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Blunt Neck Trauma

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961. Lyme Titer

Lyme Titer Lyme Titer Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Lyme Titer Lyme Titer Aka: Lyme Titer , Lyme Disease Antibody (...) blunt seroconversion IX. Protocol Tier 1: Obtain Lyme Serology (polyvalent ELISA) Initial test in all cases Move to tier 2 tests if positive or equivocal Tier 2: Western Blot Test Tests for IgM and IgG Immunoblots Confirms positive or equivocal Lyme Titer With Lyme serology, : 99-100% IgG must be positive for symptoms >4 weeks Pitfalls Avoid using labs that do not follow CDC guidelines Avoid starting at Tier 2 (Western Blot) High Faint positive bands in uninfected person is common PCR or culture

2015 FP Notebook

962. Management of Mild Head Injury

Management of Mild Head Injury Management of Mild Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Management of Mild Head (...) Injury Management of Mild Head Injury Aka: Management of Mild Head Injury , Mild Traumatic Brain Injury , MTBI , Minor Head Injury , Mild Head Injury , Mild Head Trauma From Related Chapters II. Epidemiology Mild Traumatic Brain Injury (MTBI) accounts for 75% of the 1.7 Million people in U.S. who suffer TBI annually III. Criteria : 13-15 (at two hours) Loss of consciousness may have occurred with injury Awake and oriented with normal ination IV. History See Time and mechanism of injury Loss

2015 FP Notebook

963. Primary Survey Circulation Evaluation

Primary Survey Circulation Evaluation Primary Survey Circulation Evaluation Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Primary (...) ventilations Obtain Consider potentially reversible causes See ( ) VI. Management: Trauma See Two large bore IVs (14 or 16 gauge) Shorter tubing provides faster IV rate s and Judicious use of crystalloid in or higher and textbooks still describe the use of NS or LR for 1-2 Liter bolus However, new guidelines suggest limiting crystalloid in favor of should be replaced with Indications Mean arterial pressure 65 (or systolic 70-90 mmHg) Poor response to IV fluids Persistent , or <50 ml/hour (<1ml/kg/hour

2015 FP Notebook

964. Primary Survey Airway Evaluation

Primary Survey Airway Evaluation Primary Survey Airway Evaluation Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Primary Survey (...) retractions (snoring or gurgling respirations) Asymmetric lung sounds or chest wall movement IV. Evaluation See Monitor for signs of impending airway compromise is a more reliable and earlier marker of impending than Evaluate for related airway compromise Neck Laryngeal or tracheal (e.g. , ) Subcutaneous V. Management Assume Maintain inline stabilization Consider in pediatric patients Blood Mucus Dental fragments Open Airway (if is suspected) Maintain Airway VI. Pitfalls: Trauma See for intubation

2015 FP Notebook

965. Electrical Injury

Electrical Injury Electrical Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Electrical Injury Electrical Injury Aka (...) injury AC is 3 times more dangerous than DC at same voltage May result in muscle Patient involuntarily holds source Prolongs duration of contact and increases injury Direct Current (DC): High voltage May throw patient from jolt of energy May result in blunt injury in addition to burns Arc Injury Patient part of arc of current between 2 objects Most serious Electrical Injury Severe blunt may result may exceed 2500 C (4532 F) V. Management See Indications for outpatient management (all criteria) Low

2015 FP Notebook

966. Accidental Hypothermia Management

Accidental Hypothermia Management Accidental Hypothermia Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Accidental (...) only be considered after aggressive rehydration has failed to correct V. Contraindications: Pulseless, asystolic patients for whom Resuscitation efforts are futile occurred prior to cooling (based on good history) Core >89.6 F (32 C) and still in asystolic rhythm Patient is so frozen that the chest can not be compressed >12 mEq/L and pulseless Blunt tic pulseless arrest (<1% survival) Complete submersion in pulseless adults ( precedes cooling) Case reports of children surviving submersion for >1

2015 FP Notebook

967. Ear Canal Suction

Ear Canal Suction Ear Canal Suction Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ear Canal Suction Ear Canal Suction Aka: Ear Canal (...) Suction , Ear Suction , Cerumen Removal by Suction II. Indications with soft or semi-fluid cerumen Interfering with examination Ear toilet in management III. Contraindications Previous radical mastoid surgery s IV. Precautions Ear Canal Suctioning is not recommended by non-otolaryngologists The potential for middle ear injury, including ossicle disruption limits safe use by non-otolaryngologists V. Equipment Suction through otoscope head for visualization Suction tips Blunt tipped 14 gauge

2015 FP Notebook

968. FAST Exam

FAST Exam FAST Exam Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 FAST Exam FAST Exam Aka: FAST Exam , eFAST Exam , Extended FAST (...) Exam , Focused Assessment with Sonography for Trauma , Limited Trauma Ultrasound , Focused Assessment with Ultrasonography for Trauma , Ultrasound of Abdomen for FAST Exam II. Background FAST Exam typically takes 2-4 minutes depending on level of experience May take as little as 10 seconds for each of the 7 views FAST Exam is an integral part of the In some centers, FAST Exam is performed in place of auscultation of lungs and heart as part of the evaluation is the highest yield portion of the FAST

2015 FP Notebook

969. C-Spine MRI

, Cervical Spine MRI II. Indications: MRI C-Spine in Trauma suspected (neurologic deficits with normal imaging) Most often associated with pediatric , but also occurs in adults suspected (symmetric upper extremity > lower extremity neurologic deficits) Vascular neck injury suspected Severe blunt force neck injury Significant hyperextension or hyperflexion injury Unexplained neurologic deficits base Cervical l in region of l arteries Penetrating neck injury in region of neck vascular structures Severe (...) C-Spine MRI C-Spine MRI Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 C-Spine MRI C-Spine MRI Aka: C-Spine MRI , MRI C-Spine

2015 FP Notebook

970. Cervical Spine XRay

Cervical Spine XRay Cervical Spine XRay Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cervical Spine XRay Cervical Spine XRay Aka (...) : Cervical Spine XRay , C-Spine XRay , Cervical Spine XRay in Acute Traumatic Injury II. Efficacy: Blunt Trauma Inadequate for most patients ( is preferred) Adequate visualization of the entire is achieved in <30% of plain film C-Spine XRays Misses up to 16% of c-spine s in seriously injured, obtunded blunt patients However, NEXUS found that adequate 3-view C-Spine XRays have >99% for significant III. Indications: Acute Trauma Decision rules for imaging in general See See See Cases in which plain C-Spine

2015 FP Notebook

971. Upper Eyelid Eversion

Upper Eyelid Eversion Upper Eyelid Eversion Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Upper Eyelid Eversion Upper Eyelid (...) Eversion Aka: Upper Eyelid Eversion , Eyelid Eversion II. Indications Exam Examination of superior cul-de-sac and III. Technique Patient looks down with both eyes open Depress the mid-portion of upper lid laterally Use Cotton swab or other blunt instrument Grasp the lashes of the upper lid and lift upward Upper lid remains relaxed while patient looks downward Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Upper Eyelid Eversion

2015 FP Notebook

972. Hyphema

Hyphema Hyphema Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Hyphema Hyphema Aka: Hyphema , Anterior Chamber Hemorrhage From (...) Related Chapters II. Definition Bleeding in the anterior chamber of the eye III. Causes Blunt (most common) Injury to the iris root (outer edge of the iris where it meets the ) Subsequent bleeding arises from the iris blood vessels Post-surgical Spontaneous bleeding without injury history IV. Exam Determine amount of bleeding (height of Hyphema) Evaluate for High pressure suggests blood clogging the trabecular drainage V. Labs Sickle Cell preparation in non-caucasian patients Perform even in tic cases

2015 FP Notebook

973. Adult Safety Belt

Adult Safety Belt Adult Safety Belt Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Adult Safety Belt Adult Safety Belt Aka: Adult (...) to maternal death in blunt Protecting the mother is the best way to protect the fetus MVAs affect 2% of pregnant women (accounts for 50% of all tic injuries in pregnancy) Maternal (U.S.): 368 maternal deaths per year Fetal: MVAs account for 82% of fetal deaths Properly positioned Seat Belts decrease the risk of fetal injury while keeping their mothers safer Uterine injury and fetal risk does increase if belts are incorrectly placed across the dome of the of fetal loss if unbelted: 2.8 Fetal outcomes

2015 FP Notebook

974. Tick Removal

Tick Removal Tick Removal Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Tick Removal Tick Removal Aka: Tick Removal II. Technique (...) : Manual tick extraction Tools Blunt angled forceps with medium size to fine tips Specific Tick Removal devices Sawyer Tick Pliers (B & A Products) Pro-Tick Remedy (SCS Limited) Ticked Off (Ticked Off, inc.) Removal Grasp tick as close to embedded mouth as possible (closest to skin), and avoid crushing Gently pull perpendicular to skin without twisting and tick will eventually release Post-extraction care Retained parts of mouth or head may be left and will fall away in the subsequent days No need

2015 FP Notebook

975. Cullen's Sign

Cullen's Sign Cullens Sign Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cullen's Sign Cullen's Sign Aka: Cullen's Sign , Cullen (...) Sign , Periumbilical Purpura II. Signs Blue discoloration from subcutaneous and edema in periumbilical subcutaneous fat III. Causes Ruptured Ruptured Blunt with intraabdominal IV. References Wikipedia Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Cullens Sign." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Cullen's sign (C0233200) Concepts

2015 FP Notebook

976. Esophageal Rupture

Esophageal Rupture Esophageal Rupture Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Esophageal Rupture Esophageal Rupture Aka (...) (but lethal if unrecongized) IV. Causes Severe or (Mallory-Weis Tear) Penetrating Blunt force to left chest, or epigastrium Forces gastric contents into the esophagus V. Precautions Consider in the injured patient with a left or without a VI. Symptoms Follows Retrosternal pain radiates to back or epigastrium Pain increases with swallowing or neck movement VII. Signs Sudden collapse and patient appears acutely ill Signs develop only gradually Subcutaneous Mediastinal air VIII. Labs (CBC) IX. Diagnostics

2015 FP Notebook

977. Esophageal Foreign Body

Esophageal Foreign Body Esophageal Foreign Body Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Esophageal Foreign Body Esophageal (...) ) Household Toxins Lecture, ACEP PEM Conference, attended 3/8/2016 Requires emergent upper endoscopy for removal (typically gastroenterology) Asymptomatic button batteries below the esophagus (e.g. ) may be followed with serial XRay Expect to pass through pylorus within 48 hours and out with stool by 72 hours VII. Imaging (e.g. coins, some medications, bones) Soft tissue neck PA and lateral (as indicated) Upright PA and lateral (as indicated) Foreign body location Free air under diaphragm Abdominal XRay

2015 FP Notebook

978. Gallstone

Gallstone Gallstone Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Gallstone Gallstone Aka: Gallstone , Cholelithiasis From Related (...) immunosuppression risks blunted gallbladder symptoms and increased risk of Gallbladder dysmotility and small Gallstones Increased risk of gallstone Pregnancy and recurrent or intractable biliary pain (or associated complications) Symptomatic management is preferred However is indicated if uncontrolled, persistent symptoms A or B is indicated for symptomatic Gallstones (despite the increased complication risk) and indications Percutaneous cholecystostomy drainage indications (with delayed ) Older or critically

2015 FP Notebook

979. Ketamine

Ketamine Ketamine Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Ketamine Ketamine Aka: Ketamine , Ketalar , Ketaphol , Ketafol (...) infusion V. Dosing: Sedation Intravenous Initial Adult: 1.0 mg/kg slow IV over 1-2 min (some start at 1.5 mg/kg) Child: 1.5 mg/kg slow IV over 1-2 min Next Administer 1/2 of intial dose every 10 min as needed Intramuscular (esp. for as ) Initial: 4-5 mg/kg IM (adult and child) Repeat 4-5 mg/kg IM after 10 min for one dose if needed Intranasal Ketamine 2 mg/kg intranasal Consider concurrent (especially in adults) Blunts effect Reduces (emergence reaction) on recovery from Ketamine ( ) dosing: 0.03 mg/kg

2015 FP Notebook

980. Kaposi's Sarcoma

Kaposi's Sarcoma Kaposis Sarcoma Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Kaposi's Sarcoma Kaposi's Sarcoma Aka: Kaposi's (...) . However, treating KS does not improve survival from HIV/AIDS itself. NIH: National Cancer Institute Definition (NCI) A malignant neoplasm characterized by a vascular proliferation which usually contains blunt endothelial cells. Erythrocyte extravasation and hemosiderin deposition are frequently present. The most frequent site of involvement is the skin; however it may also occur internally. It generally develops in people with compromised immune systems including those with acquired immune deficiency

2015 FP Notebook

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