Tactical Medicine News Blog

In this POCUS Cases video Dr. Rob Simard reviews the literature on accuracy of identifying LV dysfunction on POCUS by non-radiologists, the steps in assessing LV dysfunction, and cautions us when it comes to patients with chronic LV dysfunction... The post POCUS Cases 8 – LV Dysfunction appeared first on Emergency Medicine Cases.

Background: Management and workup of fever in the neonate has been a long-standing challenge. This unique age group is particularly susceptible to serious bacterial infections (SBI’s) despite their clinical “well” appearance. Newborns, specifically those < 60 days of age are considered high risk for SBI’s (urinary tract infections, bacteremia, bacterial meningitis) primarily due to an underdeveloped immune system. As fragile hosts, simple bacterial infections are easily communicated via hematogenous spread, from one system to another. Once bacteremic, spread of infection through their permeable blood-brain barriers is relatively easy. Through a cascade of cellular events, bacteria are able to easily penetrate the CNS, leading to overwhelming meningitis &/or death.[1] Confounding their vulnerability, is the lack of immunizations in the first month of life. If you recall, at birth, newborns are given just their first hepatitis B vaccine. The remainder of baseline immunizations (Pneumococcal, Haemophilus influenzae type b [Hib], Rotavirus, Diphtheria, tetanus & acellular Pertussis [DTap], and Polio) are traditionally not given until 6 weeks – 2 months of age.[2] Thus infants in the < 60 day age range are dependent on their mothers’ antibodies for protection. Lastly as any clinician who has taken care of a sick newborn can attest, babies at this age rarely manifest an “ill-appearance” until they are critically ill, making their exam in the early stages of bacteremia falsely reassuring. Collectively this makes the workup of fever (38 ℃/100.4 ℉) in this age group particularly challenging.

Despite decades of experience with endotracheal intubation, we continue to find approaches to improving the process of how we intubate.  In today’s post we are not only going to talk about how to avoid post intubation cardiac arrest, but we are also going to cover 5 rather controversial topics in airway management including: Apneic oxygenation (ApOx), use of video laryngoscopy (VL) compared to direct laryngoscopy (DL), bougie 1st intubation, back up head elevated (BUHE) intubation, and finally bag valve mask ventilation (BVM) prior to intubation.

Welcome to the Neurology Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to neurological emergencies. 6 blog posts within the past 12 months (as of January 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module.

Take Home Points on Blunt Cardiac Injury No single test can be used to exclude BCI. However a thorough physical exam combined with a 12-lead EKG, troponin measurement, and echocardiography can be used to characterize BCI and direct care Obtain a 12-lead EKG in all thoracic trauma patients  A chest x-ray may help to identify associated injuries. However, isolated musculoskeletal injuries such as sternal fractures do not correlate with a risk of BCI Bedside TTE can quickly evaluate for life-threats such as cardiac tamponade; A TEE is both sensitive and specific across the spectrum of BCI pathology and is part of a comprehensive evaluation BCI can be excluded in a patient without EKG abnormalities and a negative troponin I