iEM in MEMC19 – Dubrovnik, Croatia

iEM in MEMC19

iEM team is attending the Mediterranean Emergency Medicine Congress 2019 in Dubrovnik Croatia. The Xth Mediterranean Emergency Medicine Congress will be held 22-25 September 2019 at the Sun Gardens Hotel. Pre-congress courses will be held on 22 September with the first full day of Congress programming beginning 23 September and running until 25 September.

In addition to attending scientific sessions, iEM team will also be interviewing with Judith Tintinalli and Melanie Stander. Interviews will be shared from iem-student.org platform.

Melanie Stander
Melanie Stander
Judith Tintinalli
Judith Tintinalli

Organizers

The American Academy of Emergency Medicine (AAEM)  and the Mediterranean Academy of Emergency Medicine (MAEM) are two main organizers of the 2019 congress.

Pre-Congress Courses (September 22, 2019)

Scientific Program

The scientific program will be run at 6-7 different rooms with a variety of topics presented by emergency physicians joining from different countries.

lisa moreno walton

Lisa Moreno, MD MS MSCR FAAEM, AAEM President-Elect and MEMC19 Executive Chair, invites you to join us in Dubrovnik

CME

The American Academy of Emergency Medicine designates this live activity for a maximum of 32.25 AMA PRA Category 1 Credits™.  

iEM Monthly – September 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Hot News!

FLAME endorsed iEM

This month we received a great news from one of the regional emergency medicine organizations. Latin America Emergency Medicine Federation – Federacion Latinoamericana De Medicina De Emergencias endorsed iEM Education Project. We are looking forward to collaborate with them to improve undergraduate emergency medicine education around the globe. 

FLAME

iEM will attend MEMC2019 at Dubrovnik.

The 10th Mediterranean Emergency Medicine Congress will be held 22-25 September 2019 at the Sun Gardens Hotel in Dubrovnik, Croatia. The congress is organized by American Academy of Emergency Medicine and Mediterranean Academy of Emergency Medicine.

Pre-congress courses will be held on 22 September with the first full day of Congress programming beginning 23 September and running until 25 September.

iEM will interview with Judith Tintinalli

iEM Team will interview with one of the icons of Emergency Medicine history, Judith Tintinalli during MEMC2019. 

iEM continues to meet and interview with world famous leaders of Emergency Medicine. Ian Stiel, Simon Carley, Tracy Sanson, Rob Rogers, Neil Cunningham are couple of them. You can watch or listen published episodes here.  

Judith Tintinalli

Free Emergency Medicine Clerkship iBook and pdf

iEM Free Book (2018e) reached to >3200 downloads. The book is written by 133 authors from 19 countries. It includes 106 topics, 841 pages, 454 images.

Blog Authors

There are three new blog authors joined our team in August, Bryn from USA, Sajan from Nepal and Neha from UAE. We welcome all of them. To see full blog authors team please click this link – https://iem-student.org/iem-blog-authors/

Bryn Dhir

USA

Bryn Dhir is a researcher and physician-scientist, interested in Emergency Medicine residency programs. Bryn has numerous leadership and management skills for various clinical, administrative, and work initiatives around the globe.

neha 2

UAE

Neha Hudlikar is a graduate of RAK Medical & Health Sciences University and is currently training in Emergency Medicine at Zayed Military Hospital, Abu Dhabi. A big supporter of the FOAMed movement, she is passionate about developing and supporting innovative ideas that promote free access to medical education for all. Her main interests in Emergency Medicine include trauma, disaster medicine, PoCUS and development of EM in resource limited settings. She currently also serves as the Associate Editor of Emirates Society of Emergency Medicine Newsletter. Outside of medicine, an avid reader, tree-hugger and an advocate of gender equality.

Sajan Acharya

Nepal

I am a medical graduate from Nepal. I am an eager supporter of FOAMed movement. I have always loved books. Medical school wanted me to read particular types, so I did. A poet at my core; I love to write about things that touch my heart. What better world to be in than medicine when you are on look out for moments that touches you. I find medicine fulfilling also because it feeds my passion for teaching.

Blog Posts

We published 12 posts during August 2019. The article “The research predicting septic shock” by Bryn Dhir was the top read article in August

Bryn Dhir
Bryn Dhir

Top Countries by Views

The iEM platform reached to 169 countries around the globe. In August, top countries by views are given below. 

iEM Content

iEM content general

iEM Website

iem webpage

iEM website is designed to provide a wide range of resources to medical students and educators. You can find all the topics of 2018 book provided by international authors, blog posts, and many details regarding iEM education project.

iEM 2018 Book in iBook and pdf formats

Download all content written by world-renowned professionals, emergency medicine education enthusiasts. It is a fantastic collaboration of all stakeholders.

2018 Book includes 106 topics, 841 pages, 454 images provided by 133 authors from 19 countries.

iEM Blog Posts

We have a wide range of blog authors from Nepal to Brazil, Canada to Sri Lanka, the USA to Tanzania. We post 2-3 times a week.

iEM Flickr Clinical Image Archive

iEM YouTube Video Archive

iEM Monthly – July 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

This month we received two positive responses from regional emergency medicine organizations. Asian Society for Emergency Medicine and African Federation for Emergency Medicine endorsed iEM Education Project. We are looking forward to collaborate with them to improve undergraduate emergency medicine education around the globe. 

ASEM logo
AFEM logo

iEM Free Book

iEM Free Book (2018e) reached to >3000 downloads. The book is written by 133 authors from 19 countries. It includes 106 topics, 841 pages, 454 images.

Blog Authors

There are two new blog authors joined our team in July, Shaza from UAE and Masuma from Tanzania. We welcome both of them. To see full blog authors team please click this link – https://iem-student.org/iem-blog-authors/

shaza karrar

UAE

Shaza Karrar is a graduate of Sharjah University, School of Medicine, an Emergency Medicine board certified physician and a winner of multiple Resident Awards, serving as the Editor-in-Cheif of the Emirates Society for Emergency Medicine (ESEM) Newsletters. Big Medical Education Advocate and  Founder and Creator of the EM Space Podcast supporiting FOAMed and FOAMTox right out of the MENA region, with a profound interest in Toxicology and Disaster Medicine.

masuma ali

Tanzania

Masuma Ali Gulamhussein is a second-year Emergency Medicine (EM) resident in Tanzania, at the Muhimbili University of Health and Allied Sciences (MUHAS) with interests in global health and advocating for EM worldwide. She is interested in advancing in EM research and also finds it fulfilling interacting with a diverse cross-cultural society and EM colleagues from all parts of the world.

Blog Posts

We published 12 posts during July 2019. The article “Pediatric tube sizes” is the top read article in July. It reached 939 views. 

Top Countries by Views

The iEM platform reached to 169 countries around the globe. In July, top countries by views are given below. 

Toxicology Pearls – Active Charcoal – Infographic

toxicology pearls - active charcoal

Activated Charcoal Application

Emergency Indications

  • Oral intake < 60 minutes
  • the life-threatening dose of the toxic substance

Multi-Dose Activated Charcoal (MDAC) Indications

  • Life-Threatening Oral Intake of
    • Carbamazepine
    • Dapsone
    • Phenobarbital
    • Quinine
    • Theophylline

Contraindications

  • For patients with compromised airway reflexes, unless they are intubated. If the critical situation of the patient indicates intubation, then, gastric lavage may be performed. Intubation, only for decontamination, is not recommended.
  • Oral intake of caustic substances
  • Late presentation
  • Increased risk and severity of aspiration associated with AC use (e.g., hydrocarbon ingestion)
  • Need for endoscopy (e.g., significant caustic ingestion)
  • Toxins poorly adsorbed by AC (e.g., metals including iron and lithium, alkali, mineral acids, alcohols)
  • Presence of intestinal obstruction (absolute contraindication) or concern for decreased peristalsis (relative contraindication)

Equipment and Patient Preparation

There is no specific equipment for activated charcoal administration. However, drinking the charcoal can be very unpleasant for many patients, especially children. Therefore, mixing with fruit juice can be an option. In addition, if necessary nasogastric or orogastric tube placement can facilitate the active charcoal treatment.

Procedure steps

  • Recommended empirical single-dose of activated charcoal is as follows:
    • <1 year – 0.5-1 g/kg or 10-25 g
    • 1-12 years – 0.5-1 g/kg or 25-50 g
    • >12 years – 1-2 g/kg or 25-100 g
By James Heilman, MD [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons
By James Heilman, MD [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons
  • Multidose activated charcoal
    • Give the recurrent dose of charcoal by 0.5 g/kg (≤50 g) every 4 hours
  • How to administer:
    • If the patient is awake and cooperative, AC may be given orally. Alternatively, it may be given by gastric or nasogastric tube, if these procedures are indicated.
    • Mixing the activated charcoal with fruit juices increases tolerability.
    • If the patient is unconscious or airway is compromised, gastric lavage should be done, and activated charcoal should be given after intubation. Tracheal intubation is not recommended solely in order to give activated charcoal. Only activated charcoal is to be given, the nasogastric tube is adequate and is preferred.
    • If MDAC is indicated, the gastric tube should be withdrawn after gastric lavage and the first dose of activated charcoal. Further doses should be given via nasogastric tube.

Hints and Pitfalls

  • The substances that cannot bind to activated charcoal are as follows:
    • Lithium
    • Strong acids and bases
    • Metals and inorganic minerals
    • Alcohols
    • Hydrocarbons
  • Multi-dose activated charcoal enhances elimination of (But not necessarily indicated in all)
    • Amitriptyline
    • Aspirin
    • Caffeine
    • Carbamazepine
    • Cyclosporine
    • Dapsone
    • Digoxin
    • Disopyramide
    • Nadolol
    • Phenobarbital
    • Phenytoin
    • Piroxicam
    • Quinine
    • Sotalol
    • Sustained-release thallium
    • Theophylline
    • Valproate
    • Vancomycin
  • MDAC increase the risk of constipation and bowel obstruction in some cases. Therefore, consider adding a cathartic agent to the second or third dose of AC.

Post Procedure Care and Recommendations

  • Control possible nausea and vomiting.
  • Look for traces of aspiration or gastrointestinal complications.

Complications

Complications of AC and MDAC include:

  • Constipation, diarrhea, vomiting
  • Pulmonary aspiration

Pediatric, Geriatric, and Pregnant Patient Considerations

  • In pediatric and geriatric patients, extra caution should be exercised to avoid and monitor complications.
  • Activated charcoal is considered safe for pregnant women.

You may want to look these too...

Cite this article as: iEM Education Project Team, "Toxicology Pearls – Active Charcoal – Infographic," in International Emergency Medicine Education Project, July 29, 2019, https://iem-student.org/2019/07/29/toxicology-pearls-active-charcoal-infographic/, date accessed: September 22, 2019

Pediatric Tube Sizes – Infographic

Pediatric tube sizes

Recently, Sam Ghali reminded us how important pediatric tube sizes, and how easy to calculate them. We think every medical students, interns and PGY1s should know this now. Here is his message on Twitter:

PEDIATRIC TUBE SIZES

CALCULATE  ENDOTRACHEAL TUBE (ETT) SIZE
[Age ÷ 4] + 4
There are many formulas to calculate the endotracheal tube size for kids. The given formula is one of the most common. Let’s think a six yo patient. Your ETT size is 6/4 = 1.5, and +4 = 5.5

NASOGASTRIC/OROGASTRIC TUBE OR FOLEY CATHETER SIZE
ETT x 2
NG/OG tubes and Foley catheters are measured as FRENCH. (Fr) If your ETT size is 5.5, then your NG/OG and Foley sizes will be 5.5 x 2 = 11 Fr.

HOW DEEP YOUR ETT  SHOULD BE
ETT x 3
If your calculated tube size is 5.5, your depth should be 5.5 x 3 = 16.5 cm. So, 16.5 cm mark should be seen at the level of central incisors.

CHEST TUBE SIZE
ETT x 4
If the same six yo patient needs a chest tube, your chest tube size is 5.5 x 4 = 22 Fr. By the way, this is mainly for trauma. Moreover, do not forget, smaller size tubes can work as same as big ones.

Cite this article as: iEM Education Project Team, "Pediatric Tube Sizes – Infographic," in International Emergency Medicine Education Project, July 24, 2019, https://iem-student.org/2019/07/24/pediatric-tube-sizes-infographic/, date accessed: September 22, 2019

iEM Monthly – June 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Around the Globe

0
Countries
0
Visitors

Collaborative Work

0
Countries
0
Contributors
0
Chapters
0
Blog Posts
0
Downloads

ICEM2019

ICEM2019 was one of the very successful conferences of IFEM. Korean Emergency Medicine Society showed incredible organizational leadership and successfully organized such a big event for the world of emergency medicine.

Although there is a lot to talk about South Korean hospitality, foods and the Seoul city, we’d like to give some exciting numbers and highlights from the conference. There were 2725 attendees from 72 countries at the conference. 116 (4%) of the attendees were from middle and low-income countries. It is quite a high number if we compare to other ICEMs. Korean society did an outstanding job by offering discounted or free registration option for these countries. However, it is still 4%, and if we want to improve emergency medicine around the globe, we need to increase this number too. Australia was the country which had the highest attendees after South Korea, 173 and 1555, respectively. According to the conference scientific secretary, the longest registered attendee name was “Annuar Muhammad Zuljimal Bin Osman” from Malaysia. The first registrant was from USA, Eugene Kim. Highest group registration was Korean Fire Agency with 193 attendees. The youngest kid in the conference was 14 months old. Total scientific minutes were 12,030 in 29 topics. Siti Nasrina Yahaya presented 12 presentations at the conference, which is the highest number. Application of the conference downloaded 2,198 times. In 4 days, over 50 news released in media. There were 134 organizing committee members and 120 staff. The next conference ICEM2020 will be in Buenos Aires, Argentina (http://www.icem2020.net).

MOOC

One of the new project of the iEM is free massive open online course (MOOC) of Emergency Medicine for medical students who do not have structured Emergency Medicine training in their medical schools. The project aiming to create an adjustable course for different needs and various lengths. The content will be created under the guidance of the new IFEM undergraduate curriculum. 

The IFEM Core Curriculum and Education committee and IFEM Board gave us a green light to move forward to develop a MOOC and its certification process. 

IFEM Awards

The IFEM awards ceremony was held in the leadership dinner in Seoul during the ICEM2019. Melanie Stander, Vice-President of the IFEM and Prof. James Ducharme, President of the IFEM presented the awards right after the Gautam Bodiwala’s presentation regarding the history of IFEM awards. There are three awards of IFEM; Gautam Bodiwala Lifetime Achievement Award, IFEM Humanitarian Award, Order of IFEM Award. This year Gautam Bodiwala Lifetime Achievement Award was given to Prof. James Holliman. He is one of the significant figures of international emergency medicine who helped the development of emergency medicine in many countries. IFEM Humanitarian Award was given to the Korean Society of Emergency Medicine and Prof. Elisabeth M. Molyneux from Royal Collge of Emergency Medicine, UK. Order of IFEM Award entitles the recipients to use Fellow of the International Federation for Emergency Medicine (FIFEM). This year award was given to Prof. Lisa Moreno-Walton from American Academy of Emergency Medicine (AAEM president-elect), Prof. Anthony Lawler and Assoc/Prof. Sally McCarthy from Australasian College of Emergency Medicine, Prof. Arif Alper Cevik from Emergency Medicine Association of Turkey, Dr. Clifford Mann from the Royal Collge of Emergency Medicine, UK, and Dr. Lau Fei Lung from Hong Kong College of Emergency Medicine.

FIFEM Awardees – Lisa Moreno-Walton, Anthony Lawler, Sall McCarthy, Arif Alper Cevik, Lau Fei Lung, Taj Hassan (On behalf of Clifford Mann)

Arif Alper Cevik (FIFEM) and James Holliman (Gautam Bodiwala Lifetime Achievement Award)

Arif Alper Cevik who is the founder and director of iEM Education Project, was a fellow in International Emergency Medicine Fellowship Program in PennState University, Milton S. Hershey Medical Center which where Prof. James Holliman was a director. Both met in Vancouver, BC during the 7th ICEM conference in 1998, and their willingness to help and improve emergency medicine around the globe was a common topic in their discussion. But there is another common thing between them. They both born on the same day, 20th December. 

Blog Authors

There are two new blog authors joined our team in June, AlHanouv from KSA and Rebeca from Brazil. We welcome both of them. To see full blog authors team please click this link – https://iem-student.org/iem-blog-authors/

AlHanouv

KSA

I recently finished Emergency Medicine residency in KSA and continuing my training on Master of Healthcare Administration. From my little experience in working and studying Emergency Medicine, I have to admit that having such projects made things more easier and enjoyable. By using different ways of sharing knowledge, this has made a big difference in Physicians practices also in their confidence in being updated and discussing topics anywhere at anytime with everyone you can imagine. We can all benefit from each other by trying our best to find new ways in sharing/explaining knowledge in a more smoother way.

rebeca barbara rios

BRAZIL

I am a student at the end of the 3rd year of medicine, in Brasilia, capital of Brazil. I already contribute to ISAEM, with translations in FOAMed and also assisting in matters related to the national embassy. I am also Academic Coordinator of ABRAMEDE, the Brazilian Association of Emergency Medicine.

Blog Posts

We published 11 posts during June 2019. The article “Countries Recognizing Emergency Medicine As A Specialty” is the top read article in June, again. It reached 2426 views. 

Top Countries by Views

The iEM platform reached to 166 countries around the globe. In June, top countries by views are given below. 

A 19-year-old female presents with sharp right flank pain and shortness of breath

by Stacey Chamberlain

A 19-year-old female presents with sharp right flank pain and shortness of breath that started suddenly the day prior to arrival. The pain is worse with deep inspiration but not related to exertion and not relieved with ibuprofen. She denies anterior chest pain, cough, and fever. She denies leg pain or swelling and recent travel, immobilization, trauma, or surgery. She has no anterior abdominal pain, no dysuria or hematuria and no personal or family history of gallstones, kidney stones, or blood clots. She’s never had this pain before, has no significant past medical history and her only medication is birth control pills. On exam, her vital signs are within normal range, she has normal cardiac and pulmonary exams, no costovertebral angle tenderness, no chest wall or abdominal tenderness and no leg swelling.

Do you need to do any studies to evaluate this patient for a pulmonary embolism?

Pulmonary Embolism Rule-Out Criteria (PERC)

  • Age ≥ 50
  • Heart rate ≥ 100
  • O2 sat on room air < 95%
  • Prior history of venous thromboembolism
  • Trauma or surgery within 4 weeks
  • Hemoptysis
  • Exogenous estrogen
  • Unilateral leg swelling

The PERC CDR was originally derived and validated in 2004 and with a subsequent multi-study center validation in 2008. In the larger validation study, the rule was only to be applied in those patients with a pre-test probability of < 15%, therefore incorporating clinical gestalt prior to using the rule. PERC is a one-way rule, as mentioned above, which tried to identify patients who are so low-risk for pulmonary embolism (PE) as to not require any testing. It does not imply that testing should be done for patients who do not meet criteria, and it is not meant for risk stratification, as opposed to the Wells’ and Geneva scores.

Case Discussion

In order to apply the PERC CDR to the case study patient, the ED physician pre-supposes a pre-test probability of < 15%. If the ED physician has a higher pre-test probability than that, he/she should not use the PERC CDR. If the ED physician, in this case, did indeed have a pre-test probability of < 15%, the case study patient would fail the rule-out due to her use of oral contraceptives. In that case, the ED physician would need to determine if he/she would do further testing which could include a D-dimer, CT chest with contrast, ventilation/perfusion scan, or lower extremity Doppler studies to evaluate for deep vein thromboses (DVTs). The PERC CDR gives no guidance in this case.

Cite this article as: iEM Education Project Team, "A 19-year-old female presents with sharp right flank pain and shortness of breath," in International Emergency Medicine Education Project, June 17, 2019, https://iem-student.org/2019/06/17/a-19-year-old-female-presents-with-sharp-right-flank-pain-and-shortness-of-breath/, date accessed: September 22, 2019

A 57-year-old man fell from a height comes with neck pain

by Stacey Chamberlain

A 57-year-old man fell from a height of 12 feet while on a ladder. He did not pass out; he reports that he simply lost his footing. He fell onto a grassy area, hitting his head and complains of neck pain. He did not lose consciousness and denied headache, blurry vision, vomiting, weakness, numbness or tingling in any extremities. He denies other injuries. He was able to get up and ambulate after the fall and came in by private vehicle. He has not had previous spine surgery and does not have known vertebral disease. On exam, he is neurologically intact with a GCS of 15, does not appear intoxicated and has moderate midline cervical spine tenderness.

Should you get imaging to rule out a cervical spine fracture?

C-spine Imaging Rules

Canadian C-spine Rule

NEXUS Criteria for C-spine Imaging

  • Age ≥ 65
  • Extremity paresthesias
  • Dangerous mechanism (fall from ≥ 3ft / 5 stairs, axial load injury, high-speed MVC/rollover/ejection, bicycle collision, motorized recreational vehicle)
  • Focal neurologic deficit present
  • Midline spinal tenderness present
  • Altered level of consciousness present
  • Intoxication present
  • Distracting injury present

Both the Canadian C-spine Rule (CCR) and NEXUS Criteria are widely employed in clinical practice to reduce unnecessary cervical spine imaging in trauma patients with neck pain or obtunded trauma patients. The CCR uses mechanism and age criteria, whereas the NEXUS Criteria incorporates criteria including midline tenderness and additional factors that might limit a practitioner’s exam. The CCR can be difficult for some practitioners to remember all the criteria that qualify as a dangerous mechanism and is limited to ages > 16 and < 65. However, it can be used in intoxicated patients if the patients are alert and cooperative, allowing a full neurologic exam. The NEXUS Criteria are applicable over any age range (> 1 year old), but the sensitivity may be low in patients > 65 years of age. A single comparison study found the CCR to have better sensitivity (99.4% versus 90.7%); however, the study was performed by hospitals involved in the initial CCR validation study.

Case Discussion

By applying either criteria to this case, the patient would require C-spine imaging as by CCR, the patient would meet criteria for dangerous mechanism, and by NEXUS, the patient has midline tenderness to palpation.

Cite this article as: iEM Education Project Team, "A 57-year-old man fell from a height comes with neck pain," in International Emergency Medicine Education Project, June 14, 2019, https://iem-student.org/2019/06/14/a-57-year-old-man-fell-from-a-height-comes-with-neck-pain/, date accessed: September 22, 2019

A 28-year-old man presents to the ED with left ankle pain

by Stacey Chamberlain

A 28-year-old man presents to the ED with left ankle pain after twisting his ankle playing basketball. He is able to bear weight and notes pain and swelling to the lateral aspect of the ankle (he points to just below the lateral malleolus). He denies weakness, numbness, or tingling and has no other injuries. On exam, he is neurovascularly intact. Edema and tenderness are noted slightly anterior and inferior to the lateral malleolus. There is no point tenderness to the distal posterior malleoli bilaterally.

Should you get an X-ray to rule out fracture?

Ottawa Ankle Rule

Pain in the malleolar zone and any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge or tip of the tibia (medial malleolus), OR
  • Bone tenderness along the distal 6 cm of the posterior edge or tip of the fibula (lateral malleolus), OR
  • An inability to bear weight both immediately after the trauma and in the ED for four steps.

Ottawa Foot Rule

Pain in the midfoot zone and any one of the following:

  • Bone tenderness at the base of the fifth metatarsal, OR
  • Bone tenderness at the navicular bone, OR
  • An inability to bear weight both immediately after the trauma and in the ED for four steps.

Case Discussion

In the above case, using either CDR, an X-ray is unnecessary.

Cite this article as: iEM Education Project Team, "A 28-year-old man presents to the ED with left ankle pain," in International Emergency Medicine Education Project, June 10, 2019, https://iem-student.org/2019/06/10/a-28-year-old-man-presents-to-the-ed-with-left-ankle-pain/, date accessed: September 22, 2019

A 36-year-old woman slipped on ice. CT or Not CT?

by Stacey Chamberlain

A 36-year-old woman slipped on ice and fell and hit her head. She reports loss of consciousness for a minute after the event, witnessed by a bystander. She denies headache. She denies weakness, numbness or tingling in her extremities and no changes in vision or speech. She has not vomited. She remembers the event except for the transient loss of consciousness. She doesn’t use any blood thinners. On physical exam, she has a GCS of 15, no palpable skull fracture and no signs of a basilar skull fracture.

Should you get a CT head for this patient to rule out a clinically significant brain injury?

Canadian CT Head Rule

High-Risk Criteria (rules out the need for neurosurgical intervention)

Medium Risk Criteria (rules out clinically important brain injury)

  • GCS < 15 at two hours post-injury
  • Suspected open or depressed skull fracture
  • Any sign of basilar skull fracture (hemotympanum, Raccoon eyes, Battle’s sign, CSF oto or rhinorrhea)
  • Retrograde amnesia to event  ≥ 30 minutes
  • Dangerous mechanism (pedestrian struck by motor vehicle, ejection from the motor vehicle, fall from > 3 feet or > 5 stairs)

The Canadian CT Head Rule (CCHR) only applies to patients with an initial GCS of 13-15, witnessed loss of consciousness (LOC), amnesia to the head injury event, or confusion. The study was only for patients > 16 years of age. Patients were excluded from the study if they had “minor head injuries” that didn’t even meet these criteria. Patients were also excluded if they had signs or symptoms of moderate or severe head injury including GCS < 13, post-traumatic seizure, focal neurologic deficits, or coagulopathy. Other studies have looked at different CDRs for traumatic brain injury including the New Orleans Criteria (NOC). However, CCHR has been found to have superior sensitivity and specificity.

Case Discussion

By applying this rule to the above case, the patient should be considered for imaging due to the mechanism. A fall from standing for an adult patient would constitute a fall from > 3 feet; therefore, although the patient would not likely be high risk and need neurosurgical intervention, the patient might have a positive finding on CT that in many practice settings would warrant an observation admission.

Cite this article as: iEM Education Project Team, "A 36-year-old woman slipped on ice. CT or Not CT?," in International Emergency Medicine Education Project, June 7, 2019, https://iem-student.org/2019/06/07/a-36-year-old-woman-slipped-on-ice/, date accessed: September 22, 2019

iEM Monthly – May 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

Around the Globe

0
Countries
0
Visitors

Collaborative Work

0
Countries
0
Contributors
0
Chapters
0
Blog Posts

iEM Education Project Team members will be at ICEM2019, Seoul, South Korea. The ICEM (International Conference on Emergency Medicine) is a annual global conference of International Federation for Emergency Medicine (IFEM). iEM Team will be attending IFEM Core Curriculum and Education Committee meetings. The team is also looking forward to meet new contributors during the conference.

One of the new project of the iEM is free Emergency Medicine massive open online course (MOOC) for medical students who do not have structured Emergency Medicine training in their medical schools. The project aiming to create an adjustable course for different needs and various lengths. The content will be created under the guidance of the new IFEM undergraduate curriculum. 

Thank you for your interest in iEM’s free Emergency Medicine Clerkship book. We published its chapters on the website in May 2018. Pdf and iBook formats were announced to download last month and downloaded more than 2600 times.

iEM Book Announcement

We believe students/interns around the globe will be enjoying the content prepared by emergency medicine experts and enthusiasts from all levels. This is a great initiative of international emergency medicine community.

Now, we are inviting new contributors to iEM Education Project as a blog author, chapter author in 2021 book, as well as for many other contribution options.

If you would like be a member of the group aiming to provide free education resources for medical students/interns around the globe, please click this link.

Currently, we have 20 active blog authors in iEM Education Project from around the globe and look forward to have more. If you feel responsible to improve undergraduate emergency medicine education, if you have something to share with trainees, you are welcome. Please click the link and be a part of this amazing team members. 

Lucas Silva - author

Lucas Oliveira J. e Silva

BRAZIL

Henrique Puls BW

HENRIQUE A. PULS

BRAZIL, USA

kilalo mjema - BW

KILALO MJEMA

TANZANIA

ibrahim sarbay

IBRAHIM SARBAY

TURKEY

Temesgen Beyene bw

TEMESGEN BEYENE

ETHIOPIA

Jule Santos BW

JULE R. O. G. SANTOS

brazil

Job Guillen

mexico

blog posts of the month

We published 11 posts during May 2019. The article “Countries Recognizing Emergency Medicine As A Specialty” is the top read article in May. It reached 2296 views. 

The iEM platform reached to 166 countries around the globe. In May, top countries by views are given below.