Ortho Questions

Hip Fracture-Is MRI or CT more sensitive for occult fracture
> Hip fractures occur almost exclusively in older adults; plain radiographs are the appropriate initial imaging test, with a sensitivity of 90% – 98%. What is the sensitivity of CT for radiograph-occult hip fractures? Of MRI?
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> The Answer is:
> CT has a 58% – 80% sensitivity for radiograph-occult hip fractures; MRI has a sensitivity of 99% – 100% (Annals of EM, epub, 10/2/18).


Gum Elastic Bougie​


Study objective

The bougie may improve first-pass intubation success in operating room patients. We seek to determine whether bougie use is associated with emergency department (ED) first-pass intubation success.


We studied consecutive adult ED intubations at an urban, academic medical center during 2013. Intubation events were identified by motion-activated video recording. We determined the association between bougie use and first-pass intubation success, adjusting for neuromuscular blockade, video laryngoscopy, abnormal airway anatomy, and whether the patient was placed in the sniffing position or the head was lifted off the bed during intubation.


Intubation with a Macintosh blade was attempted in 543 cases; a bougie was used on the majority of initial attempts (80%; n=435). First-pass success was greater with than without bougie use (95% versus 86%; absolute difference 9% [95% confidence interval {CI} 2% to 16%]). The median first-attempt duration was higher with than without bougie (40 versus 27 seconds; difference 14 seconds [95% CI 11 to 16 seconds]). Bougie use was independently associated with greater first-pass success (adjusted odds ratio 2.83 [95% CI 1.35 to 5.92]).


Bougie was associated with increased first-pass intubation success. Bougie use may be helpful in ED intubation.