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.
Eric Gruber, MD
Do you routinely perform large volume (or near large volume) paracentesis in your ED? If so, you need to know about a potentially life-threatening complication of this procedure...
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.
25-35% of patients with chronic liver disease with experience variceal bleeding. This post is designed to provide high-yield pearls in the evaluation and acute management of variceal bleeding.
Excited delirium syndrome is a pathophysiologic progression that Emergency Medicine physicians are exposed to daily. While the initial management often takes place in the pre-hospital setting, these patients are at high risk of respiratory and cardiac arrest if proper management is not continued after hitting our doors. Despite a growing awareness of excited delirium syndrome and it's associated increased risk of death, the majority of the 250 annual deaths from this entity occur while in police custody.