Tactical Medicine News Blog

Background: Based on the Surviving Sepsis Campaign, hemodynamic resuscitation of sepsis patients is done by repeating serum lactic acid levels every 2 – 4 hours until normalization. The issue with this strategy is that there are other things that may elevate lactate levels other than sepsis and hypoperfusion.  Another, potentially useful marker to guide hemodynamic resuscitation could be capillary refill time.  Its easy-to-use, requires no resources, and costs nothing.  To answer this question the ANDROMEDA-SHOCK randomized controlled trial tried to evaluate the use of a peripheral perfusion-targeted resuscitation strategy during septic shock in adults.

The ALiEM Chief Resident Incubator (“CRincubator”) launches its fifth class today. Every year’s class has a unique personality with wide-reaching projects. But all the chief residents share consistent characteristics – a deep dedication to resident education and wellness, a growth-minded approach to learning, and a desire for ongoing professional development. Are you an incoming chief resident in emergency medicine with a similar outlook, looking for a year-long community of your peers to share ideas with and bounce ideas off of? Want access to CRincubator alumni and respected educators in our field? Sign up early enough to attend our in-person launch event in Seattle on March 31, 2019 at the Council of EM Residency Director’s Academic Assembly.

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. This case provide strategies for addressing some of the common social media fears among faculty.

Background: 1st trimester vaginal bleeding and abdominal pain is a common complaint seen in the ED.  As EM physicians it is important to make the diagnosis of ectopic pregnancy early in the clinical course as it can prevent rupture, difficulty with future fertility, and even death.  Typically, when non-ruptured, hemodynamically stable, ectopic pregnancy is diagnosed, our Ob/Gyn colleagues get consulted and the usual first-line treatment is methotrexate initiated in the ED with 24 – 72hours follow-up in an ideal world. Unfortunately, this does not always happen, and some patients will return to the ED for increased pain. It is important to be aware of methotrexate outcomes and have suspicion for failure of methotrexate in patients returning to the ED.

Have you ever wondered how researchers are able to conduct prospective studies on truly emergent conditions, such as cardiac arrest and status epilepticus? How can they obtain informed consent? In this Research Learning Series podcast episode from SAEM, Dr. Jill Baren (University of Pennsylvania) shares stories, pearls, and roadblocks in her career, conducting emergency research under the Exception From Informed Consent (EFIC) regulations. As an established researcher in this area,1–9 Dr. Baren shares advice and stories which include reaching to the community, getting angry hot-line comments, and getting push-back from the U.S. Food and Drug Administration.