2-10-2020 Conference Notes

GME disability discussion – Calvin Rasey

• Endorsed by UofL
• COVID long term effects “long haulers.”

Pediatric Fractures – Elizabeth Lehto

• Torus fracture
• Plastic deformation, kids < 4
  • Generally associated fractures
  • >20 degrees of angulation require reduction
• Greenstick, kids < 10
  • Convex surface fracture
• Complete fractures
• Salter-Harris Fracture – SALTER vs know your MEME
  • I – Straight through the growth plate, may be radiographically absent
  • II – Above, through the growth plate and above into the metaphysis
  • III – Lower, fracture through growth plate and epiphysis
  • IV – Through both epiphysis, growth plate, and metaphysis
  • V – Rammed, growth plate crush injury
• Name that fracture game
• Elbow fractures
  • Capitellum – age 1
  • Radial head – age 3
  • Internal  epicondyle – age 5
  • Trochlea – age 7
  • Olecranon – age 9
  • External epicondyle – age 11
  • Need true 90 degree flexion X-rays – don’t get lazy with them.
    • Anterior fat pad – normal
      • Big sail sign = lipohemearthrosis
    • Posterior fat pad – pathological
    • Radiocapitellar Line
    • Anterior humeral line
  • Supracondylar fractures
    • Volkman’s Contracture if neurovascular injury
    • Anterior interosseous syndrome – normal if a good “okay sign”
  • Nursemaid’s elbow
• Non-accidental trauma
  • Torso, ears, neck, 4 years or younger
  • Watch out for kids that aren’t pulling up or walking – they should not have any bruises.
  • High specificity fractures
    • Metaphyseal fractures
      • Corner fractures – oblique avulsions of the metaphysis
      • Bucket handle fractures – horizontal avulsions of metaphysis
    • Rib fractures
      • Posterior more specific; CPR causes anterior rib fractures
    • Skull fractures
      • Non-parietal, cross suture lines, depressed
    • Scapular fractures
    • Sternal fractures
    • Spinous process fractures
• Leg fractures
  • Tibial fractures
    • High risk for compartment syndrome
      • Tibial shaft fractures requiring reduction tend to be admitted
    • Toddler’s fracture – distal shaft spiral/oblique fracture between 9-3 years
  • Juvenile Tillaux fracture – SH III
    • May require CT to evaluate closed vs open reduction, <2mm can be reduced
  • Triplane fracture, distal SH IV  – requires CT
• Hand fractures
  • Carpal fractures
    • Scaphoid fracture, think FOOSH, snuffbox tenderness
  • Distal phalanx fractures
    • Tuft fractures, splinted in DIP extension
    • Nailbed associated fractures – give abx
    • Seymour fracture – displaced SH II fracture, generally open, and requires reduction.
• Hip fractures
  • SCFE
    • Fat teens presenting with knee pain
    • Surgical pinning and NWB
  • Avascular necrosis – Legg-Calve-Perthes Disease
    • Preteen, insidious onset, antalgic gait

GI Review Game – Dr. Shaw

• NEC – new babies, mostly premature, pre-E, cocaine use in pregnancy
  • Amp/Gent, bowel rest
• Giardia – treat with flagyl
• Boerhaave – L pleural effusion, CXR with pneumomediastinum
• Esophageal foreign bodies
  • Esophageal bodies align in coronal plane
  • Sharp objects, objects > 6cm in length require surgical removal, then 24h trial of passage
  • All EFB require GI f/u to rule-out structural abnormalities
• AAA
  • >5.5cm = OR, include the mural thrombus
• Hernias
  • Indirect vs direct vs femoral hernias
    • Indirect follows inguinal canal

Ventilator Management Lecture – Obrien

• Check out Scott Weingart’s post on EMcrit regarding mastering the vent.
• PRVC or VC is preferred
• Remember ARDSNet