This post is not intended to be a comprehensive review of skull fracture types and management, but rather a discussion of two subtypes of skull fracture – open and depressed fractures. I chose this topic because it’s something I saw frequently during my recent elective working in an emergency department in Kumasi, Ghana. In the United States at trauma centers these patients are frequently managed immediately by neurosurgery; however, with few consultants available, I was able to be more involved in the prolonged care of these patients. If faced with these types of severe head/skull injuries in a community hospital, it is important to feel comfortable with the initial management.
Ever wonder where the the current American Heart Association and American Stroke Association (AHA/ASA) guidelines for thrombolysis in acute ischemic stroke come from? Included is a summary of the landmark studies that have contributed to these recommendations (NINDS& ECASS III) as well as a review of IST-3.
Acetaminophen (Tylenol, Paracetamol, APAP) is a commonly used analgesic and antipyretic agent found in many over the counter and prescription medications. It is one of the most common toxic exposures responsible for an estimated 450 deaths annually in the United States, and it is the most common cause of acute liver failure in the United States.
Chvostek’s sign is momentary contraction of the nose and/or lips in response to tapping the facial nerve at the angle of the jaw. Associated with hypocalcemia, it has been found to be poorly sensitive and specific. It is seen in 10-25% of healthy individuals with normal calcium levels, whereas approximately one third of patients with hypocalcemia will not demonstrate this sign.
What may appear (and smell) impressive in the ED does not always require emergent intervention, yet understanding how to determine the severity of lower gastrointestinal bleeding, need for aggressive resuscitation, and diagnostic/consultant resources are key for the emergency provider.