Femur fractures should not be considered distracting injuries for cervical spine assessment Robert T. Dahlquist, Peter E. Fischer, Harsh Desai, Amelia Rogers, A. Britton Christmas, Michael A. Gibbs, Ronald F. Sing
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 10 2015
x The National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries.
Application of National Emergency X-Ray Utilizations Study low-risk c-spine criteria in high-risk geriatric falls Daniel Evans, Luis Vera, Donald Jeanmonod, Jonathan Pester, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 1 2015
x We sought to validate National Emergency X-Radiography Utilizations Study low-risk cervical spine (C spine) criteria in a geriatric trauma population. We sought to determine whether patients' own baseline mental status (MS) could substitute for Glasgow Coma Scale (GCS) to meet the criteria “normal alertness.” We further sought to refine the definition of “distracting injury.”
Injuries distracting from intraabdominal injuries after blunt trauma Peter C Ferrera, Vincent P Verdile, Joel M Bartfield, Howard S Snyder, Richard F Salluzzo
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90032-8
The American Journal of Emergency Medicine , Vol. 16 , Issue 2 ,
Published in issue: March 1998
x While most conscious patients with severe intraabdominal injuries (IAI) will usually present with either abdominal pain or tenderness, there is a small group of awake and alert patients in whom the physical examination will be falsely negative because of the presence of associated extraabdominal (“distracting”) injuries. We sought to define the types of extraabdominal injuries that could lead to a false negative physical examination for potentially severe IAI in adult victims of blunt trauma. This study was prospectively performed on consecutive blunt trauma patients over a 14-month period in our level I trauma center.
Evaluation of pediatric cervical spine injuries Chris Baker, Howard Kadish, Jeff E Schunk
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90111-0
The American Journal of Emergency Medicine , Vol. 17 , Issue 3 ,
Published in issue: May 1999
x To compare historical features, clinical examination findings, and radiographic results among pediatric patients with cervical spine injury (CSI), a retrospective review of patients who were diagnosed with CSI was undertaken. Two main groups were identified: radiographically evident cervical spine injury (RESCI), and spinal cord injury without radiographic abnormality (SCIWORA). Demographic, historical, clinical, and radiographic information was obtained from patients' charts and analyzed to determine factors associated with CSI and to determine the efficacy of the various radiographic views.
How distracting is distracting pain? Siu Fai Li, Peter Wagoner Greenwald
DOI: http://dx.doi.org/10.1053/ajem.2003.50003
The American Journal of Emergency Medicine , Vol. 21 , Issue 1 ,
Published in issue: January 2003
x The study was to determine the effect of preexisting pain on the perception of a painful stimulus. We conducted a cross-section study at an urban ED using convenience sampling. Adult patients who had a 20-g IV catheter placed as part of their ED care were eligible for the study. Patients were excluded for the following reasons: more than one IV attempt, altered mental status, visual impairment, intoxication, or a physical abnormality at the IV site. Patients were asked to indicate on a 10-cm visual analog scale (VAS) the amount of pain they had at baseline immediately before IV placement.
Application of clinical criteria for ordering radiographs to detect cervical spine fractures Ronald M. Moscati, E. Brooke Lerner, Jennifer L. Pugh
DOI: http://dx.doi.org/10.1016/j.ajem.2006.05.015
The American Journal of Emergency Medicine , Vol. 25 , Issue 3 ,
Published in issue: March 2007
x The aim of the study was to determine if spinal-immobilized patients met clinical criteria for x-rays and which clinical criteria were associated with cervical fractures.
Significant hemoperitoneum in blunt trauma victims with normal vital signs and clinical examination Michael Blaivas, Paul Sierzenski, Daniel Theodoro
DOI: http://dx.doi.org/10.1053/ajem.2002.32637
The American Journal of Emergency Medicine , Vol. 20 , Issue 3 ,
Published in issue: May 2002
x Clinical examination of the abdomen is generally reliable in stable trauma patients with no distracting or head injury. Patients involved in relatively minor trauma with normal examinations can be safely sent home in most instances. We report 6 cases of blunt abdominal trauma that had completely normal clinical examinations and vital signs but were found to have significant hemoperitoneum on trauma ultrasound examination. Four of the patients were examined for educational purposes just before planned discharge from the emergency department.
Computed tomography for blunt abdominal trauma in the ED: A prospective study John R Richards, Robert W Derlet
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90122-X
The American Journal of Emergency Medicine , Vol. 16 , Issue 4 ,
Published in issue: July 1998
x A study was undertaken to determine the criteria for ordering abdominal computed tomography (CT) in the emergency department (ED) for stable patients who sustained blunt trauma and to identify a patient population at high risk for having intra-abdominal injury (IAI) utilizing physical examination, decrease in hematocrit, and hematuria. Patients in a university ED who had abdominal CT from April 1995 to October 1995 were evaluated prospectively. Before the scan, the examining physician completed an entry form that included physical findings, hematocrit, hematuria, Glasgow Coma Scale score, intoxication, distracting injuries, reasons for obtaining the scan, and planned disposition.
Orthopedic pitfalls in the ED: Calcaneal fractures Carl A. Germann, Andrew D. Perron, Mark D. Miller, Susan M. Powell, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2004.09.008
The American Journal of Emergency Medicine , Vol. 22 , Issue 7 ,
Published in issue: November 2004
x Fractures of the calcaneus are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Due to distracting injury and variations in clinical findings, calcaneal fractures may be initially missed or misdiagnosed. This review article examines the clinical presentation, diagnostic techniques, and management of calcaneal fractures applicable to the emergency practitioner.
Orthopedic pitfalls in the ED: tibial plafond fractures Carl A. Germann, Andrew D. Perron, Timothy W. Sweeney, Mark D. Miller, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2004.01.002
The American Journal of Emergency Medicine , Vol. 23 , Issue 3 ,
Published in issue: May 2005
x Fractures of the tibial plafond, or distal tibial articular surface, are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Because of distracting injury and variations in clinical findings, tibial plafond fractures may be initially missed or misdiagnosed. This review examines the clinical presentation, diagnostic techniques, and management of tibial plafond fractures applicable to the emergency practitioner.
Complete common iliac artery transection: an easily misdiagnosed but fatal complication of blunt abdominal injury Shih-Yu Ko, Ken-Hing Tan, Chung-Yu Cheng-Huang, Meng-Kai Huang, Vei-Ken Seow, Chien-Chih Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.017
The American Journal of Emergency Medicine , Vol. 25 , Issue 2 ,
Published in issue: February 2007
x Complete transection of the common iliac artery without initial presentation of shock signs is exceedingly rarely reported as a consequence of acute blunt abdominal injury, in part because of its protected position in the retroperitoneum. It may result in fatal hemorrhage if not dealt with by the emergency physician in a brisk and effective manner. We report a 33-year-old man who presented to the emergency department with lower abdominal pain after blunt abdominal trauma without shock signs and with negative findings in focused abdominal sonography for trauma (FAST) initially.
Correspondence to “Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration” Tzu-Chin Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.029
The American Journal of Emergency Medicine , Vol. 29 , Issue 3 ,
Published online: December 15 2010
x I read the article “Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration” by Lee et al [1] with great interest. In their study, they came to the conclusion that “In patients with blunt abdominal trauma, elevated WBC counts together with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are strongly associated with liver laceration and warrant further imaging studies and management.” They also proposed an algorithm for managing patients with occult hepatic injuries after blunt abdominal trauma.
Imaging in the NEXUS-negative patient: when we break the rule John Morrison, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.062
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 7 2013
x In spite of general acceptance and validation of NEXUS (National Emergency X-Radiography Utilization Study) in the clearance of cervical spine (C-spine) immobilized patients, clinicians often elect to image NEXUS-negative patients in clinical practice.
Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma: Hoffman JR, Mower WR, Wolfson AS, et al. N Engl J Med 2000;343:93–98.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80157-1
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
Evaluation of the acute cervical spine: a management algorhithm: Banit DM, Grau G, Fisher JR. J Trauma 2000;49:450–456.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80158-3
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
C-Spine injury associated with gunshot wounds to the head: Retrospective study and literature review: Lanoix R, Grupta R, Leak L, et al. J Trauma 2000;49:860–863.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80159-5
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
Is routine arteriography mandatory for penetrating injuries to zone 1 of the neck?: Edy VA. J Trauma 2000;48:208–224.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80160-1
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
Treatment of posttraumatic internal carotid arterial pseudoaneurysms with endovascular stents: Coldwell DM, Novak Z, Ryu RK, et al. J Trauma 2000;48:470–472.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80161-3
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
Correspondence James J. Walter, Peter E. Doris, Mark A. Shaffer
DOI: http://dx.doi.org/10.1016/0735-6757(85)90109-3
The American Journal of Emergency Medicine , Vol. 3 , Issue 3 ,
Published in issue: May 1985
Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis: Velmahos GC, Chahwan S, Hanks SE, et al. Am Surgeon 2000;66:858–861.
DOI: http://dx.doi.org/10.1016/S0735-6757(01)80153-4
The American Journal of Emergency Medicine , Vol. 19 , Issue 5 ,
Published in issue: September 2001
