Tactical Medicine News Blog

The final EMU365 video from EMU2018 features Dr. Amit Shah who discusses decision making and dosing around the use of thrombolytics in PE in the context of cardiac arrest, massive PE and submassive PE; the controversy around using half dose alteplase, and nuanced decision making around which patients with submassive PEs should have thrombolysis... The post EMU 365 Thrombolysis in Pulmonary Embolism with Amit Shah appeared first on Emergency Medicine Cases.

Background: Syncope and presyncope are common presenting complaints to the Emergency Department. Orthostatic vital signs are often included in the ED evaluation of syncope to assess for volume depletion despite their poor performance characteristics as previously discussed. In particular, it is important to understand that older adults often have abnormal orthostatic vitals at baseline,  due to numerous causes including medications, despite having a normal physiologic state (Ooi 1997, Aronow 1988). In spite of the evidence, orthostatic vital signs measurements continue to be recommended by the AHA/ACC/HRS guidelines (Shen 2017) and occupy valuable provider and nursing time.

In 2014-15, we hosted a “How I Work Smarter” (HIWS) series, led by Dr. Ben Azan, focusing on the individual strategies of high-performing, successful emergency physicians. After the conclusion of the series, Ben went one step further and recruited a team which included Drs. Marilyn Innes, Brent Thoma, myself, Alex Van Duyvendyk, Zafrina Poonja, and Teresa Chan to conduct a thematic analysis, which was just published in Cureus [open access full text].​1​ Although the content is from 2014-15 and many of the featured contributors have moved institutions with different roles, the themes and tips remain salient and informative in today’s era of digital and cognitive overload in the clinical and non-clinical environments.

Many of you are asked to take a leadership role in leading a team, whether it’s for research, administration, or even clinical. It is easy to feel unprepared for these roles, and there are many pitfalls waiting to sabotage your team’s productivity. The ALiEM Faculty Incubator has created a series of 10 case-based teaming problems to provide you with evidence-based advice and solutions for tackling some of the more common problems encountered in our professional team experiences – including the wayward collaborator!

Every now and again someone raises the issue on social media about resuscitative thoracotomy.  What are the indications (we have the EAST guidelines for that), what are the risks (highlighted in this important recent paper), and of course, whether EM or surgery should be doing it in the trauma bay (guess what – it’s in the curriculum for both specialties). That’s not the point of this post.  This post is about how I think you, as the emergency medicine physician (EP), working in a system where your surgeon is not in-house, but is available in a reasonable amount of time, should proceed when faced with the patient who meets the indications.  You’ve gone through your HOTTT(T) algorithm and are now at that final “T” – you have to open the chest.