Grand Rounds: September 10, 2015

trach pic

Dr. Emily Rose presents a quick recap of important pediatric orthopedics cases, Dr. Ariel Bowman gives an outstanding overview of tracheostomy complications seen in the ED, Dr. Manuel Montano relates EM-relevant pearls he learned during 4 weeks rotating in the burn ICU, and Dr. Jim Yen reviews the management of limb ischemia.

Dr. Emily Rose presents a quick recap of important pediatric orthopedics cases. Remember to think about non-accidental trauma. Also, if you suspect a fracture and don’t see one on the day of the injury, consider splinting and referring for repeat films in 1 week. Finally, always maintain a high suspicion for septic arthritis, as this disease process leads to long-term complications if not treated promptly.

Dr. Ariel Bowman gives an outstanding overview of tracheostomy complications seen in the ED. She proposes algorithms for how to diagnose and treat trach complications. Of note, try not to replace any trach that is less than 7 days old (usually still has trach ties in place); however, if the patient is sick, you may have to replace the trach anyway!

Dr. Manuel Montano relates EM-relevant pearls he learned during 4 weeks rotating in the burn ICU. Remember that inhalational burns count as 20% TBSA when using the Parkland formula, so make sure to give these patients plenty of fluid resuscitation. Also, when in doubt that there may exist airway compromise, intubate prior to transferring to a burn center.

Dr. Jim Yen reviews the management of limb ischemia. His main take home point was that if there are decreased pulses and a suspected vascular problem, go ahead and consult vascular. Additionally, remember that critical limb ischemia presents as new pain at rest, ischemic ulcers, and gangrene. Finally, remember the 6 P’s: pain, pallor, paresthesias, poikilothermia, paralysis, and pulselessness.

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