Podcasts about cspine

Ken Milne the author of skeptics guide to emergency medicine SGEM reviews the hottest critical care literature for 2018 2019. Ken reviews articles from the Lomaghi trial on magnesium for rate control in Atrial fibrillation, Expulsive therapy for renal calculi with Tamulosin, Oxygen therapy in critical illness in the Iota trial and finally aromatherapy for nausea and vomiting.

Host: Alex Kaminsky MD: PGY-3 UCSF Fresno Guest: Jerry Hoffman MD: Professor Emeritus UCLA Deputy Editor/Contributor: Mat Goebel MD: PGY-1 Baystate Overview:  In this inaugural Journal Club episode, we discuss the over-utilization of cervical spine imaging in traumatic patients via landmark papers from the NEXUS group.  X-radiography of the C-spine has been widely replaced by CT-radiography, but the principles remain the same. Patient with low mechanism injuries are often over-irradiated due to physician fears of a statistically small percentage of true clinically significant C-spine injuries. Physicians often neglect to recognize the number needed to harm during diagnostic studies. This is particularly important in C-spine imaging as the anatomic target is directly adjacent to the radiosensitive thyroid gland. With the Assistance of Dr. Hoffman (Primary Author), we will delve into the overall study with some advanced pearls. Key Resources: Initial Paper: Hoffman JR, Wolfson AB, Todd KH, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998;32:461-469. PMID:9774931 https://www.ncbi.nlm.nih.gov/pubmed/9774931 Hoffman JR, , Mower WR, Todd KH. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94-1. PMID: 10891516  https://www.nejm.org/doi/10.1056/NEJM200007133430203?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov   https://www.mdcalc.com/nexus-criteria-c-spine-imaging#evidence   Key Points:   NEXUS C-Spine is an INSTRUMENT designed to augment clinical judgement. It was designed to support common-sense practices.   Criteria – 99.6% Sensitive (If all negative, reassured no significant fracture)    No Focal Neurologic Deficit No Altered Consciousness No Intoxication – Requires Judgement (common sense) No Distracting Injury – Requires Judgement (common sense) Is a finger fracture? Is a corneal ulceration? No Midline Tenderness   Study Highlights: >34,000 Patients over 21 hospitals in 4 geographic US regions >800 true positive C-spine injuries identified Sensitivity reported at 99.6% Two clinically significant “misses” identified   One likely chronic injury. No change in outcome at follow-up. Patient asymptomatic. One patient underwent surgical intervention Of note authors suggest patient actually did not meet NEXUS criteria as he had paresthesias   NEXUS C-spine: Overall 12.6% reduction in C-spine imaging

This is the second part of a two part episode reviewing the decision rules that form the base of selective spinal immobilization protocols. In order to properly apply a rule and identify those patients at low risk for spinal injury who do not require spinal motion restriction (SMR). Part two covers the application of the decision rules to our individual patients. Follow along in the show notes at http://medicaldirectorminute.com/cspinepart2.   paramedicine, paramedic, c-spine, SMR, trauma The Medical Director Minute podcast is a high yield, rapid fire podcast bringing you high impact discussions on clinical topics right to your smart phone. Each podcast is around 10 minutes in length to make it easy to listen with your busy schedule.

This is the first part of a two part episode reviewing the decision rules that form the base of selective spinal immobilization protocols. In order to properly apply a rule and identify those patients at low risk for spinal injury who do not require spinal motion restriction (SMR). Part one covers the two decision rules that many protocols are based on, the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-Spine Rule. Both have pros and cons, which we discuss in the episode. Follow along in the show notes at http://medicaldirectorminute.com/cspinepart1.   paramedicine, paramedic, c-spine, SMR, trauma The Medical Director Minute podcast is a high yield, rapid fire podcast bringing you high impact discussions on clinical topics right to your smart phone. Each podcast is around 10 minutes in length to make it easy to listen with your busy schedule.

This episode will discuss the NEXUS study.  NEXUS was a study that studied thousands of patients to validate a set of rules so that we can "clinically clear" patients with possible c-spine injury without getting an x-ray. This study has helped us avoid radiation in certain low-risk patients, saved the cost of x-rays and CT scans, and speed these patients through the ED. We'll talk a lot about the statistical side of this study and how you can apply it in your everyday practice.