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Clinical Excellence Series Volume V an Evidence-Based Approach to Traumatic Emergencies Clinical Excellence Series n Volume V An Evidence-Based Approach To Traumatic Emergencies Inside Neck Trauma: Don’t Put Your Neck On The Line Orthopedic Sports Injuries: Off The Sidelines And Into The Emergency Department Blunt Abdominal Trauma: Priorities, Procedures, And Pragmatic Thinking Wrist Injuries: Emergency Imaging And Management Brought to you exclusively by the publisher of: An Evidence-Based Approach To Traumatic Emergencies CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume V: An Evidence-Based Approach To Traumatic Emergencies is published by EB Practice, LLC, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excel- lence Series, and An Evidence-Based Approach to Traumatic Emergencies are trademarks of EB Practice, LLC. Copyright © 2009 EB Practice, LLC. All rights reserved. No part of this publication may be reproduced in any format without written consent of EB Practice, LLC. Price: $199. Call 1-800-249-5770 to ask about multiple-copy discounts. Brought to you exclusively by the publisher of: Editor-in-Chief Nicholas Genes, MD, PhD Emergency Medicine, Massachusetts Corey M. Slovis, MD, FACP, FACEP International Editors Andy Jagoda, MD, FACEP Instructor, Department of General Hospital, Harvard Medical Professor and Chair, Department Peter Cameron, MD Professor and Chair, Department Emergency Medicine, Mount Sinai School, Boston, MA of Emergency Medicine, Vanderbilt Chair, Emergency Medicine, of Emergency Medicine, Mount School of Medicine, New York, NY University Medical Center, Charles V. Pollack, Jr., MA, MD, Monash University; Alfred Hospital, Sinai School of Medicine; Medical Nashville, TN Michael A. Gibbs, MD, FACEP FACEP Melbourne, Australia Director, Mount Sinai Hospital, New Chief, Department of Emergency Chairman, Department of Jenny Walker, MD, MPH, MSW York, NY Medicine, Maine Medical Center, Emergency Medicine, Pennsylvania Assistant Professor; Division Chief, Giorgio Carbone, MD Editorial Board Portland, ME Hospital, University of Pennsylvania Family Medicine, Department Chief, Department of Emergency Health System, Philadelphia, PA of Community and Preventive Medicine, Ospedale Gradenigo, William J. Brady, MD Steven A. Godwin, MD, FACEP Medicine, Mount Sinai Medical Torino, Italy. Professor of Emergency Medicine Associate Professor, Associate Michael S. Radeos, MD, MPH Center, New York, NY and Internal Medicine; Vice Chair Chair and Chief of Service, Assistant Professor of Emergency Amin Antoine Kazzi, MD, FAAEM of Emergency Medicine, University Department of Emergency Medicine, Medicine, Weill Medical College of Ron M. Walls, MD Associate Professor and Vice of Virginia School of Medicine, Assistant Dean, Simulation Cornell University, New York, NY Professor and Chair, Department Chair, Department of Emergency Charlottesville, VA Education, University of Florida of Emergency Medicine, Brigham Medicine, University of California, Robert L. Rogers, MD, FACEP, COM-Jacksonville, Jacksonville, FL and Women’s Hospital, Harvard Irvine; American University, Beirut, Peter DeBlieux, MD FAAEM, FACP Medical School, Boston, MA Lebanon Professor of Clinical Medicine, Gregory L. Henry, MD, FACEP Assistant Professor of Emergency LSU Health Science Center; CEO, Medical Practice Risk Medicine, The University of Scott Weingart, MD Hugo Peralta, MD Director of Emergency Medicine Assessment, Inc.; Clinical Professor Maryland School of Medicine, Assistant Professor of Emergency Chair of Emergency Services, Services, University Hospital, New of Emergency Medicine, University Baltimore, MD Medicine, Elmhurst Hospital Hospital Italiano, Buenos Aires, Orleans, LA of Michigan, Ann Arbor, MI Center, Mount Sinai School of Argentina Alfred Sacchetti, MD, FACEP Medicine, New York, NY Wyatt W. Decker, MD John M. Howell, MD, FACEP Assistant Clinical Professor, Maarten Simons, MD, PhD Associate Professor of Emergency Clinical Professor of Emergency Department of Emergency Medicine, Emergency Medicine Residency Medicine, Mayo Clinic College of Medicine, George Washington Thomas Jefferson University, Research Editor Director, OLVG Hospital, Medicine, Rochester, MN University, Washington, DC; Director Philadelphia, PA Lisa Jacobson, MD Amsterdam, The Netherlands of Academic Affairs, Best Practices, Francis M. Fesmire, MD, FACEP Scott Silvers, MD, FACEP Chief Resident, Mount Sinai School Inc, Inova Fairfax Hospital, Falls Director, Heart-Stroke Center, Medical Director, Department of of Medicine, Emergency Medicine Church, VA Erlanger Medical Center; Assistant Emergency Medicine, Mayo Clinic, Residency, New York, NY Professor, UT College of Medicine, Keith A. Marill, MD Jacksonville, FL Chattanooga, TN Assistant Professor, Department of CME Accreditation Information This CME activity is sponsored by EB Medicine. Release Date: October 1, 2009 Date of Most Recent Review: August 1, 2009 Termination Date: October 1, 2012 Time To Complete Activity: 16 hours Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the sponsorship of EB Medicine. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation Statement: EB Medicine designates this educational activity for a maximum of 16 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Needs Assessment: The need for this educational activity was determined by a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation of prior activities for emergency physicians. Goals & Objectives: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the stron- gest clinical evidence; (2) cost-effectively diagnose and treat the most critical ED presentations; and (3) describe the most common medicolegal pitfalls for each topic covered. Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents. Discussion of Investigational Information: As part of the book, faculty may be presenting investigational information about pharmaceuti- cal products that is outside Food and Drug Administration-approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product. Disclosure of Off- Label Usage: This book, An Evidence-Based Approach To Traumatic Emergencies, discusses no off-label use of any pharmaceutical product. Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. This information will be available as part of the course material. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Matt S. Friedman, Dr. Benjamin Friedman, the original authors and peer reviewers for each chapter, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation. Method of Participation: Read the printed material and complete the Evaluation Form on page 129 or online at www.EBMedicine.net/ CME. CME certificates will be sent to each participant scoring higher than 70%. Hardware/Software Requirements: None required Copyright © 2009 EB Medicine. All rights reserved. EB Medicine is not affiliated with any pharmaceutical company or medical device manufacturer and does not accept any commercial support. 3 Table Of Contents Introduction ..................................................................................................................................................3 by Matt S. Friedman, MD Neck Trauma: Don’t Put
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