The EM Educator Series: Trauma Chameleons and Missed Injuries

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

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed. Today’s edition covers trauma chameleons, difficult populations, and missed traumatic injuries.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. We are working on retroactively doing this for the past posts as well. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Mini-Case: Trauma Chameleons and Missed Injuries

A 78-year-old male presents to the ED via EMS on backboard with cervical collar after head-on MVC. The patient remembers driving and then woke up with his car rolled on its side. His ABCs are intact, and he has several abrasions. VS are stable, and FAST is negative.

Considerations:

1. What is the etiology of the traumatic event, and what doesn’t fit?
2. What medical co-morbidities should you consider, and how do they impact the trauma patient?
3. One size doesn’t fit all… What should you consider in the pediatric, elderly, pregnant, obese, etc., patient?
4. What do we do with incidentalomas in the trauma work-up?
5. What are missed injuries in blunt and penetrating, and what is the importance of the tertiary survey?
6. Should we ambulate and PO challenge every trauma patient?

Suggested resources:

• https://emergencymedicinecases.com/pediatric-trauma-2/
• http://www.emdocs.net/pediatric-trauma-pearls-pitfalls/
• http://www.emdocs.net/geriatric-trauma-medical-illness-pearls-pitfalls/
• https://lifeinthefastlane.com/what-the-elderly-should-say/
• http://www.emdocs.net/resuscitation-of-the-pregnant-trauma-patient-pearls-pitfalls/
• https://coreem.net/podcast/episode-34-0-trauma-in-pregnancy/
• https://lifeinthefastlane.com/trauma-tribulation-006/
• https://lifeinthefastlane.com/trauma-tribulation-007/
• http://blog.ercast.org/pulmonary-nodule-incidentaloma/
• http://www.emdocs.net/blunt-trauma-what-do-we-misshow-can-we-improve/
• http://www.emdocs.net/the-cleared-trauma-patient-what-could-we-be-missing/
• http://www.emdocs.net/penetrating-trauma-what-we-miss-and-how-we-can-improve/