recent articles

practice updates

Pearls for the management of GSW associated traumatic injury

The patient with GSW can present in a variety of states ranging from hemodynamic stability to loss of pulses. Several literature updates have evaluated specific components of the care of these patients including airway, breathing, hemorrhage control, thoracotomy, and REBOA. This post evaluates the updated literature and provides pearls and pitfalls in the care of these potentially sick patients.


Cervical Collars for C-Spine Trauma: The Facts

Based on the available data, it does not appear that cervical collars have any appreciable positive effect on patient care. However, at this point in time, they are the recommended treatment option. Hopefully this knowledge will help your daily practice by understanding the effects of cervical immobilization.

practice updates

The Difficult Airway: Common Errors During Intubation

Airway management is a vital component to caring for critically-ill patients in the emergency department. The peri-intubation time can be chaotic. Planning for the difficult airway and preparing for all possible scenarios is best done before the arrival of a crashing patient. The following post explores some common failures in airway management and how to avoid making fatal mistakes in a critical situation.

practice updates

Bleeding Hand Wounds

Hand and digital wound bleeding should be managed with hemorrhage control, an adequate exam and proper treatment. There are many tools to help manage bleeding and allow for an adequate exam. Using a topical analgesic such as lidocaine, can be helpful with pain control. The addition of epinephrine to a topical analgesic in hand and digital wounds may not be as scary as once thought and may be considered to help with hemorrhage control in certain wounds.

practice updates

Neuro Intubation Highlights

You are working a busy shift when you receive a phone call from EMS that they are bringing in a “sick trauma patient.” As you prepare the trauma bay, the patient arrives. He is the victim of an assault and in clear need of intubation. He is unconscious with a GCS of 5, HR 125, BP 180/11, Sp02 88% on NRB 15 lpm, RR 22. As you prepare your medications, what are the best options for this scenario? Pre-treatment with lidocaine, fentantyl or esmolol? Is it okay to use ketamine in trauma patients in traumatic brain injury (TBI)?

practice updates

Asymptomatic Hypertension

"We should only intervene under very specific circumstances"
Asymptomatic hypertension in the ED: Should we be screening for end-organ damage? Should we intervene? Joshua Bucher, MD covers the 2013 ACEP Clinical Policy addressing these common questions.