Vomiting not that special anymore?

Well here's another dogma sort of destroyed - In my training, I was taught that it was very sensitive. Have to keep it in context though (the vomiting that is).

Courtesy of Journal watch:

Katherine Bakes, MD Reviewing Dayan PS et al., Ann Emerg Med 2014 Jun 63:657
And in children with isolated vomiting, the risk for intracranial injuries was low.
In a secondary analysis of patients presenting with blunt head trauma to centers in the Pediatric Emergency Care Applied Research Network (PECARN), investigators evaluated whether isolated vomiting is a predictor of intracranial injuries. Isolated vomiting was defined two ways: (1) vomiting in a patient acting normally and without loss of consciousness, altered mental status, skull fracture, scalp trauma, headache, seizure, neurologic deficits, or amnesia (extensive definition); (2) vomiting in the absence of all other criteria of the PECARN head injury rules (NEJM JW Emerg Med Sep 25 2009). Clinically important brain injury was defined as injury resulting in death, a neurosurgical procedure, intubation, or hospitalization for two or more nights.
Of 5392 children with head trauma and vomiting, 815 (15%; median age, 2 years) met the extensive definition for isolated vomiting, and of these, 2 (0.2%) had clinically important injuries (hospitalization for 2 or more nights). Both cases had severe mechanisms of injury (as defined in the PECARN rules). Among patients who met the PECARN-based definition of isolated vomiting, none of 567 patients aged <2 years and 10 of 1501 patients (0.7%) aged 2 to 18 years had clinically important brain injuries. Five patients required neurosurgery; all had mild to moderate headaches and vomited within 1 hour of injury, and three had scalp hematomas. Surprisingly, in multivariable analyses of children with any vomiting (isolated or otherwise), fewer episodes of vomiting were associated with increased risk for intracranial injury but not clinically important brain injury.
Comment
For well-appearing children with head injury and isolated vomiting, the risk of intracranial injury is low. Children without a major mechanism of injury or other symptoms of intracranial injury can be safely discharged if they do not deteriorate during an observation period and if they can tolerate liquids by mouth.

SEMS 2014: John Tobin - A paradigm shift in CPR

John Tobin was the keynote speaker at the EMS track for ASM 2014 and gives an account of where he works and the efforts they have made to pre-hospital deaths in his EMS.


The slides are here:


SEMS 2014: Yao Yi Ju - Novel recreational drugs you may see on your shift

Continuing our tox track videos: Dr Yao Yi Ju (PhD) is from the analytical side of things and this is her perspective of the novel recreational substances of abuse visible in today's EDs.

SEMS 2014: Chan Wui Ling - Recreational drugs

Dr Chan Wui Ling gives us the rundown on new "rec" drugs in the party scene these days and their impact.

SEMS 2014: Gene Ong on Paediatric Toxicology

Adj A/Prof Gene Ong from KKH Children's Emergency Dept gives us a quick rundown on common toxicological scenarios in modern city life. He gives this version of toxicology via the child's perspective - which is refreshing.





Webucation 10/6/14

Web wisdom this time comes from the realms of microbiology, paeds, radio and even some good ol' pharmacology. Remember to support the original content providers.

  • Log roll finger bum ? - More dogmalysis on a topic we've been trying to bury for a decade now. Is it really necessary to rectally relieve ALL or ANY of your patients???
The last point mirrors our opinion as well. I cannot recall doing a DRE on a conscious, neurologically intact patient for years... its time we all spread the myth-busting surrounding the anal abuse in EDs! 

Apple off cup or cup off axis or ???

Prof Larry Mellick gives us a tour de force video on a reduction of a carpal bone dislocation. Much conjecture not just in the video but in reality on the floor in most departments as well.
Enjoy and spread the knowledge.

SEMS 2014: Augustine Tee - The inpatient MET

Medical Emergency Teams (MET) are commonplace now all around the globe. They act as an early warning radar to pick up potentially crashing patients on the ward and try to stave off an ICU stay. Here's Changi Hospital's Dr Augustine Tee on our hospital's experience.




Here are the slides: