One-Stop Pain Control for Trimalleolar Fractures
​The incidence of all ankle fractures is about 187 cases per 100,000 people each year. Trimalleolar fractures occur in seven to 11 percent of those cases. (Orthop J Sports Med. 2019;7[11 Suppl 6]; https://bit.ly/3eQ4lRl.) Trimalleolar fractures involve the lateral and medial malleolus and the distal posterior aspect of the tibia (sometimes called the posterior malleolus).These fractures are serious and often unstable. They typically but not always need urgent or even emergent surgery. Often, they are reduced with a closed reduction prior to surgery. We suggest using a hematoma block to assist with pain control during...
Source: The Procedural Pause - July 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
ENDOLIFT ® Lunch-Time Laser Lifting With No Downtime
Eufoton® is a leading Italian manufacturer specialised in developing and producing portable medical lasers.
The company was founded in 1999 by a highly-skilled medical and engineering team. Today, Eufoton®’s diode lasers are successfully used in many medical specialties.
One of the most sought-after treatment patented by Eufoton® is ENDOLIFT®, a minimally invasive outpatient laser procedure used in endo-tissutal (interstitial) aesthetic medicine.
The laser treatment is performed with the latest Eufoton® LASEmaR® 1500 (certified and approved by the American FDA for laser assisted liposuction). ENDOLIFTÂ...
Source: Medgadget - May 14, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Dermatology Sponsored Content Source Type: blogs
Part Two: Mastering Wrist Arthrocentesis
​We discussed the initial approach to the red, hot swollen wrist joint last month, and this month we focus on arthrocentesis of the joint with a full video of the procedure, including ultrasound and joint aspiration.A swollen, painful wrist that is hot to the touch with scant erythema is concerning for septic arthritis. The patient had multiple Band-Aids on his fingertips from blood glucose testing for diabetes, which increased his chances of having a septic joint with the punctures serving as an entry site for infection. Photo by Martha Roberts.The ProcedureIdentify the swollen joint, review the differential diagnosis, ...
Source: The Procedural Pause - May 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Paracentesis: The Procedure
Discussion: The Z-track method minimizes fluid leakage from the puncture site. Injecting medication into the skin using this method is important to preventing post-procedure leaking. Once a needle has entered subcutaneous tissue and muscle, it opens a track that may not reseal immediately. There are also studies suggesting that Z tracks may reduce pain during injection. We suggest using the method during your paracentesis procedure.Z tracks are used for all kinds of intramuscular injections and can be applied to other sites on the body. Pull and press the skin and tissue 2 cm caudad to the deep abdominal wall and inser...
Source: The Procedural Pause - March 3, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
TULA System for Awake Ear Tube Placement FDA Approved
Ear infections are notoriously common in children, but the usual treatment is relatively straightforward. An incision is made in the ear drum (myringotomy) and tympanostomy tubes are placed to drain out the liquid that has built-up within. However, because children are involved, pain is a major limitation and it is very difficult to get the kids to stay still long enough to achieve success. Therefore, general anesthesia is typically a required part of the process, which comes with the potential for side effects, high treatment costs, and an impression that the procedure is a full scale surgery.
Now, a company called Tu...
Source: Medgadget - January 3, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Anesthesiology ENT Pediatrics Surgery Source Type: blogs
Sharing Tension to Repair Chainsaw Injuries
​As autumn rolls around, many people are cutting wood for their fireplaces, which can precipitate chainsaw, axe, and saw injuries. These lacerations can be tricky to repair because they often bleed profusely and leave jagged edges. They may also be dirty and harbor foreign bodies such as wood chips, metal, and rust. They may even disrupt underlying tendons, ligaments, and bones. Amputations are uncommon, but do occur.Extremity injuries from chainsaws leave ugly, macerated skin disruptions and lacerations. Even chainsaws that are turned off may cause lacerations and puncture wounds. Most injuries affect the hands and legs...
Source: The Procedural Pause - September 3, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Getting the Toe Out of a Jam
Toe jam injuries are extremely painful because the feet have sensitive parts and a delicate anatomy. Patients, especially women, care about cosmetic results. EPs should consider the emergency concerns of foot wound closure and cosmetic results when attempting repair. More importantly, patients with neuropathies, diabetes, and vascular diseases warrant close attention to detail to prevent complications. High-risk patients can develop serious infections, which could result in the loss of a toe or limb. It might be excessive to call a plastic surgeon to consult on a foot wound, but it may be appropriate to consult podiatry or...
Source: The Procedural Pause - August 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Dermal fillers: The good, the bad and the dangerous
The four major structural components of our face are skin, fat, muscle, and bone. As we age, volume loss in these structures contributes to many of the visible signs of aging. Dermal fillers may help.
Over time, age-related bone loss in the face can lead to retraction of the jawline, descent of the nose, and loss of high cheekbones. The facial muscles also decrease in volume and elasticity, and deflation and movement of facial fat further accentuates the signs of aging. Finally, the skin stretches and loses elasticity — compounded by the loss of scaffolding provided by fat, muscle, and bone, this leads to wrinkles, saggi...
Source: Harvard Health Blog - July 15, 2019 Category: Consumer Health News Authors: Kristina Liu, MD, MHS Tags: Cosmetic surgery Health Skin and Hair Care Source Type: blogs
Trocar during Times of Trauma
​Seventy-five percent of trauma injuries involve some kind of thoracic insult, a quarter of which need a procedural intervention like a chest tube. (Surg Clin North Am 2007;87[1]:95; http://bit.ly/2HaoX90.) Long-term illness, lung disease, and post-operative complications may cause pleural effusions or a pneumothorax, so treating these conditions quickly can significantly decrease patient morbidity and mortality. Other indications for chest tube placement include:Trauma: Pneumothorax, hemopneumothorax, or tension pneumothoraxLong-term illness: Pleural effusion (cancer, pneumonia)Infection: Em...
Source: The Procedural Pause - April 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Goodbye to Compounded Analgesic Creams
This study is one of the largest and best-designed study I ' m aware of of these creams, and the findings are pretty clear: such creams benefit patients via placebo mechanisms, aka they don ' t work.Note that there is a separate body of research on some other topicals which should not be confused with this study. Eg, the 5% lidocaine patch for post-herpetic neuralgia, topical capsaicin for a variety of neuropathies, and at least some topical NSAIDs for osteoarthritis, and topical opioids. I ' m not broadly endorsing those either - it ' s complicated - however they weren ' t tested here and the take home point is we should ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2019 Category: Palliative Care Source Type: blogs
The Anoscope for Foreign Bodies in the Rectum
​Rectal exams are difficult for the patient and require true expertise. You cannot expect to complete a good rectal exam or remove a rectal foreign body without the correct information, good bedside relationship, and the right equipment.Ensuring your patient has confidence in your ability is vital. Take the time to get to know what equipment is available in your ED. It's important to know what to do before a patient comes to your department with a rectal complaint.Most departments have a box dedicated to the anoscope. It typically will have two handles for light sources and two sizes of obturators with casing. The items ...
Source: The Procedural Pause - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Foreign Bodies in the Ear and Nose a True Test of EP Mettle
​Pediatric patients frequently put foreign bodies into their mouths, noses, and ears. The spectrum of foreign bodies that children place into their facial orifices are impressive. Paper, vegetable matter (such as peanuts), toys, beads, metal screws, and Play-Doh are just a few examples.The insertions are often done surreptitiously, only to be discovered days or sometimes weeks later. Occasionally, the retained foreign nasal bodies will ferment and present with a purulent, unilateral nasal drainage, accompanied by an unrelentingly repulsive odor. Sometimes an occasional cockroach wanders into the external auditory canal l...
Source: M2E Too! Mellick's Multimedia EduBlog - November 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?
Conclusion of first report:In patients with anterior Killip class II or less ST-segment –elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI.Conclusion of 2nd report: In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer h...
Source: Dr. Smith's ECG Blog - October 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Time is a gift in the ER
Fourteen hours into their shift, the intern headed down to the lobby to pick up the delivery. Today it was Indian food. He struggled to push the elevator button while holding the bags but managed to make it up to the top floor ICU. The rest of the surgeons gathered around the table cluttered with spent pens, journal articles and unused bottles of lidocaine to eat. Someone offered up their extra samosa to share. The sun drooped lower in the sky, and the light outside burned golden and fought with the pale white glow from the fluorescent lights inside.
The day had been so hot that the doctors could see it from the hospital w...
Source: Kevin, M.D. - Medical Weblog - August 30, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/lauren-schmidt" rel="tag" > Lauren Schmidt, MD < /a > Tags: Physician Emergency Medicine Surgery Source Type: blogs
