The Ossification centres of the paediatric elbow Xray can cause confusion. Is that normal or is there a fracture? is a common question in this age group. If you remember CRITOE you'll be better prepared! CRITOE refers to the order these ossification centres appear on the Xray. The year of ossification can vary slightly but they always appear in the same order: Capitellum - 1yr (age visible on the Xray) Radial head - 3yrs Internal epicondyl - 5 yrs Trochlear - 7yrs Olecranon - 9yrs External epichondyl - 11 yrs Case courtesy of Leonardo Lustosa, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/80555">rID: 80555</a> Why is this important? Knowing the order will allow you to see if there is an ossification centre missing, i.e it may have avulsed and may be hidden in the Xray. If for example you can see the ossification centre of the trochlear or the olecranon but cannot see the internal epicondyl be very suspicious of an avulsion of the internal epicondyl. The video below from Radiopaedia explains this in greater depth. Martin Dore Nov 2020
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A 41 year old patient presents following and Out Of Hospital Cardiac Arrest. His identity is unknown but the ambulance service do bring his I-Phone with him. Click the Emergency button on the bottom of the locked home screen then click *Medical ID on the bottom of the next screen. Have you updated your own phone? Click Emergency SOS in the settings Menu, then click Edit Emergency Contacts in Health in the next menu and fill in your ICE details. Steve Fordham, November 2020
The are a number of studies in the literature looking at the value of the ECG after an Out of Hospital Cardiac Arrest with ROSC.
Circ Cardiovasc Interv. 2015;8:e002784. DOI: 10.1161/CIRCINTERVENTIONS.115.002784. This 2015 paper looked at 210 Patients who had ROSC after an out of hospital cardiac arrest. The post arrest ECG was classified into 3 main groups. 1) ST elevation or presumably new left bundle branch block (2) Other ECG signs indicating myocardial ischaemia (3) No ECG signs indicating myocardial ischaemia. Coronary Angiography findings were then correlated with the ECG findings. Notable findings were: 1) Mean age 62 +/- 12 years 2) 6 Month survival with good neurological outcome 54% 3) STEMI or presumed new LBBB identified patients with reduced TIMI flow with sensitivity 70%, specificity 62%. 4) An acute coronary occlusion was found in 11% of patients in group (3), those with a post resuscitation ecg showing no signs of Myocardial Ischaemia. 5) 32% of patients with initial non shockable rhythms had significantly reduced TIMI flow at angiography. What does this tell us? After initial resuscitation of the patient with an Out of Hospital Cardiac Arrest consider carefully the need for Emergency PCI even if the ecg shows no ischaemia. Want to read more? https://rebelem.com/the-difoccult-trial-time-to-change-from-stemi-nstemi-to-omi-nomi/ This October 2020 paper and post highlighted by Nick Pocock proposes a new way of thinking in Post Cardiac Arrest Care. Steve Fordham November 2020 |
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