eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Scapular

Joseph C Schmidt, MD, Assistant Professor, Program Director, Department of Emergency Medicine, Baystate Medical Center

Updated: Sep 2, 2009

Introduction

Background

The primary function of the scapula is to attach the upper extremity to the thorax and provide a stabilized platform for upper extremity movement. The scapula is attached to the clavicle by the acromioclavicular and coracoclavicular ligaments and articulates with the humerus. The scapula is protected by its surrounding musculature (supraspinatus, infraspinatus, subscapularis) and its ability to move along the wall of the thorax; the body and spine of the scapula are most protected. Fractures to scapular structures typically require significant force. These factors explain the infrequent occurrence of scapular fractures.

Pathophysiology

The primary anatomic features of the scapula provide insight into the mechanisms of injury and offer a convenient classification system. Injuries to the body or the spine of the scapula typically result from a direct blow with significant force, as depicted in the image below, such as from a motor vehicle accident or a fall.

Scapular anatomy. Muscle origin and insertion.

Classification of glenoid cavity fractures: IA - Anterior rim fracture; IB - Posterior rim fracture; II - Fracture line through the glenoid fossa exiting at the lateral border of the scapula; III - Fracture line through the glenoid fossa exiting at the superior border of the scapula; IV - Fracture line through the glenoid fossa exiting at the medial border of the scapula; VA - Combination of types II and IV; VB - Combination of types III and IV; VC - Combination of types II, III, and IV; VI - Comminuted fracture

Frequency

United States

Scapular fractures occur infrequently and account for approximately 1% of all fractures and fewer than 5% of shoulder girdle injuries.¹

Mortality/Morbidity

• Morbidity and mortality result primarily from associated injuries.
• Traditional wisdom holds that scapular fractures serve as markers of increased morbidity and mortality in patients with blunt trauma. One retrospective study comparing patients with scapular fractures due to blunt trauma with control subjects matched for age, sex, and mechanism of injury demonstrated an increase in associated thoracic injuries yet revealed no difference in mortality or neurovascular injury.²  Another study confirmed an association between scapular fractures and concomitant injuries but noted that most of the association could be explained by differences in injury severity scores.³
• A large force is usually required to fracture the scapula, particularly the body or the spine; however, suspect scapular fractures and thoroughly search for associated injuries.

Sex

Scapular fractures are more common among men than among women because of their increased incidence of significant blunt trauma.

Age

Scapular fractures predominate in persons aged 25-40 years because of the increased occurrence of significant blunt trauma in this population.

Clinical

History

The mechanisms of injury for various scapular fractures include the following:

• Body or spine fracture (40-75%): Fractures of the body or the spine of the scapula usually result from a severe direct blow, as in a fall or a motor vehicle accident.
• Acromion fracture (8-16%): Acromion fractures typically result from a downward blow to the shoulder. Superiorly displaced fractures may occur as the result of a superior dislocation of the shoulder.
• Neck fracture (5-32%): A direct anterior or posterior blow to the shoulder is the typical mechanism for a scapular neck fracture.
• Glenoid fracture (10-25%): Glenoid rim fractures often result from a fall onto a flexed elbow. A direct lateral blow is the common mechanism for a stellate fracture of the glenoid.
• Coracoid fracture (3-13%): Coracoid process fractures usually result from 1 of 2 mechanisms.
  • A coracoid process fracture is the result of a direct blow to the superior point of the shoulder or humeral head in an anterior shoulder dislocation.
  • An avulsion fracture may result from abrupt contractions of the coracoacromial muscle, short head of the biceps, or coracohumeral muscle.

Physical

Findings at physical examination may include the following:

• Body or spine fracture
  • Most common findings are tenderness, edema, and ecchymosis over the affected area.
  • The upper extremity is held in adduction, and any attempt to abduct the extremity (which results in scapular rotation) increases pain.
• Acromion fracture
  • Tenderness directly over the acromion process is the most common finding.
  • Deltoid contraction and arm abduction exacerbate pain.
  • Perform a careful neurologic examination to determine the presence of an associated brachial plexus injury.
• Neck fracture
  • A patient with a scapular neck fracture resists all movement of the shoulder and holds the extremity in adduction.
  • Maximal tenderness occurs at the lateral humeral head.
• Glenoid fracture
  • Stellate fractures of the glenoid have a presentation similar to that of scapular neck fractures, with severe pain on shoulder movement.
  • Avulsion fractures are occasionally associated with shoulder dislocations.
• Coracoid fracture
  • Patients with coracoid process fractures present with tenderness over the coracoid.
  • Forced adduction of the shoulder or flexion of the elbow exacerbates pain.

Causes

Scapular fractures are usually the result of significant blunt trauma.

Differential Diagnoses

Workup

Laboratory Studies

• Tailor the laboratory evaluation of a patient with scapular fracture to the likelihood of associated injuries.

Imaging Studies

• Radiography
  • An anteroposterior shoulder view, along with a lateral scapular view, demonstrates the vast majority of scapular fractures.
  • A lateral scapular (trans-scapular) view, combined with an anteroposterior shoulder view, provides the necessary 2-plane assessment of the scapula.
  • A lateral axillary view isolates the coracoid process and helps to delineate associated shoulder dislocations.
  • Tangential oblique views aid in the evaluation of small or subtle scapular body fractures.
• Computed tomography: A CT scan may be a helpful adjunct in glenoid and coracoid fracture assessment.^4,5

Treatment

Prehospital Care

• Prehospital care involves transport, with immobilization of the affected extremity.
• Because of the significant forces involved in producing a scapular fracture, consider life-threatening associated injuries.

Emergency Department Care

The following discussion of the ED treatment of scapular fractures assumes that a prudent search for associated injuries revealed negative findings.

• Body or spine fracture
  • Use of ice, analgesics, and sling and swath immobilization suffice for most fractures to the body or spine of the scapula.
  • Early range-of-motion exercises are recommended.
• Acromion fracture
  • Nondisplaced fractures of the acromion usually can be treated with sling immobilization, ice, and analgesics.
  • Displaced fractures and those associated with rotator cuff injuries often require surgical intervention, strategies depicted below.
    • 
      

      

      Fixation of acromion fractures. (A) tension band construct; and (B) plate-screw fixation (most appropriate for proximal fractures).

      
      
• Neck fracture
  • Manage nondisplaced scapular neck fractures with a sling, ice, analgesics, and early range-of-motion exercises.
  • Displaced neck fractures, as in the image below, require urgent orthopedic consultation for traction or surgical reduction.
    • 
      

      

      Classification of glenoid neck fractures. Type I includes all minimally displaced fractures. Type II includes all significantly displaced fractures (translational displacement greater than or equal to 1 cm; angulatory displacement greater than or equal to 40°)

      
      
• Glenoid fracture
  • Small and minimally displaced glenoid rim fractures usually respond to conservative therapy with a sling, ice, and analgesics, followed by early range-of-motion exercises.
  • Large or significantly displaced fractures, as well as those associated with triceps impairment, often require surgical treatment.
  • All stellate glenoid fractures require early orthopedic consultation.
• Coracoid fracture: Coracoid fractures respond well to conservative therapy with sling immobilization, ice, analgesics, and early mobilization.

Consultations

Follow-up care with an orthopedic surgeon is advised in all cases because of the possibility of long-term complications such as bursitis and posttraumatic arthritis.

Medication

Nonsteroidal anti-inflammatory agents and opioid analgesics are typically required for scapular fractures.

Nonsteroidal anti-inflammatory agents (NSAIDs)

These agents are most commonly used for the relief of mild to moderate pain. Effects of NSAIDs in the treatment of pain tend to be patient specific, yet ibuprofen is usually the DOC for initial therapy. Other options include naproxen, flurbiprofen, and ketoprofen.

Ibuprofen (Ibuprin, Advil, Motrin)

Usually DOC for the treatment of mild to moderate pain, if no contraindications exist; inhibits inflammatory reactions and pain, probably by decreasing cyclooxygenase activity, which results in prostaglandin synthesis.

Dosing

Adult

200-400 mg PO q4-6h prn; not to exceed 3.2 g/d

Pediatric

<6 months: Not established
6 months to 12 years: 20-40 mg/kg/d PO divided tid/qid
>12 years: 200-400 mg PO q4-6h prn; not to exceed 3.2 g/d

Interactions

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy

Ketoprofen (Oruvail, Orudis, Actron)

Used for the relief of mild to moderate pain and inflammation. Administer small doses initially to smaller patients and older persons. Doses of >75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient.

Dosing

Adult

25-50 mg PO q6-8h prn; not to exceed 300 mg/d

Pediatric

<3 months: Not established
3 months to 12 years: 0.1-1 mg/kg PO q6-8h
>12 years: Administer as in adults

Interactions

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy

Naproxen (Anaprox, Naprelan, Naprosyn)

Used for relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing cyclooxygenase activity, which decreases prostaglandin synthesis.

Dosing

Adult

500 mg followed by 250 mg PO q6-8h; not to exceed 1.25 g/d

Pediatric

<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d

Interactions

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion may be at risk for acute renal failure; leukopenia occurs rarely and is transient, and condition usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug

Flurbiprofen (Ansaid)

Has analgesic, antipyretic, and anti-inflammatory effects; may inhibit cyclooxygenase, causing inhibition of prostaglandin biosynthesis that may result in analgesic and anti-inflammatory activities.

Dosing

Adult

200-300 mg/d PO divided bid/qid

Pediatric

Not established

Interactions

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion, risk acute renal failure; leukopenia occurs rarely and is transient, and condition usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug

Analgesics

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have fractures.

Acetaminophen (Tylenol, Panadol, Aspirin-Free Anacin)

DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs or in those with upper GI disease or taking oral anticoagulants.

Dosing

Adult

325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d

Pediatric

<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4-6h; not to exceed 5 doses/d

Interactions

Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Contraindications

Documented hypersensitivity; known G-6-PD deficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible in persons with chronic alcoholism at various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; many OTC products contain acetaminophen, and combined use of these products may result in cumulative doses exceeding the recommended maximum dose

Acetaminophen and codeine (Tylenol #3)

Drug combination indicated for the treatment of mild to moderate pain.

Dosing

Adult

30-60 mg/dose based on codeine content PO q4-6h or 1-2 tab PO q4h; not to exceed 12 tab/d

Pediatric

0.5-1 mg/kg/dose based on codeine content PO q4-6h; 10-15 mg/kg/dose based on acetaminophen content; not to exceed 2.6 g/d of acetaminophen

Interactions

Toxicity increases with CNS depressants or tricyclic antidepressants

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in patients dependent on opiates because this substitution may result in acute opiate-withdrawal symptoms; caution in severe renal or hepatic dysfunction

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Drug combination indicated for the relief of moderate-to-severe pain.

Dosing

Adult

1-2 tab/cap PO q4-6h prn

Pediatric

<12 years: 10-15 mg/kg/dose acetaminophen PO q4-6h prn; not to exceed 2.6 g/d of acetaminophen
>12 years: 750 mg acetaminophen PO q4h; single dose not to exceed 10 mg of hydrocodone bitartrate; not to exceed 5 doses/d

Interactions

Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants

Contraindications

Documented hypersensitivity; high-altitude cerebral edema; elevated intracranial pressure

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

Precautions

Tablets contain metabisulfite, which may cause hypersensitivity; caution in patients dependent on opiates because this substitution may result in acute opiate-withdrawal symptoms; caution in severe renal or hepatic dysfunction

Oxycodone and acetaminophen (Percocet)

Drug combination indicated for the relief of moderate to severe pain; DOC for aspirin-hypersensitive patients.

Dosing

Adult

1-2 tab/cap PO q4-6h prn

Pediatric

0.05-0.15 mg/kg/dose based on oxycodone content PO; not to exceed 5 mg/dose of oxycodone q4-6h prn

Interactions

Phenothiazines may decrease analgesic effects; toxicity increases with coadministration of CNS depressants or tricyclic antidepressants

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

Precautions

Duration of action may increase in elderly patients; be aware of the total daily dose of acetaminophen that the patient is receiving; do not exceed 4,000 mg/d of acetaminophen; higher doses may cause liver toxicity

Oxycodone and aspirin (Percodan)

Drug combination indicated for relief of moderate to severe pain.

Dosing

Adult

1-2 tab/cap PO q4-6h prn

Pediatric

0.05-0.15 mg/kg/dose based on oxycodone content PO; not to exceed 5 mg/dose of oxycodone PO q4-6h prn

Interactions

Phenothiazines may decrease analgesic effects; conversely, toxicity increases when administered concurrently with CNS depressants or tricyclic antidepressants; may also potentiate anticoagulant effects of warfarin

Contraindications

Documented hypersensitivity; liver damage, hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; children <16 y with flu (because of the association of aspirin with Reye syndrome)

Precautions

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Duration of action may increase in elderly patients; caution in renal or liver impairment, peptic ulcer disease, and erosive gastritis

Morphine sulfate (Duramorph, Astramorph, MS Contin)

DOC for narcotic analgesia because of its reliable and predictable effects, safety, and ease of reversibility with naloxone. IV doses vary and commonly are titrated until desired effect is obtained.

Dosing

Adult

Starting dose: 0.1 mg/kg IV/IM/SC
Maintenance dose: 5-20 mg/70 kg IV/IM/SC q4h
Relatively hypovolemic patients: Start with 2 mg IV/IM/SC and reassess hemodynamic effects of dose

Pediatric

Neonates: 0.05-0.2 mg/kg/dose IV/IM/SC q2-4h prn
Children: 0.1-0.2 mg/kg/dose IV/IM/SC q2-4h prn

Interactions

Phenothiazines may antagonize analgesic effects of opiate agonists; tricyclic antidepressants, MAOIs, and other CNS depressants may potentiate adverse effects of morphine

Contraindications

Documented hypersensitivity; hypotension; potentially compromised airway where rapidly establishing airway control would be difficult

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hypotension, respiratory depression, nausea, emesis, constipation, and urinary retention; caution in atrial flutter and other supraventricular tachycardias; has vagolytic action and may increase ventricular response rate

Follow-up

Transfer

• Transfer the patient with a scapular fracture when evaluation or treatment of associated injuries or surgical repair of the fracture is necessary and when neither is available at the initial institution.

Deterrence/Prevention

• Enforcement of traffic safety laws and injury prevention education are the two most productive measures for reducing scapular fractures.

Complications

• After associated injuries are excluded, the most common complication of an isolated scapular fracture is posttraumatic arthritis or bursitis.

Prognosis

• If no significant associated injury exists, the prognosis for complete or near complete recovery is excellent.

Patient Education

• Patient education about the use of sling immobilization, ice, and analgesics is important.
• A critical part of most treatment regimens is early range-of-motion exercises.
• For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education articles, Shoulder Dislocation and Broken Collarbone.

Miscellaneous

Medicolegal Pitfalls

• Missed diagnosis
• Failure to consider associated injuries

Multimedia

Media file 1: Classification of glenoid cavity fractures: IA - Anterior rim fracture; IB - Posterior rim fracture; II - Fracture line through the glenoid fossa exiting at the lateral border of the scapula; III - Fracture line through the glenoid fossa exiting at the superior border of the scapula; IV - Fracture line through the glenoid fossa exiting at the medial border of the scapula; VA - Combination of types II and IV; VB - Combination of types III and IV; VC - Combination of types II, III, and IV; VI - Comminuted fracture

Media file 2: Classification of glenoid neck fractures. Type I includes all minimally displaced fractures. Type II includes all significantly displaced fractures (translational displacement greater than or equal to 1 cm; angulatory displacement greater than or equal to 40°)

Media file 3: Superior shoulder suspensory complex. (A) anteroposterior view of the bony/soft tissue ring and the superior and inferior bony struts; and (B) lateral view of the bony/soft tissue ring.

Media file 4: Fixation of acromion fractures. (A) tension band construct; and (B) plate-screw fixation (most appropriate for proximal fractures).

Media file 5: Scapular anatomy. Muscle origin and insertion.

References

1. Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma. Mar 2006;20(3):230-3. [Medline].

2. Stephens NG, Morgan AS, Corvo P, Bernstein BA. Significance of scapular fracture in the blunt-trauma patient. Ann Emerg Med. Oct 1995;26(4):439-42. [Medline].

3. Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: a marker for concomitant injury? A retrospective review of data in the National Trauma Database. J Trauma. Aug 2008;65(2):430-5. [Medline].

4. McAdams TR, Blevins FT, Martin TP, DeCoster TA. The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma. Jan 2002;16(1):7-11. [Medline].

5. Bartonicek J, Tucek M, Fric V. [Radiographic evaluation of scapula fractures]. Rozhl Chir. Feb 2009;88(2):84-8. [Medline].

6. Hart RG, Rittenberry TJ, Uehara DT. Handbook of Orthopaedic Emergencies. Lippincott-Raven; 1999:149-55.

7. Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. Mosby Year Book; 2002:584-586.

8. Simon R, Koenigcknecht S. Emergency Orthopedics: The Extremities. Appleton and Lange; 1995:207-15.

9. Tintinelli J, Ruiz E, Krome R. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 2000:1784-1787.

10. Veysi VT, Mittal R, Agarwal S, Dosani A, Giannoudis PV. Multiple trauma and scapula fractures: so what?. J Trauma. Dec 2003;55(6):1145-7. [Medline].

Keywords

scapula, scapular fractures, acromion injuries, scapular neck fractures, glenoid rim fractures, glenoid fracture, stellate glenoid fractures, coracoid process fractures, coracoid fracture, shoulder girdle injuries

Contributor Information and Disclosures

Author

Joseph C Schmidt, MD, Assistant Professor, Program Director, Department of Emergency Medicine, Baystate Medical Center
Joseph C Schmidt, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michelle Ervin, MD, Chair, Department of Emergency Medicine, Howard University Hospital
Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David B Levy, DO, FACEP, FAAEM, Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

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