Venous thromboembolism

• 90 day overall PE mortality rates were 17% in 1999, 16% in 2018
• Inari FLASH registry 30 day mortality rates for High and intermediate risk PE patients were 0.8%
• Nearly half of submassive 30 day mortality occurs outside of hospital
• Lightning Lectures:

Pelvic Fractures

-3 month mortality 3x higher in trauma patients with pelvic fractures

-Increased concern for bladder/urethra injury

-Sacral fractures -zone 1, 2, 3- 3 is worst prognostically

-APC 1 <2.5 cm pubic symph

-APC 2 >2.5 + anterior ligament

-APC 3 >2.5 + ant+ post

-Vertical sheer

-Pelvic binders: unstable and pelvic injury suspected. Over trochanters.

-Inlet/outlet films, judet AP and lateral decubitus position once stable

-FAST can help determine if needs lap (+ blood) or embolization

Compartment Syndrome

-1-10% of tibial fractures, ant compartment most common

-Normal compartment pressure < 10 mmHg

-<20 mmHg unlikely to cause damage

-CK, UA for myoglobin (rhabdo in 40%)

-Stryker- compartment >30 mmHg in one compartment

– Delta pressure: diastolic – pressure (30 or less is indication for fasciotomy)

-Fasciotomy w/in 6 hrs 100% recovery

-12 hr 66%

Ortho Plain Films

-Most often missed finding is the 2^nd finding

-More views are better

-Axillary view very helpful in glenohumeral joint evaluation

-Posterior shoulder dislocations- hard to see, patient can’t externally rotate (lightbulb sign), lack of crescent sign

-4 views at the elbow

-Monteggia fracture- Proximal ulnar fracture with dislocation of radiocapetallar joint (radial head dislocation)

-Galeazzi fracture- Mid to distal third of ulna with dislocation of distal radioulnar joint

-Maisonneuve- total disruption of interosseous membrane