Tactical Medicine News Blog

Envenomation by the pictured snake would be expected to produce which clinical effects? Bradycardia and hypotension Bruising and epistaxis Difficulty swallowing and muscle weakness Severe swelling and blistering

Background: Emergency intubation in the ED is a potentially life-saving procedure in critically ill patients, but does have risks associated with it as we have discussed before on this blog. The authors of the study we are going to review today described a first-attempt intubation success (FPS) rate in the ED to be 85%, despite new technologies such as video laryngoscopy [2]. Successful endotracheal intubation on the initial attempt is vital as it reduces the likelihood of adverse events. Use of the bougie as the primary intubation approach may increase FPS but it is typically reserved as a rescue device only after failed intubation attempts. This is the first randomized controlled trial comparing the bougie vs endotracheal tube + stylet (ETT + stylet) in ED patients with at least 1 characteristic predictive of difficult intubation.  The trial is titled the Bougie use in Emergency Airway Management (BEAM) trial.

Obstructive Physiology: Setting up the ventilator for a patient with severe obstructive physiology like asthma or COPD is almost a completely opposite strategy compared to the patient with severe metabolic acidosis. They both have problems with ventilation (removal of carbon dioxide), but for the patient with obstructive disease it takes a very long time to expire due to inflammation and bronchoconstriction.  Instead of setting a high respiratory rate to blow off more CO2 like our severe metabolic acidosis patient, here, you want to set a low respiratory rate to give your patient time to empty more effectively.

Acute respiratory distress syndrome (ARDS) is a complex, life-threatening form of respiratory failure. It is responsible for almost 75,000 annual deaths in the United States.1Management remains lung-protective mechanical ventilation, an intervention that can begin in the ED. The Berlin Definition of ARDS has better predictive validity for mortality in comparison to previous definitions of ARDS.2 ALiEM Cards: ARDS, written by Dr. Michelle Lin, reviews the Berlin Definition and provides EPs with an on-shift resource to help manage critically-ill patients.

Welcome to the Endocrine 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 Endocrine emergencies. 8 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 2 AIR and 6 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module.