Episode Chapters
- Introduction – Swami Gets Pumped9:09Rib Fractures in the Elderly15:41Paper Chase 1 – Helmet PAP5:13Dyspnea in the Palliative Care PatientFree Chapter11:58Bouncebacks – Beta Blocker Overdose19:57Paper Chase 2 – Apneic Oxygen and the Airway Hero3:59Ankle Fractures21:16Point of Care Pediatric Urinalysis12:07Paper Chase 3 – Step-by-Step-Again4:23Toxicology Sessions – Loperamide Isn’t So Benign7:02Critical Care Mailbag – Head Trauma Etiquette14:47Nurse Practitioner Response Unit8:44Catheter Directed Thrombolysis for PE22:39Paper Chase 4 – Albuterol, Lactate, and Potassium3:52Lido in the IO4:21Strayerisms – Preventing Alcohol Withdrawal11:57Paper Chase 5 – Flex Ex Gets Spanked4:20Peri-arrest3:46Annals of Emergency Medicine – Postpartum Headache17:23Induction Doses in Shock6:05Summary19:11EM:RAP 2017 January Canadian Edition22:10EM:RAP 2017 January Australian Edition43:30EM:RAP 2017 January German Edition1h, 30mEM:RAP 2017 January French Edition32:33EM:RAP 2017 January Spanish Edition1h, 05m
EM:RAP 2017 January Written Summary 926 KB - PDF
When it comes to ankle fractures, it’s all about how distal and how displaced.
Broken Ankles, Ribs, and Pumps Full episode audio for MD edition 227:43 min - 318 MB - M4AEM:RAP 2017 January Canadian Edition Canadian 22:10 min - 31 MB - MP3EM:RAP 2017 January Australian Edition Australian 43:30 min - 60 MB - MP3EM:RAP 2017 January German Edition Deutsche 90:03 min - 124 MB - MP3EM:RAP 2017 January French Edition Français 32:33 min - 45 MB - MP3EM:RAP 2017 January Spanish Edition Español 65:46 min - 90 MB - MP3EM:RAP 2017 January Board Review Answers 220 KB - PDFEM:RAP 2017 January Board Review Questions 202 KB - PDFEM:RAP 2017 January Separate MP3 Files 265 MB - ZIPEM:RAP 2017 January Spanish Written Summary 1 MB - PDFEM:RAP 2017 January Written Summary 926 KB - PDF
Patrick B. - February 8, 2017 9:37 AM
My non-op and op EBM ortho and sportsmed experts are in fairly strong disagreement with the speakers strong suggestion that Achilles injury is best treated nonop. I think the segment seemed a bit biased for the take home message that it was clear cut to not fix most of these....
Rob O - February 8, 2017 3:45 PM
Here is the response from Dr. Ramadorai.....
Patrick,
My treatment preferences for Achilles tendon treatment is certainly biased. Every surgeon has his/her protocols based on training and hopefully evidence based medicine. The most recent high quality studies concerning operative vs. nonoperative management of Achilles tendon ruptures shows no significant benefit of surgical management when the appropriate nonoperative protocol is employed so that is my preference. In addition, that is what was favored during my fellowship training. The complications that can arise from operative management (whether it be open or percutaneous) can be catastrophic so unless there is a well done prospective study demonstrating a clear superiority of surgical management, I will continue treating them conservatively. That is certainly not the opinion of every orthopaedic surgeon. I am sure if you sat 20 of us down in a room and asked us our preference you would get a wide variety of responses. Ultimately this podcast is for the emergency room provider and the emphasis should be placed on making the diagnosis and getting the patient properly immobilized with appropriate follow-up. The orthopaedic surgeon can then make the decision concerning operative versus nonoperative management with the patient. Please see the below resources.
Nilsson-Helander K, Silbernagel KG, Thomee R, et al. Acute Achilles
tendon rupture: a randomized, controlled study comparing surgical
and nonsurgical treatments using validated outcome measures. Am
J Sports Med. 2010;38(11):2186-2193.
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical
versus nonsurgical treatment of acute Achilles tendon rupture:
a meta-analysis of randomized trials. J Bone Joint Surg Am.
2012;94(23):2136-2143.
Wallace RG, Heyes GJ, Michael AL. The non-operative functional
management of patients with a rupture of the tendo Achillis leads
to low rates of re-rupture. J Bone Joint Surg Br. 2011;93(10):1362-
1366.
4. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative
treatment of acute Achilles tendon ruptures: a multicenter randomized
trial using accelerated functional rehabilitation. J Bone Joint
Surg Am. 2010;92(17):2767-2775.