Which physical exam finding is most suggestive of a LeFort facial fracture?
A) CSF rhinorrhea
B) Infraorbital anesthesia
C) Limited upward gaze
D) Mobility of the mandible
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This pearl by special request of one Dr. Scofi
Basic thermal burn management: COOL, ANALGESIA, CLEANSE, TETANUS as needed
1st degree (sunburn or sunburn like; epidermal only) – supportive care, cool under cold running water (no ice directly on burn), analgesia with aloe, NSAIDs are usually sufficient. these burns usually heal within 1 week.
2nd degree (blisters, partial thickness; epidermal/superficial-partially through dermis) – supportive care, cool under running water, analgesia may require higher doses or stronger medications or opioids, clean with gentle soap/water.
you may consider debriding these blisters if they are very large, obviously contaminated, or over joints, use your clinical judgement to determine if the blister will cause more discomfort unless you debride it. small blisters or bullae should be left intact as the skin layer forms a barrier from infection.
in terms of dressing these burns, use silvudene (do not use on face because of risk of scarring), or bacitracin (good for face) or a triple antibiotic is just as effective, cover with your choice of gauze, xeroform, tegaderm. other more expensive/specific dressings exist but are not necessary
these usually heal in 2-8 weeks (depending on if they are superficial or deep 2nd degree)
3rd degree (full thickness, painless; epidermis/dermis all layer) or 4th degree (full thickness, painless; epidermis/dermis/underlying structures – muscles/nerves etc.)- clean, cool, these patients may require escharotomy so be sure to monitor for compartment syndrome, particularly in circumferential burns, these patients are usually admitted to the hospital or a burn center, and ultimately require excision
Partial thickness>25% BSA age 10-50y
Partial thickness>20% BSA, age <10y or >50 y
Full thickness>10% BSA, any age
Burns involving hands, face, feet, perineum
Burns crossing major joints
Circumferential burns of an extremity
Burns complicated by inhalation injury
Burns complicated by fracture or other trauma
Burns in high-risk patients
Partial thickness 15-25% BSA, age 10-50y
Partial thickness 10-20% BSA, age<10y or >50y
Full thickness burns <10% BSA, any age
Admission to hospital
Partial thickness <15% BSA, age 10-50y
Partial thickness<10% BSA, age <10y or >50y
Full thickness <2% anyone
Schwartz LR, Balakrishnan C. Thermal Burns. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915557. Accessed September 29, 2014
Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Marx, John A.; Hockberger, Robert S., et al.; Rosen, Peter. (2013)
77-year-old woman, immobile due to advanced rheumatoid arthritis, presented to the emergency department with a 3-day course of a progressively painful and purple left lower extremity. Examination reveals stable vital signs, weak pulses in a very tender LLE, and the leg appears as the image below:
Doppler ultrasound shows extensive clot in the iliofemoral vein.
Thank you to Dr. Vazquez for this case.
You are working in the peds ED, a full term 3 day old presents with bilious vomiting after each feed x 1 day associated with increasing abdominal distension. No pertinent birth or maternal history. Also noted to have mild jaundice from head to toe. Per mother patient is having normal wet diapers, no fevers, passed 2 meconium stools after birth but has not had a bowel movement in 24hrs. Normal activity.
VS: 140, 100/60, 36, 100% RA
Gen: NAD, well appearing, active
HEENT: mild scleral icterus, mucous membranes moist, TMs wnl b/l
CVS: RRR no m/r/g
Resp: CTAB, normal effort, no retractions
Abd: normal bowel sounds, distended, tympanitic, patient cries on palpation diffusely, no hepatosplenomegaly
Ext: warm, well perfused, normal cap refill
DRE: no stool in the vault, however, when you remove your finger, patient has explosive gas and stool.
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