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Emergency Trauma Care: Current Topics And Controversies, Volume III (Trauma CME) - $249.00

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Includes 18 Trauma CME Credits!

New Features

Included In This Resource:

1. 97 pages of evidence-based content, covering 5 critical topics
2. 18 AMA PRA Category 1 Credits^TM. Included as part of the 18 credits, this CME activity is eligible for 18 trauma credits, 4.5 Pharmacology credits, and 3.5 Pain Management credits.
3. This activity is approved for 18 ANCC Contact Hours and 4.6 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
4. Two instructional videos on utilizing ultrasound and identifying often-missed fractures
5. Nine supplemental issues of Calculated Decisions
6. Summarized information to help you keep up with current guidelines and best practices
7. Treatment recommendations to help you determine the critical actions required when caring for these patients
8. And much more!

To view a sample of Emergency Trauma Care, click here.

The 5 topics covered in this volume address some of the most pressing concerns for emergency clinicians:

Chapter 1: Traumatic Wound Care Management: Isolated soft-tissue wounds are rarely life-threatening, but the goals of care are to optimize pain control, hemostasis, cosmesis, prevention of infection, and rapid wound healing. This chapter will help emergency clinicians become facile and comfortable with the basics of complex wound repair.

Chapter 2: Utilizing Ultrasound in Trauma: As the number of applications of point-of-care ultrasound (POCUS) in the trauma patient has expanded, so have controversies related to how it should be used in different clinical scenarios. This chapter discusses the strengths and limitations of POCUS in the trauma setting in order to facilitate optimal care for your patients. In addition, a bonus video on using ultrasound in trauma—by Dr. Turandot Saul from Mount Sinai—is included.

Chapter 3: Blast Injuries and Mass-Casualty Trauma: The morbidity and mortality of blast events varies greatly, depending on several factors. In this chapter, you will learn the best approach to the management of blast injuries and mass-casualty events, which focuses on reducing morbidity and mortality.

Chapter 4: Fracture Care in Trauma: The goal for treatment of any fracture is realignment of bony fragments and re-establishment of neurovascular anatomy to promote healing and functional restoration. This chapter will help you identify frequently missed orthopedic injuries and manage various types of traumatic fractures. Also included is a bonus video by Dr. Melissa Leber from Mount Sinai that discusses the diagnosis and management of orthopedic trauma injuries.

Chapter 5: Nonopioid Analgesic Modalities for Management of Acute Traumatic Pain: Despite the fact that opioids are the traditional cornerstone of traumatic pain management in the ED, several factors make their utilization less than optimal. Broader use of combinations of nonopioid analgesics in managing acute traumatic injuries in the ED and a more refined and judicious use of opioids is encouraged; however, this must also be balanced with an understanding of the specific risks and benefits of nonopioid analgesia as well as consideration of each patient’s unique characteristics. This chapter will help you appropriately apply methods of nonopioid pharmacological pain management in trauma care.

Publication Information

Price: $249

Publication Date: March 1, 2018

CME Expiration Date: March 1, 2021

CME Credits: This enduring material includes 18 AMA PRA Category 1 Credits^TM. (Trauma CME)

CNE Credits: This activity is approved for 18 ANCC Contact Hours and 4.6 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Editors

Eric Legome, MD, FACEP

Lee W. Shockley, MD, MBA

Authors

Nadia Baranchuk, MD

Department of Emergency Medicine, Division of Emergency Ultrasound, Mount Sinai St. Luke’s, Mount Sinai West, New York, NY

John Bedolla, MD, FACEP

Assistant Professor and Assistant Director of Research Education, University of Texas at Austin, Dell Medical School, Austin, TX

Moira Davenport, MD

Associate Professor of Emergency Medicine, Associate Residency Director, Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA

Itamar Goldstein, MD

Department of Emergency and Internal Medicine, SUNY Downstate – Kings County Hospital Center, Brooklyn, NY

Michael Hilton, MD, MPH, FACEP, FAEMS

Assistant Professor, Associate Medical Director for EMS and Disaster Preparedness, Department of Emergency Medicine, Mount Sinai St. Luke’s, Mount Sinai West, New York, NY

Alexis LaPietra, DO

Medical Director of Emergency Medicine Pain Management, Fellowship Director of Emergency Medicine Pain Management Fellowship, St. Joseph’s Regional Medicine Center, Paterson, NJ

Elyse K. Lavine, MD

Assistant Professor, Director of Emergency Department Trauma Services, Department of Emergency Medicine, Mount Sinai St. Luke’s, Mount Sinai West, New York, NY

Melissa Leber, MD

Assistant Professor of Orthopedics and Emergency Medicine, Director of Emergency Department Sports Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Sergey Motov, MD, FAAEM

Associate Research Director, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY

Leslie Pendery, MD

Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Gabriel Rose, DO

Assistant Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Ultrasound Division Associate Director, Department of Emergency Medicine, Mount Sinai St. Luke’s, Mount Sinai West, New York, NY

Turandot Saul, MD

Associate Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Ultrasound Division Director, Department of Emergency Medicine, Mount Sinai St. Luke’s, Mount Sinai West, New York, NY

Joshua Schechter, MD

Clinical Assistant Professor, Program Director Combined Emergency Medicine-Internal Medicine Residency, SUNY Downstate – Kings County Hospital Center, Brooklyn, NY

Ryan Tansek, MD

Department of Emergency Medicine, Division of Emergency Ultrasound, Mount Sinai St. Luke’s, Mount Sinai West, New York, NY

Peer Reviewer

Bonny J. Baron, MD

Associate Professor, Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital; Emergency Department Trauma Liaison, Kings County Hospital, Brooklyn, NY

Commentary Experts

Jeffrey S. Rabrich, DO, FACEP

Chairman of Emergency Medicine, Montefiore Nyack Hospital, Nyack, NY

Michael Klein, MD

Assistant Professor, Department of Surgery, New York University School of Medicine, Bellevue Hospital Center, New York, NY

Cherisse Berry, MD

Assistant Professor of Surgery, Department of Surgery, Division of Acute Care Surgery, New York University School of Medicine, New York, New York

Mary Leas, RN, BSN, MSN-L, CCRN

Director of Emergency Nursing, Mount Sinai West Hospital, New York, NY

James B. Haering, DO, SFHM

Hospitalist, Sound Physicians, Tacoma, WA; Associate Professor, Department of Medicine, Michigan State University College of Human Medicine and College of Osteopathic Medicine, Lansing, MI

Chapter 1: Traumatic Wound Care Management

1. Introduction
2. Epidemiology and Pathophysiology
   1. Epidemiology
   2. Anatomy
   3. Pathophysiology and Classification
3. Emergency Department Evaluation
   1. Initial Evaluation
   2. Timing of Wound Repair
   3. Physical Examination
   4. Foreign Bodies Within a Wound
      1. History and Physical Examination for Wound Foreign Bodies
      2. Using Diagnostic Studies to Identify Wound Foreign Bodies
      3. Management of Wound Foreign Bodies
      4. Risk Management for Wound Foreign Bodies
4. Treatment
   1. Anesthesia
      1. Topical Anesthesia
      2. Local infiltration
      3. Regional Anesthesia
   2. Irrigation
      1. Irrigation Solutions
      2. Irrigation Pressure
   3. Hair Removal
   4. Wound Repair
      1. Sutures
         • Nonabsorbable Sutures
         • Absorbable Sutures
      2. Staples
      3. Tissue Adhesives
      4. Surgical Tapes
   5. Delayed Primary Closure
   6. Dressing
   7. Systemic Antibiotics
5. Advanced Wound-Closure Principles and Techniques
   1. Advanced Wound-Closure Techniques
      1. Tissue Handling
      2. Running Sutures
      3. Undermining and Defatting Wounds
      4. Deep Dermal Subcutaneous Sutures and 2-Layer Repair
      5. Running Subcuticular Suture
      6. Wound Eversion with Mattress Sutures
      7. Sharp Trimming of Ragged or Nonviable Edges
   2. Advanced Closure Techniques in Difficult Scenarios
      1. Stellate Lacerations or Ragged Edges
      2. V-Shaped or Acute-Angle Corners
      3. Wound Over a Joint or High-Tension Area
      4. Missing Tissue
      5. Parallel Lacerations
      6. Beveled (Tangential) Lacerations
      7. Varying-Depth Lacerations
6. Disposition
7. Emergency Medical Services Commentary
8. Charting Commentary
9. Clinical Pathway for Management of Wounds in the Emergency Department
10. Tables and Figures
    1. Table 1. Risk Factors for Wound Infection
    2. Table 2. Centers for Disease Control and Prevention Guidelines for Tetanus Wound Management
    3. Table 3. Indications for Foreign Body Removal
    4. Table 4. Topical Anesthetics
    5. Table 5. Common Infiltrative Anesthetic Agents
    6. Table 6. Types of Absorbable Sutures
    7. Table 7. Suture Selection and Removal Times
    8. Figure 1. Layer for Dissection to Undermine and Free the Skin
    9. Figure 2. Subcutaneous Sutures and 2-Layer Repair Technique
    10. Figure 3. Tangential Laceration Repair
11. Videos
    1. Advanced Wound-Closure Techniques
    2. Advanced Closure Techniques in Difficult Scenarios
12. References
13. Calculated Decisions: Wound Closure Classification
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Advice
    6. Evidence Appraisal
    7. Calculator Creator
    8. References

Chapter 2: Utilizing Ultrasound in Trauma

1. Bonus Video: Utilizing Ultrasound in Trauma
2. Introduction
3. The Role of the FAST Examination in Thoracoabdominal Trauma
   1. Blunt Thoracoabdominal Trauma
      1. Pericardial Injury
      2. Pleural Injury
      3. Intraperitoneal Injury
      4. Summary
   2. Evaluation for Free Fluid in the Left Subphrenic Space
   3. Evaluation of Pneumothorax
4. Evaluation of Intracranial Pressure Using Optic Nerve Sheath Diameter
5. Evaluation of Femoral Fractures Using Ultrasound
6. Time- and Cost-Effective Strategies
7. Additional Resources
8. Charting Commentary
   1. What procedure was done
   2. Who performed and who interpreted the ultrasound
   3. Why the test was performed
   4. What was found
   5. Common CPT® Procedure Codes for Ultrasound
   6. Sample Documentation
9. Figures
   1. Figure 1. Position of the Phrenicocolic Ligament and Resulting Patterns of Flow of Free Fluid Surrounding the Spleen
   2. Figure 2. Left Upper Quadrant Ultrasound
   3. Figure 3. Probe Positioning for the E-FAST Examination
   4. Figure 4. The “Seashore” Sign and the “Barcode” Sign on Ultrasound
   5. Figure 5. Fluid Accumulation in the Subarachnoid Space, Expanding the Diameter of the Optic Nerve Sheath
   6. Figure 6. Ultrasound Measurement of the Optic Nerve Sheath Diameter
   7. Figure 7. Ultrasound of the Femoral Neck
10. References
11. Calculated Decisions: Focused Assessment With Sonography for Trauma (FAST)
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Advice
    6. Critical Actions
    7. Evidence Appraisal
    8. Important
    9. Calculator Creator
    10. References

Chapter 3: Blast Injuries and Mass-Casualty Trauma

1. Epidemiology
2. The Physics of Blast Events
3. Risk Factors for Morbidity and Mortality
4. Dirty Bombs
5. Improvised Explosive Devices
6. Categories of Blast Injury
7. Management of Specific Blast Injuries in the Emergency Department
   1. Blast Auditory Injury
   2. Blast Lung Injury
   3. Blast Intestinal Injury
   4. Blast Eye Injury
   5. Central Nervous System Injuries
   6. Musculoskeletal System Injuries
8. Time- and Cost-Effective Strategies
9. Emergency Medical Services Commentary
10. Mass-Casualty Emergency Preparedness Commentary
11. Nursing Commentary
12. Charting Commentary
    1. Head Injury
    2. Burns
    3. Multiple Significant Trauma
13. Tables and Figures
    1. Table 1. Expected Injuries to Unprotected Victims at Relative Distances From a High-Explosive Detonation in Open Air
    2. Table 2. Categories of Blast and Their Associated Injuries
    3. Figure 1. A Blast Pressure Wave Over Time
    4. Figure 2. Blast Lung Injury on Chest X-Ray
    5. Figure 3. Intestine of a Sheep Model Exposed to a Blast
14. References
15. Calculated Decisions: TASH Score (Trauma-Associated Severe Hemorrhage)
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Evidence Appraisal
    6. Calculator Creator
    7. References
    8. Related Calculator
16. Calculated Decisions: Blast Lung Injury Severity Score
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Evidence Appraisal
    6. Calculator Creator
    7. References
17. Calculated Decisions: Bastion Classification of Lower Limb Blast Injuries
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Evidence Appraisal
    6. Calculator Creator
    7. References
18. Calculated Decisions: Glasgow Coma Scale Score
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Critical Actions
    6. Evidence Appraisal
    7. Calculator Creator
    8. References
    9. Related Calculator
19. Calculated Decisions: Parkland Formula for Burns
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Advice
    6. Critical Actions
    7. Evidence Appraisal
    8. Calculator Creator
    9. References

Chapter 4: Fracture Care in Trauma

1. Bonus Video: Can't-Miss Orthopedics: Musculoskeletal Cases for the Urgent Care Provider
2. Epidemiology Of Fracture
3. General Management Of Fractures
   1. Nomenclature And Classification
      1. Classification Of Pediatric Fractures
   2. High-Risk Fractures
4. Hand Fractures
   1. Scaphoid Fractures
   2. Distal Phalanx Fractures
   3. Metacarpal Fractures
5. Wrist And Forearm Fractures
   1. Distal Radial And Ulnar Fractures
      1. Colles Fracture
      2. Smith Fracture
      3. Monteggia Fracture
      4. Galeazzi Fracture
6. Humerus And Elbow Fractures
   1. Supracondylar Fractures
   2. Radial Head And Neck Fractures
7. Shoulder Fractures
   1. Clavicular Fractures
   2. Proximal Humeral Fractures
8. Pelvic Fractures
9. Hip Fractures
   1. Femoral Neck Fractures
   2. Femoral Shaft Fractures
10. Knee And Lower Leg Fractures
    1. Tibial Plateau Fractures
    2. Patellar Fractures
    3. Tibial Shaft Fractures
11. Ankle And Foot Fractures
    1. Ankle Fractures
    2. Talar Fractures
    3. Calcaneal Fractures
    4. Navicular Fracture
    5. Lisfranc Injuries
    6. Fifth Metatarsal Fractures
12. Treatment And Complications
    1. Open Fractures And Infection
    2. Vascular Injuries
    3. Nerve Injuries
    4. Compartment Syndrome
    5. Avascular Necrosis
13. Summary
14. Time- And Cost-Effective Strategies
15. Risk Management Pearls
16. Additional Resources
17. Emergency Medical Services Commentary
18. Nursing Commentary
19. Charting Commentary
    1. Documentation of Fractures
    2. Gustilo Classification and “Open” Versus “Closed” Fractures
20. Tables and Figures
    1. Table 1. Common Fractures and Appropriate Immobilization Techniques
    2. Table 2. Orthopedic Injuries and Associated Potential Nerve Injuries
    3. Figure 1. Salter-Harris Classification of Fractures and the SALTER Mnemonic
    4. Figure 2. Normal Flexion of Fingers Pointing Toward the Scaphoid, With Acceptable Angulation
    5. Figure 3. Colles Fracture on X-Ray
    6. Figure 4. Monteggia Fracture on X-Ray
    7. Figure 5. X-Ray of Normal Alignment of Elbow With Long Axis of the Radius Intersecting the Distal Third of the Capitellum
    8. Figure 6. Galeazzi Fracture on X-Ray
    9. Figure 7. Young-Burgess Classification of Pelvic Fracture
    10. Figure 8. Ottawa Ankle Rule
    11. Figure 9. Weber Classification of Ankle Fractures
21. References
22. Calculated Decisions: Ottawa Knee Rule
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Advice
    6. Critical Actions
    7. Evidence Appraisal
    8. Calculator Creator
    9. References
23. Calculated Decisions: Ottawa Ankle Rule
    1. Introduction
    2. Points & Pearls
    3. Why and When to Use, and Next Steps
    4. Calculator Review Author
    5. Advice
    6. Critical Actions
    7. Evidence Appraisal
    8. Calculator Creator
    9. References

Chapter 5: Nonopioid Analgesic Modalities for Management of Acute Traumatic Pain

1. Introduction
2. Acetaminophen
3. Nonsteroidal Anti-Inflammatory Drugs
4. Subdissociative Ketamine
5. Local Anesthetics
6. Alpha-2 Adrenergic Receptor Agonists
7. Gabapentinoids
8. Nitrous Oxide
9. Nonpharmacological Pain Management
10. Time- and Cost-Effective Strategies
11. Conclusion
12. Emergency Medical Services Commentary
13. Nursing Commentary
14. Surgical Commentary
15. Charting Commentary
16. Tables
    1. Table 1. Indications, Contraindications, Dosing, and Side Effects of Subdissociative Ketamine for Traumatic Pain
    2. Table 2. Ultrasound-Guided Regional Anesthesia in Trauma
    3. Table 3. Guidelines for Regional Anesthesia for Traumatic Orthopedic Injuries
    4. Table 4. Nitrous Oxide for Traumatic Pain
    5. Table 5. Nonopioid Analgesic Modalities for Acute Traumatic Injuries in the Emergency Department
17. References