medicine, Department of Neurology and Neurocritical Care, University of Cincinnati Medical Center, Cincinnati, OH
Whitney Bryant, MD, MPH, MEd
Associate Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
Drew Clare, MD
Assistant Professor, Department of Emergency Medicine, University of Florida College of Medicine–Jacksonville, Jacksonville, FL
Bonny J. Baron, MD
Professor, Department of Emergency Medicine, State University of New York Downstate Health Sciences University; Emergency Department Director of Trauma Performance Improvement and Clinical Functions, NYC Health+Hospitals/Kings County, Brooklyn, NY
Jennifer Maccagnano, DO, FACEP, FACOEP
Assistant Professor, NYIT College of Osteopathic Medicine, Old Westbury, NY; Attending Emergency Physician, Maimonides Medical Center, Brooklyn, NY

Accreditation

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

EB Medicine designates this enduring material for a maximum of 16 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Objectives

Upon completion of this article, you should be able to:

  1. Utilize chest x-ray, CT, and eFAST as indicated to assess for traumatic pneumothorax and determine appropriate management of pneumothorax, including needle decompression, tube thoracostomy, pigtail catheter, or observation.
  2. Select the appropriate methods and materials for wound closure and identify wounds that are at high risk for complications.
  3. Describe the utility of various clinical findings and imaging studies for rib fracture diagnosis and utilize evolving treatment algorithms for rib fractures in both inpatients and outpatients.
  4. Utilize a diagnostic approach to the patient with possible spinal cord injury (SCI) and outline a management pathway while also identifying patients who are at risk for acute decompensation from respiratory and/or hemodynamic complications.

Table of Contents

Traumatic Pneumothorax: Updates in Diagnosis and Management in the Emergency Department (Trauma CME)

  1. About This Issue
  2. Abstract
  3. Case Presentation
  4. Introduction
  5. Anatomy and Pathophysiology
  6. Emergency Department Evaluation
    1. Primary Survey
    2. Secondary Survey
  7. Diagnostic Studies
    1. Chest X-Ray
    2. Ultrasonography
    3. Computed Tomography
  8. Emergency Department Management
    1. Needle Decompression
    2. Chest Tube Insertion
    3. Observation
  9. Controversies and Cutting Edge
    1. Positive-Pressure Ventilation
    2. Observation Versus Thoracostomy
    3. Chest Tube Sizing
  10. Strategies for Management of Traumatic Pneumothorax
  11. Summary
  12. Case Conclusions
  13. Clinical Pathway for Detection and Management of Pneumothorax in the Emergency Department
  14. Tables and Figures
  15. References

Emergency Department Management of Cervical Spine Injuries (Trauma CME)

  1. About This Issue
  2. Abstract
  3. Case Presentations
  4. Introduction
  5. Critical Appraisal of the Literature
  6. Epidemiology and Pathophysiology
    1. Epidemiology
    2. Anatomy
    3. Pathophysiology
  7. Differential Diagnosis
    1. Spinal Fracture
    2. Nontraumatic Spinal Compression
    3. Visceral Injuries
    4. Vascular Injury
    5. Muscle Spasm
  8. Prehospital Care
    1. Recognition
    2. Immobilization
      1. Summary Recommendations
  9. Emergency Department Evaluation
    1. History
    2. Physical Examination
      1. Airway
      2. Breathing
      3. Circulation
      4. Disability
      5. Exposure
    3. Secondary Survey
    4. Neurological Assessment
  10. Diagnostic Studies
    1. Decision Rules in Imaging
    2. Plain Films
    3. Computed Tomography
    4. Magnetic Resonance Imaging
    5. Assessing Ligamentous Stability
    6. Assessing for Vascular Injury
  11. Treatment
    1. Supportive Care
      1. Airway Management
      2. Blood Pressure Augmentation
    2. Medical Therapy
    3. Surgical Therapy
      1. Closed Reduction
      2. Decompression
  12. Special Populations
    1. Pediatric Patients
      1. Atlantoaxial Rotatory Fixation
      2. SCIWORA
  13. Controversies and Cutting Edge
    1. Stem Cell Treatment
  14. Disposition
  15. Summary
  16. Time- and Cost-Effective Strategies
  17. Risk Management Pitfalls for Spinal Cord Injury in the Emergency Department
  18. Case Conclusions
  19. Clinical Pathway for Emergency Department Management of Blunt Cervical Trauma in Adult Patients
  20. Tables, Figures and Appendix
    1. Table 1. Incomplete Spinal Cord Injuries
    2. Table 2. Unstable Spinal Fractures
    3. Table 3. Stable Spinal Fractures
    4. Table 4. Differential Diagnosis of Spinal Injury
    5. Table 5. Guidelines for Prehospital Spinal Immobilization
    6. Table 6. Immediate Life Threats in Spinal Cord Injury
    7. Table 7. The NEXUS Low-Risk Criteria for Cervical Spine Imaging
    8. Table 8. Comparison of NEXUS Criteria and Canadian C-Spine Rule
    9. Table 9. Modified Denver Screening Criteria for Blunt Cerebrovascular Injury
    10. Table 10. Summary of Key Updates in Management of Spinal Injuries
    11. Figure 1. Causes and Demographics of Spinal Cord Injury in the United States
    12. Figure 2. The Denis 3-Column Model of Spinal Stability
    13. Figure 3. Spinal Cord Anatomy and Function
    14. Figure 4. The Canadian C-Spine Rule
    15. Figure 5. Thoracolumbar Imaging Clinical Decision Tool
    16. Figure 6. Atlantoaxial Rotatory Fixation
    17. Appendix. The American Spinal Injury Association Spinal Assessment Worksheet
  21. References

Emergency Department Management of Rib Fractures (Trauma CME)

  1. About This Issue
  2. Abstract
  3. Case Presentations
  4. Introduction
  5. Critical Appraisal of the Literature
  6. Etiology and Pathophysiology
  7. Differential Diagnosis
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. History
    2. Physical Examination
  10. Diagnostic Studies
    1. Chest X-Ray
    2. Computed Tomography
    3. Ultrasound
    4. Laboratory Testing
  11. Treatment
    1. Pain Management
      1. Oral, Intravenous, and Topical Pharmacological Treatments
        • Adjuvant Pharmacologic Pain Management Agents
      2. Regional and Neuraxial Analgesia
        • Ultrasound-Guided Regional Anesthesia
      3. Nonpharmacological Treatments
      4. Pain Management Summary
    2. Ventilatory Support
      1. Noninvasive Positive Pressure Ventilation
      2. High-Flow Nasal Cannula
      3. Invasive Mechanical Ventilation
      4. Summary of Ventilatory Support Options
    3. Operative Fixation of Acute Rib Fractures
    4. Treatment of Complications of Rib Fractures
  12. Special Populations
  13. Controversies and Cutting Edge
  14. Disposition
  15. Risk Management Pitfalls for Managing Rib Fractures in the Emergency Department
  16. Summary
  17. Time- and Cost-Effective Strategies
  18. Case Conclusions
  19. Clinical Pathway for Emergency Department Management of Rib Fractures
  20. Tables and Figures
    1. Table 1. American College of Radiology Appropriateness Criteria® for Chest Imaging after Minor Blunt Trauma Confined to the Chest
    2. Table 2. Ventilation Recommendations for Patients With Rib Fractures
    3. Table 3. Battle Score for Mortality Complications in Emergency Department Patients with Rib Fracture
    4. Table 4. RibScore Criteria
    5. Figure 1. Rib Cage Anatomy, Anterior View
    6. Figure 2. Pneumothorax on Chest X-Ray and Computed Tomography
    7. Figure 3. Ultrasound of a Normal Lung Versus an Injured Lung
    8. Figure 4. Kinesiotaping of Rib Fracture
    9. Figure 5. Emergency Department Rib Fracture Management Pathway According to Forced Vital Capacity
  21. References

Acute Traumatic Wounds: Evaluation, Cleansing, and Repair in the ED (Trauma CME and Pharmacology CME)

  1. About This Issue
  2. Abstract
  3. Introduction
  4. Pathophysiology
    1. Anatomy
    2. Mechanism of Injury
    3. Phases of Wound Healing
      1. Hemostasis and Inflammation
      2. Proliferative Phase
      3. Maturation and Remodeling
  5. Differential Diagnosis
  6. Prehospital Care
  7. Emergency Department Evaluation
    1. History
    2. Physical Examination
  8. Diagnostic Studies
    1. Laboratory Studies
    2. Imaging Studies
  9. Treatment
    1. Closure Decisions and Time Since Injury
    2. Wound Irrigation
    3. Aseptic Versus Sterile Technique
    4. Anesthesia
      1. Topical Anesthetics
      2. Intradermal Anesthesia
      3. Nerve Blocks
      4. Anesthesia Adjuncts and Procedural Sedation
    5. Sutures
      1. Simple Interrupted Suture
      2. Continuous Running Suture
      3. Running Subcuticular Suture
      4. Mattress Suture
      5. Corner Stitch
    6. Tissue Adhesive
    7. Staples
    8. Hair Apposition
    9. Adhesive Tape
    10. Prophylactic Antibiotics
    11. Post-Repair Wound Care
      1. Sun Exposure
  10. Special Circumstances
    1. Specialist Consultation
    2. Facial Lacerations
      1. Eyelid Lacerations
      2. Intraoral Lacerations
      3. Lip Lacerations
      4. Cheek Lacerations
  11. Controversies
    1. Absorbable Sutures for Percutaneous Closure
  12. Disposition
  13. Time- and Cost-Effective Strategies
  14. Risk Management Pitfalls in Wound Management
  15. Clinical Pathway for Management of Acute Traumatic Wounds in the Emergency Department
  16. Tables and Figures
    1. Table 1. Dosing Recommendations for Commonly Used Local Anesthetics
    2. Table 2. Optimal Suture Material for Facial Wounds
    3. Figure 1. Proposed Diagnostic Algorithm to Enhance the Detection of Radiolucent Foreign Objects in the Hand
    4. Figure 2. Digital Block Techniques
    5. Figure 3. Simple Interrupted Suture
    6. Figure 4. Continuous Running Suture
    7. Figure 5. Running Subcuticular Suture
    8. Figure 6. Vertical Mattress Suture
    9. Figure 7. Horizontal Mattress Suture
    10. Figure 8. Corner Stitch
    11. Figure 9. Hair Apposition Technique
    12. Figure 10. Skin Tension Lines
    13. Figure 11. Lip Laceration Repair
    14. Figure 12. Cheek Anatomy
  17. References