EM Boards Survival Guide: Trauma 1

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)

Welcome back to the EM Boards Survival Guide! This emDocs series will provide you with regular tips and must-know items for EM boards and inservice. Each post will feature several key takeaways on a specific organ system. This week we cover trauma.


Boards Must-Knows:

1) Abdominal trauma: Blunt trauma: spleen (#1); Penetrating trauma MC injured organ: liver. Who goes to OR versus who to work up further in ED bay. US misses retroperitoneal injuries. Know commonly missed injuries on CT e.g. ureter, diaphragm, etc. Chance fractures and intra-abdominal injuries.

2) Diaphragmatic injury: Commonly missed on 1stpresentation. More likely penetrating mechanism, L-sided. Liver protects on R side. Late presentation: incarcerated/strangulated hernia.

3) Recognize Cullen’s and Grey Turner’s signs => retroperitoneal hemorrhage.

4) Amputation: Know stepwise care of amputated part. Know injuries that qualify for re-implantation. Update tetanus!

5) Bite wound: Special bugs to know => Pasteurella (cat); Capnocytophaga (dog); Eikenella (human); remember: Staph and Strep will still be common offenders. Know which wounds not to suture. Know antibiotics; update tetanus!

6) Compartment syndrome: have a differential diagnosis for pain out of proportion to exam (compartment syndrome, mesenteric ischemia, necrotizing fasciitis, etc.)  Tib-fib MC area. Know the 6 Ps for exam. Know delta pressure and direct compartment pressure.

7) High-pressure injection injury: subtle injury/photo. Update tetanus + prophylactic Abx + OR. Do not use digital block.

8) Penetrating arterial injury: Know soft and hard signs. Know how to perform ABI and important cut-offs. When to obtain CTA.

9) Clavicle fractures: Middle 1/3 (most common). Medial 1/3 most interesting given potential for vascular, nerve, tracheal, and/or esophageal injuries. Consult Ortho: comminuted; significantly displaced; skin tenting.

10) Flail chest: ≥ 3 ribs in 2 places. Watch closely for airway decompensation. Lower ribs, consider intra-abdominal injury.

From Dr. Katy Hanson at Hanson’s Anatomy:

 

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