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Emergency Medicine

Burn Injuries


Burns are devastating injuries that can lead to severe disfigurement and are accompanied by a high mortality rate, particularly in the elderly or those patients with large surface area burns (1–3). The body’s response to burn injuries can be local or systemic. Burn injuries are classified based on the percent total body surface area affected (TBSA) and depth of injury. Usually burn injuries that are larger than 20% lead to a complex physiologic systemic reaction.

11/08/2022

Diagnosis and Management of Shock in the Injured Patient


Shock is defined by inadequate tissue perfusion leading to end-organ dysfunction. Fundamentally, shock is a physiologic state where metabolic demands of cellular processes are not met. In a state of shock, tissue oxygen delivery is impaired and toxic metabolites build up in tissued leading to cellular injury, and ultimately, cellular death. The trauma patient is particularly at risk for development of shock throughout the course of their injury. Shock is the second most common cause of trauma-related death, surpassed only by brain injury[1,2]. Herein, we broadly describe shock in the trauma patient and provide resources for diagnosis and initial management.

12/04/2022

Mass Causality and Triage


As medical providers, our job is to heal the sick and wounded, and often, to try to save lives. In this pursuit we often will pour immense time and resources to give the individual under our care the best chance they have to survive. We want everyone to live. But when there are many patients, this is not always possible. In situations where the number of patients exceeds the local resources, i.e. a mass casualty, there is a limited amount of supplies, personnel, and time that have to be rationed amongst the patients. And as the number of patients to be treated increases, that allocation becomes more and more critical. It also becomes more likely that people will die. The goal at that point is to save as many as possible. While our instinct is to treat the absolute sickest first, as they are seen as the most urgent, the priority in a mass casualty is to treat the sickest that are most likely to survive with timely intervention. The purpose of triage is thus to sort patients into categories of survival probability and acuity in order to determine priority of treatment. Therefore, those that have a low chance of survival must be bypassed for those that are more likely to survive with appropriate care. While this may be difficult, it is important to realize that we are not treating one patient but many at the same time and focusing on the one sickest may result in the death of several other patients that could have survived. It is therefore vital that patients in a mass casualty are appropriately and continually triaged so that the appropriate care is provided to those that have the best chance to benefit. Save as many as we can.

12/04/2022

Management of Radiation Exposure


Radiation is perhaps one of the most feared yet misunderstood phenomena in the history of humankind. The Cold War created an ever-present undercurrent of nuclear anxiety which continues in many forms to this day. Current events demonstrate the ending of the Cold War has not erased the threat of a nuclear attack. This chapter provides an overview of radiation injuries and associated management as well as the unique considerations applicable to the treatment of casualties of radiation events.

12/04/2022

Blast Injuries


Classifications of Explosions Low-order Explosions: Explosions that react by rapid burning and produce subsonic shock wave (e.g. gunpowder, Molotov cocktails, etc.). High-order Explosions: Explosions that produce extreme heat, energy, and pressure which rapidly produce a over-pressurized supersonic shock waves in the “positive phase” and then produces a longer period of decreasing pressure which causes a […]

30/06/2022

Rape, Sexual Assault, and Sexual Violence


Introduction and definitions Rape, sexual assault, and sexual violence are prevalent globally, affect all demographics, and have varying definitions. Sexual violence is an umbrella term encompassing all violent sexual acts, including rape and sexual assault. Some countries define rape very narrowly, for example, the United States at a federal level defines rape as “the penetration, […]

16/06/2022

Initial Evaluation of the Pediatric Trauma Patient


Compared to adults, children have anatomic and physiological differences that influence their response to injury, evaluation, and treatment. Blood, fluid, and medication dosing are determined by the weight of the child. Hypotension is unusual in children even with severe volume depletion and, when it does occur, is associated with a worse outcome. Blunt injury more often results in multisystem injury in children than in adults.

24/03/2022

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