221-226 of 226 results with category "Trauma"
- High-quality CT is adequate for clearing c-collar in obtunded patients.
- A follow-up exam before discharging the patient strengthens your decision making and documentation.
- MRI can be reserved for high-risk patients, patients who are being admitted to surgical critical care units, and those who have residual findings once alert.
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Question
(Please note the prior version of this pearl was incorrect with respect to the images referenced. This version is corrected.)
Patient s/p blunt chest trauma. CXR (image 1) vs. lung ultrasound (image 2), do you see any inconsistencies?
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Question
44 y/o female restrained driver s/p motor vehicle crash complaining of chest pain and shortness of breath.
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Lidocaine with Epinephrine and it use on Fingers and Toes
It has been taught for a long time that Lidocaine with Epinephrine should not be used on fingers, toes, ears and nose [There has to be a kid's song in there somewhere] due to the risk of vasoconstricition/vasospasm and possible digitial infarcation.
The short story is that this practice is not supported by the literature, and there are now numerous publications that have shown that lidocaine with epinephrine is safe for use on the finger tips. It turns out the the original case reports were submitted with procaine and epinephrine and not lidocaine with epinephrine. Most of the cases of digital infarction where with straight procaine that is now thought to have been contaiminated or too acidic pH close to 1 when injected.
The effects of epinephrine last approximately 6 hours. This time is well within the accepted limit of ischemia for fingers that has been established in digitial replanation.
So why use Lidocaine with Epinephrine:
- Provides a longer period of anesthesia
- Decreases bleeding which:
- Improves visualization of tendons and underlying structures
- Makes repairs easier
- Decreases need for a torniquet