Thanks to Dr. Joanna Middleton for her summary
Edited by Dr David Lewis
Top tips from this month’s rounds:
Imaging for Bone Mets
Plain radiographs are not very sensitive for detecting bone metastases. Metastases to bone become apparent on radiographs only after the loss of more than 50% of the bone mineral content at the site of disease. The diagnostic utility of plain films of the skull, spine, and pelvis is limited by superposition effects. In these areas, the sensitivity of plain films for bone metastases is only in the range of 44–50%.
Reproduced from:Imaging of bone metastasis: An update – World Journal of Radiology
Further resources – Diagnostic Imaging of Bone Metasteses
Imaging for Thoracolumbar Spine Trauma
Plain radiography is not sensitive for thoracolumbar spine trauma – Trauma of the spine and spinal cord: imaging strategies – European Spine Journal (Full Text)
We have a guideline for imaging Thoracolumbar trauma. Click image below for larger version.
Any of: High energy mechanism, Inability to ambulate, extremity paresthesia, bladder/bowel deficit, saddle anesthesia – mandates CT
Cervical Spine Precautions
Not all trauma patients transferred by EMS require cervical spine precautions. New Brunswick EMS have guidelines (click image for full size):
Rapid Sequence Intubation – Paralysis with Rocuronium
The recommended dose of Rocuronium for RSI is 1.2 – 1.5mg/kg (not 0.6mg/kg as stated in many drug references)
Rocuronium can be rapidly reversed by Suggamadex (and it’s reversal is quicker than waiting for Sux to wear off)
Excellent RSI reference article from LIFL – Rapid Sequence Intubation (RSI)
Rocuronium vs. Succinylcholine from reuben strayer on Vimeo.
Graded Assertiveness vs Advocacy
A reminder that we all have a responsibility to ‘speak-up’ and challenge when we see an issue. There are a number of described methodologies (see below), however the key factor is acting on your concern, don’t be that person who watches an unfolding series of errors and think ‘I wish I had said something earlier’….
As the person being challenged – be grateful that someone has had the courage to ‘speak-up’ and potentially save your ass!
Graded Assertiveness
More from LIFL here – Speaking Up
AMI – STEMI – Early Diagnosis and Reperfusion significantly impacts Mortality
We shouldn’t need reminding that early diagnosis of STEMI via history and ECG significantly impacts mortality. Dynamic ECG changes must be recognised and reperfusion strategies initiated as soon as possible.
Delayed reperfusion increases mortality.
