Tactical Medicine News Blog

Ethanol withdrawal is a complex disease state. Two of the main players are GABA (an inhibitory neurotransmitter) and glutamate (an excitatory transmitter that can act on NMDA receptors). Simplistically, chronic ethanol use leads to a down-regulation of GABA receptors and an up-regulation in glutaminergic receptors, such as NMDA. When ethanol is abruptly discontinued, we are left with a largely excitatory state with less ability for GABA-mediated inhibition and more capacity for NMDA/glutamate-mediated excitation. While much of the treatment of severe ethanol withdrawal is focused on GABA, there are agents, such as phenobarbital and propofol, that can suppress the glutaminergic response. Ketamine seems like it should confer benefit, as well, due to its NMDA antagonist properties. Until recently there was only one clinical study using ketamine for severe ethanol withdrawal.1 Now there are three.2,3

Abscess management has evolved somewhat in the 14 years since my residency graduation. The point at which antibiotics are likely to be more helpful than harmful is not always easy to assess, and evidence based expert opinion has flip flopped impressively. Based on current evidence, I would like to answer 3 big questions that every clinician may have when confronted with an abscess: Who needs antibiotics? Which abscesses need to be drained? How should abscesses be drained?

Our seventh case of season 5, The Case of the Orphaned Patient, presented the scenario of a junior orthopedic surgery resident rotating in the ED and receiving significant pushback when trying to transfer the care of a clinically deteriorating patient to a more appropriate service. The outcome of this pushback was a patient without a service feeling primarily responsible for further care, leaving the patient “orphaned” in the ED. If you haven’t had a chance yet, we urge you to check out the case and share your thoughts on this important topic! The MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma) hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert opinions. Than you to all participants for contributing to the very rich discussions surrounding this case!

Background:Intubation is a commonly performed procedure in the ED and ICU. We have discussed the physiologically difficult intubation before on REBEL EM.  One of the tenants in managing these patients is “resuscitate before you intubate.”  Two publications in the past [1][2] discussed the incidence and risk factors associated with cardiac arrest complicating RSI.  In the first study [1], 542 patient underwent emergency intubation, 4.2% had a cardiac arrest, meaning nearly 1 in 25 intubations were associated with cardiac arrest.  In the second study [2], 2,403 patients underwent emergency tracheal intubation, and 1.7% had a cardiac arrest, meaning nearly 1 in 60 intubations were associated with cardiac arrest.  A new study in Critical Care Medicine was just published looking at the prevalence and risk factors associated with intubation (RSI) in 64 ICUs in France.

Urinary retention is 13 times less common in woman than it is in men, and the differential diagnosis is wide. In this EM Cases Best Case Ever we have the return of Dr. David Carr describing a woman with an unusual diagnosis who presents with urinary retention. We discuss issues around the appropriate use of chaperones and what to do in the situation when you are in over your head... The post BCE 70 Female Urinary Retention – The Return of Carr’s Cases! appeared first on Emergency Medicine Cases.