Spinal Cord Injury (Dr. McCormack):
- An “Unstable” Fracture involves disruption of at least 2 spinal columns (anterior, middle or posterior)
- 50% of all spinal cord injuries involve the cervical spine
- Unstable Cervical Injuries: “Jefferson Bit Off A Hangman’s Thumb”
- Jefferson C1 burst fracture
- Bilateral facet dislocation
- Odontoid Types 2 and 3
- Atlantoaxial dislocation
- Hangman’s C2 pedicle fracture
- Teardrop fracture
- Spinal “shock” is different from neurogenic shock:
- NO circulatory involvement (don’t see the hypotension/bradycardia as with neurogenic)
- Temporary loss of sensation, motor and reflexes
- C3, C4, C5– keeps the diaphragm alive
- C5 and C6– pick up sticks (deltoid/biceps)
- C7 and C8– lay it straight (triceps)
- L2, L3, L4– kick the door (quadriceps)
- S2, S3, S4– keeps the “Ps” of the floor (“Poo, Pee, Penis”)- bladder or anal sphincter
Unexpected Cardiac Arrest in Children and Youth Adults (Dr. Whiteman):
- Do NOT dismiss chest pain in children as not being cardiac in etiology:
- Hypertrophic cardiomyopathy– single MCC unexpected cardiac arrest in young people (30-50%)
- EKG: LVH 90% of the time
- Echo is gold standard
- Arrythmogenic Right Ventricular Dysplasia (ARVD)- cardiomyopathy primary of the RV
- EKG: RBBB, T-wave inversion, Epsilon wave
- Myocarditis– inflammation of heart’s muscle
- Long QT syndrome
- Wolf Parkinson-White syndrome
- EKG: short PR interval, delta wave, wide QRS
- Brugada Syndrome– most common channelopathy
- Exclude from sports until follow-up by cardiologist
Commonly Missed Fractures (Dr. Gruber):
- Entire lecture is full of pearls! Click below:
Evidence Based Medicine: Femoral Nerve Blocks (Dr. Cain):
- Nerve blocks are a quick and effective way to provide anesthesia to patients without compromising hemodynamic status
- Always let your consulting services know about any nerve blocks as their neurological exam will be affected
- Alternative that we are starting at Jacobi: Fascia Iliaca Block (with or without US guidance and further away from vascular structures)
Radiology of the Block Presentation: Blush on CT scans (Dr. Umphress):
- Contrast blush: area of high density with density measurements within 10 HU compared to the nearby vessel or aorta
- DDx: active arterial extravasation vs. post traumatic pseudoaneurysm vs. post-traumatic AV fistula
- Contrast blush beyond the borders of the organ must be extravasation
- Pseduoaneurysms and AV fistulas have a similar appearance as active hemorrhage on initial scanning but do not increase in size on delayed phases and follow the blood pool (wash away)
- Contrast extravasation occurs in ~18% of pts with splenic injury
- Contrast extravasation is often arterial hemorrhage so generally, non-op management is less successful (82% failure rate, 9.2x more likely to require intervention with embolization vs splenectomy)
Ultrasound of the Block Presentation (Dr. Sweeting):
- Rib/Sternal Fractures
- Probe Selection: Linear probe is ideal
- Positioning: Patient supine. Start where the patient has point tenderness. Hold probe longitudinal to the bone. Scan that rib and adjacent ribs for fracture.
- Look for interruption of the thick white stripe
- Cellulitis vs Abscess
- Probe Selection: Linear probe
- Cobble stone pattern = cellulitis
- Pocket of fluid within the skin sometimes surrounded by cellulitis = abscess
- Fluid can be hypoechoic or hyperechoic
