Emergency Medicine Reports saves you time keeping up with all the latest advances in a variety of clinical problems and gives you important time-saving techniques that can actually save lives in the ED!
Emergency Medicine Reports Latest Issue
Abdominal Wall Hernias in Adults: Diagnosis and Management July 27, 2014
- Some hernias self-reduce. Patients who present with an incarcerated hernia and no signs of strangulation can be reduced in the ED. Provide pain medication, mild sedation, and muscle relaxation, place the patient in Trendelenburg, put an ice pack on the area, and wait.
- Manual reduction is performed if self reduction does not occur within 15-30 minutes. Gently apply pressure on the distal aspect while guiding the proximal area into the defect.
- Strangulated hernias should not be reduced. Signs of strangulation include increased tenderness, leukocytosis, fever, red or ecchymotic skin, and elevated lactate.
- Mesh is often used in hernia repairs and may become infected. It may be difficult to distinguish mesh infection from cellulitis. Signs of mesh infection include fever, erythema, pain, purulent drainage, and an elevated sed rate.
Trauma Reports Latest Issue
Read the latest issue of this bimonthly, 12-page clinical monograph focusing on emergency care of adult and pediatric patients with moderate and severe traumatic injuries. Each issue gives you a practical, problem-solving, comprehensive review of a common clinical entity, packed with updated techniques you can apply immediately.
Trauma Resuscitation: The Use of Blood and Blood Products July 1, 2014
- Undifferentiated shock in trauma should be assumed to be hemorrhagic until proven otherwise. Hemorrhage represents 30-40% of mortality from trauma and may require significant volume to resuscitate.
- One pre- and post-intervention of a massive transfusion protocol showed improved outcomes with the 1:1 FFP:PRBC transfusion protocol for critically ill trauma patients at 24 hours and 30 days, and lower bleeding complications, with 18% and 21% absolute mortality reduction, respectively.
- Rapid depletion of fibrinogen has been shown in patients with significant blood loss exceeding 20% of their calculated blood volume, and fits within the conceptual understanding of the mechanism of traumatic consumptive coagulopathy.
- If thromboelastography can identify specific functional deficiencies of the traumatic coagulopathy, one can adapt the massive transfusion to simultaneously reverse the coagulopathy and shock while limiting the exposure to harm from excessive utilization of blood components.
- The most common side effects associated with PRBC transfusions reported in the CRIT trial were fever (1.9%), fluid overload (1.7%), and hypotension (1%). A pooled meta-analysis showed that the risk of developing an infectious complication was 1.8 times more likely and ARDS 2.5 times more likely with transfusion of blood.
- Clinical findings of TRALI are tachypnea, cyanosis, frothy pulmonary secretions, dyspnea, hypotension, tachycardia, and fever within 6 hours of transfusion, although most cases occur within 1-2 hours.