Tactical Medicine News Blog

Welcome to the Peripheral Vascular Disease (PVD) 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 PVD emergencies. 2 blog posts within the past 12 months (as of May 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 0 AIR and 2 Honorable Mentions. We recommend programs give 1 hour (about 30 minutes per article) of III credit for this module.

Background: In patients with an acute respiratory illness (ARI), it is often difficult to determine whether a bacterial infection is the underlying etiology and whether antibiotics are warranted. Excess antibiotic use carries risk of bacterial resistance, medical costs, and adverse drug effects. However, underuse of antibiotics risks inadequate treatment and progression of disease. In the setting of a bacterial infection, cytokines stimulate procalcitonin production and release. The serum procalcitonin level increases with the progression of bacterial infection and decreases upon recovery. Procalcitonin production is actually blocked in the setting of viral infection, resulting in low serum levels. Numerous studies have investigated the use of procalcitonin for the determination of initiating antibiotics as well as for aiding in decisions to terminate their use. This Evidence-Based Emergency Medicine (EBEM) article reviews the following systematic review: Schuetz P et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 2017. PMID: 29025194

Background: In the ED, POCUS has become one of the most important tools in discovering both the diagnosis and in the management of critically ill patients.  cardiac arrest, is ultimately as sick as a person can get in the spectrum of critical illness.  I mean how can someone be deader than dead, right?  There has been a slew of literature evaluating the use of POCUS in cardiac arrest and many providers have started to incorporate its use into their practice.  Newer literature, however indicates that the use of POCUS prolongs CPR pauses which ultimately impacts good neurological survival.  POCUS protocols may help decrease cognitive load, but many are too cumbersome and complicated.  Enter the Cardiac Arrest Sonographic Assessment (CASA) exam.

Background: In 2011, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion warning against the use of nitrofurantoin (Macrobid) during the first trimester of pregnancy due to the perceived risk of an increased rate of congenital abnormalities with its use (Committee Opinion 2017). While the committee continued to recommend that nitrofurantoin be used as a first-line agent during the second and third trimesters, they stated that it should only be considered appropriate in the first trimester when no other suitable alternative antibiotics were available. While this recommendation seems to have been slow to permeate into the emergency medicine community, growing awareness has led to clinical trepidation in the provision of nitrofurantoin.

The Wellness Think Tank created a podcast with wellness expert Dr. Shahina Braganza from the Gold Coast in Australia. Facilitated by Dr. Annahieta “AK” Kalantari and joined by EM residents Dr. Alecia Gende and Dr. Adrienne Taren, the conversation covers a broad range of topics including the concepts behind Emotional Contagion, Dr. Braganza’s published “oneED” program1, and the challenges of adopting wellness initiatives in the ED. We present the podcast and highlights below.