EM Quick Hits 9 Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma, Motivational Interviewing P2

Topics in this EM Quick Hits podcast Justin Morgenstern on the lack of evidence for burn debridement (0:30) Jesse MacLaren on ECG Cases - missed ischemia and pitfalls of "normal" computer ECG interpretations (5:20) Arun Sayal on clinical diagnosis pitfalls of compartment syndrome (9:24) Sarah Reid on pediatric asthma pitfalls and myths (16:15)  Andrew Petrosoniak on T-spine and L-spine fracture work-up (24:12) Michelle Klaiman & Taryn Lloyd on motivational interviewing part 2 (32:06) Podcast production, editing and sound design by Anton Helman Podcast content & blog post by Justin Morgenstern, Jesse MacLaren, Arun Sayal, Sarah Reid, Andrew Petrosoniak, Michelle Klaiman & Taryn Lloyd and Anton Helman Cite this podcast as: Helman, A., Morgenstern, J., MacLaren, J., Sayal, A., Reid, S., Petrosoniak, A., Klaiman, M., Lloyd, T. EM Quick Hits 9 - Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma & Motivational Interviewing. October, 2019. https://emergencymedicinecases.com/em-quick-hits-october-2019/. Accessed [date]. Is there evidence for burn blister debridement? * There is little, if any evidence that burn blister debridement is beneficial to healing or burns despite most burn surgeons advocating for debridement of blisters more than 2cm in diameter. * Since there is no evidence of benefit,  we must consider the other impacts of debridement: the added pain it causes, and the potential problems with departmental flow as patients wait for (potentially unnecessary) procedural sedation. Expand to view reference list Forage AV. The effects of removing the epidermis from burnt skin. Lancet (London, England). 1962; 2(7258):690-3. Gimbel NS, et al. A study of epithelization in blistered burns. A.M.A. archives of surgery. 1957; 74(5):800-3. Ro HS, Shin JY, Sabbagh MD, Roh SG, Chang SC, Lee NH. Effectiveness of aspiration or deroofing for blister management in patients with burns: A prospective randomized controlled trial. Medicine. 2018; 97(17):e0563. Swain AH, Berge SA, Wakeley CJ et al. Management of blisters in minor burns. Br Med J (Clin Res Ed). 1987;295:181. https://first10em.com/should-i-debride-burn-blisters/ Missed ischemia with "normal" ECG computer interpretation Never trust the ECG computer interpretation, even if it says “normal,” because: * Ischemic morphology: the computer focuses on ST segment elevation, and can miss ischemic ST-T wave morphology—including straight or convex ST segments, terminal T wave inversion, down-up T waves, hyperacute T waves,  deWinter T waves, and inverted U waves * Dynamic change: the computer interprets each ECG in isolation, and can’t compare to prior or repeat ECGs (which is critical in a dynamic process like coronary occlusion)—so it can miss subtle changes, including pseudonormalization of ST segments or T waves * STEMI criteria: computer interpretation is based on STEMI criteria, which has limited sensitivity for identifying acute coronary occlusion—so it can miss subtle ST elevation (which may be significant in small amplitude QRS complexes), ST depression in aVL (which is very sensitive for inferior MI),