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Emergency Care Updates

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We congratulate New ECSU president @prisca_kizito as Immediate past President @aalenyo hands over office during the AGM2021.

@Jkalanzi1 @MUST_EM @EMKeFoundation @Seed_Global @EmMakerere @Mulinda_EMalawi @DianaAtwine @HeikeGeduld @wallis_lee @craigwylie

Did you know #trauma is the leading cause of morbidity and mortality in children? Kids have unique injury patterns and respond to trauma differently than adults.
Learn more about special considerations when assessing and managing #pediatric trauma here | https://bit.ly/2YQtOny

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Priapism
 Non-ischemic (high-flow)Ischemic (low-flow)
Physical ExamTypically painless, not fully tumescentPainful, fully tumescent with corpus cavernosa rigidity without involvement of corpus spongiosum and glans penis
AetiologyHigh-flow priapism is extremely rare and most commonly associated with antecedent trauma including blunt trauma, or resulting from needle injury of the cavernosal artery.Low-flow priapism is caused by impaired relaxation and/or paralysis of cavernosal smooth muscle and in sickle-cell disease
ManagementNOT EmergencyEmergency
 
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Mass Casualty Triage – A bit of SALT

Triage is a fast, challenging and unforgiving dance with life and death. Those who have the task will carry the memory of the decisions they were forced to make forever. SALT, which stands for Sort, Assess, Lifesaving interventions, Treatment and/or transport is the four step process for responders to manage mass casualty incidents proposed by the National Association of EMS Physicians as part of a Centers for Disease Control and Prevention sponsored project to use the best available science and expert opinion to develop a standard guideline for mass casualty management.

Tranexamic Acid

TXA is a safe, inexpensive medication that prevents fibrin breakdown.  In traumatic bleeding, it conveys a significant mortality benefit with an impressive NNT for mortality between 7 and 67, depending on injury severity, without apparent serious safety issues.  This benefit is associated with early administration.  TXA should not be given more than three hours after injury as it may increase mortality after this timeframe.  It appears to have equal benefit in a variety of trauma practice environments.

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CRASH-3 Trial: Tranexamic Acid in Mild-Moderate Head Injury

CRASH-3 Trial examined the effect of tranexamic acid on head injury-related death in adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major
extracranial bleeding.

The results indicated a reduction in the risk of head injury-related death with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64–0·95]) but in patients with severe head injury (0·99 [0·91–1·07]) there was no clear evidence of a reduction (p value for heterogeneity 0·030).

The effect of tranexamic acid on head injury-related death stratified by time to treatment and recorded no evidence of heterogeneity (p=0·96). The RR of head injury-related death with tranexamic acid was 0·96 (95% CI 0·79–1·17) in patients randomly assigned within 1 h of injury, 0·93 (0·85–1·02) in those randomly assigned within more than 1 h and 3 h or fewer after injury, and 0·94 (0·81–1·09) in those randomly assigned more than 3 h after injury.

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