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Dog Bites

10/4/2017

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Dog bites have commonly mixed flora, with a 50% incidence of pasturella. Primary closure can be done most places except the hands and feet. For open wounds (such as the hands and feet) patients should receive prophylactic augmentin to cover most bacteria, similar to cat or human bites. Dog bites that are closed typically do not require prophylactic antibiotics. 

Wound Care

There is little evidence-based medicine to support a specific fluid for wound care. Normal saline or tap water have both been shown to have a similar infection rate (4-6%). Betadine-containing solutions have not been shown to improve outcomes or decrease infection rates. Some surgical research supports the use of betadine solutions. 

Closure

The primary reason for wound closure is for improved cosmesis. A RCT of patients presenting with dog bites found that closure of dog bite wounds does not increase the risk of infection or complication, and closed wounds had better cosmetic appearance. Hand wounds, regardless of treatment, did have a higher rate of infection. 

Antibiotics

Patients presenting with hand wounds from dog bites should receive prophylactic antibiotics. Per a Cochrane review, there is some evidence showing that dog bites in the hand have reduced infection rates with prophylactic antibiotics. The same review did not show a reduction in cats or for all dog bites. 
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Wrist Pain: X-rays and the Differential

4/26/2017

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Wrists are the most commonly injured upper extremity joint, and 8.8% of injuries are missed, with 2% being clinically important. With 27 bones and 34 muscles, there is a significant possibility of missing a fracture. A high index of suspicion is required to prevent missing a significant injury. 

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Concussion Management

1/11/2017

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Adapted from Andy Simmon's Grand Rounds lecture, January 11th, 2017. 

How to identify serious injury that requires admisison for neurosurgery or observation, and how to instruct discharged patients for recovery expectations, followup, and return precautions. 
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Describing Fractures

11/30/2016

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When consulting for fracture care, it is important to provide an accurate description of findings over the phone. This is important to improve patient outcome, ensure consultants are well informed of the patient's condition, and to ensure appropriate documentation of a patient's injuries.
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GW Ortho Notes

10/21/2016

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Abdulla Alhmoudi has made the attached PDF to help with treatment and dispo decisions for many common fractures. 

ortho-notes_aa.pdf
File Size: 324 kb
File Type: pdf
Download File

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Blunt Thoracic Trauma

10/19/2016

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Adapted from Kristin Schreiber's Grand Rounds presentation, October 18th, 2016
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Facial Trauma Assessment

10/12/2016

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Adapted from Dr. Calabrese's October 12th Grand Rounds presentation.
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Evaluation of every facial trauma patient should include a complete facial assessment
  • Do you have numbness in your face? 
    • Lower lip/chin (mental n)
    • Cheek, upper lip, nose
    • Lower lid, cheek
  • What part of your face hurts?
  • Do your teeth fit normally? 
    • Alveolar ridge fractures vs. mandibular fractures
  • Does it hurt to open your mouth?
    • Zygomatic or high mandibular fractures
  • Does your neck hurt?
  • Complete evaluation of pupils and extra-ocular movements. 

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Complex Pelvic Injuries

10/5/2016

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Adapted from Dr. Sarani's Grand Rounds presentation October 5th, 2016
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This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map