■ RSI (rapid sequence intubation) --> DAI (drug assisted intubation). ■ Needle decompression of pneumothorax: # Adults --> 4th/5th ICS anterior to midaxillary line. # Pediatric --> 2nd ICS midclavicular line. ■ Chest tube size: 28-32F (pig-tail only for small pneumothorax). ■ CXR reading mnemonic: DRSABCDE. ■ Fluid resuscitation: 1L warm crystalloid, 18G peripheral access x 2. ■ Massive transfusion: > 10U in 24h or > 4U in 1h. (1U in USA = 2U in Taiwan). ■ Tranexamic acid 1g over 10 min stat and 1g over 8h given within 3h of trauma. ■ Blunt aortic injury: targets HR = 80 MAP = 60-70 mmHg. ■ Blunt cardiac injury: emphasize ECG monitor, Tn-I inconclusive. ■Pelvic fracture without hemoperitoneum: both preperitoneal packing and TAE are acceptable. ■ High-riding prostate: not equal to urethral rupture. ■ No more DRE to detect high-riding prostate. Note that DRE still indicated in selected patients in order to detect anal sphincter tone, bowel wall integrity, and bony fragments. ■ Traumatic brain injury: # HPI: should inform neurosurgeon if patient under anticoagulation. # GCS: "to speech" --> "to sound". # GCS: "to pain" --> "to pressure". # GCS: can document as "NT (non-testable)". # Prolonged hyperventilation with PCO2 <25mmHg not recommended. # If 50-69Y: keep SBP ≥ 100mmHg. # If 15-49Y or >70Y: keep SBP ≥ 110mmHg. # Caution, high-dose propofol can produce significant morbidity. # Mannitol 0.25-1 g/Kg to control ICP, avoid arterial hypotension. # High-dose barbiturate to control refractory IICP, avoid arterial hypotension. # Phenytoin can reduce incidence of early post-traumatic seizure (within 7 days). ■ Spine: "spinal immobilization" --> "spinal motion restriction". ■ Burns > 20% TBSA: IVF = 2ml LR x KG x % TBSA burn, avoid fluid boluses unless the patient is hypotensive (pediatric: 3ml x KG x % TBSA). ■ Hypovolemia resuscitation in children: # 20 ml/kg bolus crystalloid. # 10-20 ml/kg of PRBC. # 10-20 ml/kg of FFP or platelet. ■ Trauma in Pregnancy: If vaginal fluid pH > 4.5 --> amniotic fluid leak (+).
Younger children and those with multiple AOM that year had higher risk for developing Otitis media associated with the conjunctivitis. Up to 25% of patients with conjunctivitis have concurrent otitis media (even in the abscence of ear pain) and up to 73% of patients with purulent conjunctivitis. Non-typeable H. influenzae is the most common recovered bacteria. For these patients, systemic (oral) antibiotics are recommended and the topical ophthalmic antibiotics are NOT necessary. Antibiotics should cover beta-lactamase producing organisms, e.g. high dose amoxicillin-clavulanic acid (45 mg/kg BID).
Every patient with conjunctivitis should have an examination of his/her tympanic membraness, as your management may change.
an extra-articular fracture at the metadiaphyseal junction of the fifth metatarsal.
Avulsion fracture of the 5th metatarsal styloid
also known as a pseudo-Jones fracture or a dancer fracture, is one of the more common foot avulsion injuries and accounts for over 90% of fractures of the base of the 5th metatarsal.
Stress fracture of the 5th metatarsal
the least common fracture type of the proximal 5th metatarsal, with an avulsion fracture being the most common, followed by Jones fracture. Stress fractures typically occur within 1.5 cm distal to the metadiaphyseal junction.