Tactical Medicine News Blog

Definition: Orthostatic hypotension (OH) is a form of low blood pressure that occurs with positional change (i.e. sitting up from lying down, standing up from sitting). It is commonly used for the diagnosis of volume depletion Orthostatic Vital Signs A reduction of systolic blood pressure (SBP) of at least 20 mm Hg A reduction in diastolic blood pressure (DBP) of at least 10 mm Hg An increase in heart rate (HR) by > 30 beats per minute One of the above criteria must be met while measured 3 minutes after standing from a supine position. Clinical Question: Are orthostatic vital signs useful in finding patients with occult volume loss? Do they add to our standard clinical assessment of patients?

Computed tomography (CT) is increasingly available across U.S. Emergency Departments and has changed the practice of medicine. However, it is coupled with potential side-effects from radiation and contrast media. Emergency Medicine is beginning to make a concerted effort to identify clinical scenarios in which CT may be unnecessary, producing outcomes research and validated clinical decision rules. Renal colic and pulmonary embolism, in particular, seem amenable to this area of investigation. The ACEP E-QUAL Network podcast, a partnership with ALiEM to promote clinical practice improvements, reviewed this topic with experts Dr. Chris Moore (Emory University) and Dr. Jeffrey Kline (Indiana University). We present highlights from their discussion with Dr. Jason Woods.

Background: There are several classes of medications available to treat pediatric migraines and because of this many providers have different combinations that they like to use.  Typically, NSAIDs, anticholinergics, and dopamine antagonists are used with varying degrees of success.  There is little evidence to guide providers if these agents fail in terms of which medications would be helpful for further abortive therapy.  There have been several trials published in the adult population regarding the use of low dose propofol (LDP) for acute migraines.  Propofol is great in the ED setting due to its short acting duration of action, as well as its anti-emetic properties.  Many things done in pediatrics are extrapolated from adult literature, however the authors of this paper wanted to see if LDP was any better than standard therapy (ST) in the treatment of acute pediatric migraines.

Background:  Normal Saline (NS) is one of the most commonly used IVFs in resuscitation today.  The use of balanced vs unbalanced crystalloids has been one of the biggest debates in resuscitation of the critically ill in recent history due to concerns of unbalanced fluids causing acute kidney injury, hyperchloremic metabolic acidosis,  and worsened mortality.  In 2015, we saw the publication of the SPLIT trial, which we covered on REBEL EM. This was a randomized clinical trial of over 2200 patients in 4 ICUs in New Zealand comparing 0.9% Saline (NS) vs Plasma-Lyte.  This trial had many issues including, >70% of patients coming from the OR, only 15% came from the ED, only 4% had sepsis, and the biggest issue with this trial was that the majority of patients only received 1 – 2L of NS, making it unclear if larger volumes of unbalanced crystalloid would have worsened morbidity and mortality.  Since the publication of this study, two more trials have been published: The SALT-ED Trial and The SMART trial (Both Just published in the NEJM Feb 27th, 2018).

In this live podcast on Blunt Ocular Trauma from The EM Cases Course 2018 with Anna MacDonald we discuss the most important diagnoses to consider, describe how physical exam in queen while CT can misguide you, explain a simple approach to orbital compartment syndrome with retrobulbar hematoma, give you tips on lateral canthotomy, how to pick up subtle hyphemas, why sickle cell patients are high risk, describe the key clinical clues to subtle globe rupture, the role of tranexamic acid in eye bleeds and much more... The post Ep 107 Blunt Ocular Trauma Live from The EM Cases Course appeared first on Emergency Medicine Cases.