Introduction

• Peripheral vascular injury can be life-threatening or limb-threatening.  Proper understanding of pathology and management is important in the ER.
• Vascular injuries can be internal and may not be obvious on presentation. Patients with blunt or penetrating trauma who remain hypotensive after a fluid bolus challenge may have internal hemorrhage.
• Incidence of penetrating and blunt trauma in the US has been rising.
• Blunt and penetrating causes of peripheral vascular injuries are about equal in the US.
• Low velocity gunshot wounds are the second leading cause of death in the 15- to 34-year-old age group in the US.  Peripheral vascular injury has been reported to be present in up to 50% of these cases.

On my first month in the Parkland ED, I saw multiple patients with post-lumbar puncture headaches and even iatrogenically caused one myself.  Often I found myself wondering what proven preventative measures during an LP decrease the incidence of such headaches, what could I have done better, and what literature supports treatment of post-lumbar puncture headaches in the emergency department. [...]

Chief Complaint: “Seizures” History of Present Illness: 25-year-old male with no PMHx, BIBEMS after he had episode of tonic-clonic seizure. As per wife, who gave medical history, the patient was found down in a hotel with "his whole body shaking."  Upon EMS arrival, he was given 5mg of Valium. On arrival to the ED, patient combative, not following commands with frothy oral secretions.  Wife endorses that patient has had weakness, dizziness, and malaise x 3 days, but no other complaints. Patient had another seizure while in the ER without regaining full consciousness. [...]

Author: Albert Arslan, MD and Anthony Scoccimarro, MD (Resident Physicians, Lincoln Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital)   Prevent and Identify – the ED’s equivalent of Search & Rescue when managing elevated Intracranial Pressures (ICP). The causes of elevated ICP are typically described in the context […]

Continuous quantitative waveform capnography, also known as end-tidal carbon dioxide, PetCO2, or ETCO2, is a measurement of the partial pressure of CO2 in the exhaled breath. This technology has been around since the mid-19th century and only relatively recently has its potential in emergency medicine begun to be explored. [...]

Sepsis is the most common cause of death in children worldwide. What is the optimal evaluation and management of pediatric sepsis?

We're excited to announce our next AMA: Kevin Klauer will be with us TODAY: Tuesday, September 2nd, from 2-4pm CST.

Some background on Dr. Klauer from his bio page on emp.com:

• Chief Medical Officer of Emergency Medicine Physicians, one of the leading providers of emergency medical services in the nation
• Has received the ACEP National Faculty Teaching Award and the EMRA Robert J. Dougherty Teaching Fellowship Award
• He is the ACEP Council Vice Speaker and serves as Medical Editor-in-Chief for ACEP Now
• Co-author of two risk management books: Emergency Medicine Bouncebacks: Medical and Legal and Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals

Included below is a summary of numerous blog posts and podcasts that discuss the sometimes controversial issue of permissive hypotension or minimum volume resuscitation in the bleeding trauma patient.

The Basics

• Idea of keeping BP low in traumatic hemorrhage to avoid “popping the clot”
• Based mostly on data from animal trials and penetrating trauma in humans
• Common practice in most major trauma centers in USA
• The exact approach still remains controversial around the world